నైరూప్య

An observational study of hand hygiene behaviours among healthcare workers in four peri-urban health facilities in Zambia

Jenala Chipungu,Isabel Scott Moncrieff, Lavuun Verstraete, Nicolas Osbert, Swathi Manchikanti, et al

Objective: Hand washing with soap and regular application of hand sanitising gel are simple and effective methods for reducing transmission of hospital acquired infections (HAIs) in health settings. However, such practices are generally poor amongst health care workers (HCW) globally. This study documents hand hygiene practices and their determinants amongst HCWs in four peri-urban health facilities in Zambia. Methods: Eighteen observation sessions, nine semi-structured interviews and three focus group discussions with health care providers in four high patient-load public health facilities were conducted. Framework analysis helped identify predominant themes which were pre-categorised using the determinants provided by the Behaviour Centred Design (BCD) framework. Results: Of the 780 hand hygiene opportunities observed across all four health facilities, HCWs washed their hands with soap only 8 times (1%). Hand washing was especially motivated by the fear of infection with apparently, or potentially, infectious patients and especially of more deadly conditions like cholera. Barriers included the large patient load which heightened HCWs’ sense of urgency and fairness in seeing clients quickly rather than spending time washing hands and, the discomfort of standing up to reach the hand washing station. Limited, inconveniently located or broken sinks and the absence of soap were additional barriers to hand washing with soap. Conclusions: A holistic approach including communication on risk to patients, provision of hardware, resource allocation for hand hygiene and regular monitoring of hand hygiene practices are all needed to address barriers to good practice.