Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda ('WardGel' study)

Hiroki Saito, Kyoko Inoue, James Ditai, Benon Wanume, Julian Abeso, Jaffer Balyejussa, Andrew Weeks, Hiroki Saito, Kyoko Inoue, James Ditai, Benon Wanume, Julian Abeso, Jaffer Balyejussa, Andrew Weeks

Abstract

Background: Good hand hygiene (HH) practice is crucial to reducing healthcare associated infections (HAIs). Use of alcohol-based hand rub (ABHR) at health facilities is strongly recommended but it is limited in Uganda. Data on the practice of HH and the incidence of HAIs is sparse in resource-limited settings. We conducted a quasi-experimental study to evaluate HH practices of health care providers (HCPs) utilizing locally made ABHR and the incidence of HAIs.

Methods: HH compliance among HCPs and the incidence of HAIs were assessed at Mbale Regional Referral Hospital, a teaching hospital in rural Uganda. Inpatients from the obstetrics/gynecology (OBGYN), pediatric and surgical departments were enrolled on their day of admission and followed up during their hospital stay. The baseline (pre-intervention) phase of 12-weeks was followed by a 12-week intervention phase where training for HH practice was provided to all HCPs present on the target wards and ABHR was supplied on the wards. Incidence of HAIs and or Systemic Inflammatory Response Syndrome (SIRS) was measured and compared between the baseline and intervention phases. Multivariate survival analysis was performed to identify associated variables with HAIs/SIRS.

Results: A total of 3335 patients (26.3%) were enrolled into the study from a total of 12,665 admissions on the study wards over a 24-week period. HH compliance rate significantly improved from 9.2% at baseline to 56.4% during the intervention phase (p < 0.001). The incidence of HAIs/SIRS was not significantly changed between the baseline and intervention phases (incidence rate ratio (IRR) 1.07, 95% CI: 0.79 - 1.44). However, subgroup analyses showed significant reduction in HAIs/SIRS on the pediatric and surgical departments (IRR 0.21 (95% CI: 0.10 - 0.47) and IRR 0.39 (95% CI: 0.16 - 0.92), respectively) while a significant increase in HAIs/SIRS was found on the OBGYN department (IRR 2.99 (95% CI: 1.92 - 4.66)). Multivariate survival analysis showed a significant reduction in HAIs/SIRS with ABHR use on pediatric and surgical departments (adjusted hazard ratio 0.26 (95% CI: 0.15 - 0.45)).

Conclusions: To our knowledge, this study is one of the largest studies that address HAIs in Africa. During the 24-week study period, significant improvement in HH compliance was observed by providing training and ABHR. The intervention was associated with a significant reduction in HAIs/SIRS on the pediatric and surgical departments. Further research is warranted to integrate HAIs surveillance into routine practice and to identify measures to further prevent HAIs in resource limited settings.

Trial registration: ClinicalTrials.gov NCT02435719, registered on 20 April, 2015 (retrospectively registered).

Keywords: Alcohol-based hand rub; Healthcare epidemiology; Infection prevention and control.

Conflict of interest statement

The study was approved by the Mbale Regional Hospital Institutional Review Committee (MRHIRC)(REIRC IN – COM 098/2014). In this observational study of hospital infection rates, we did not request individual consent from the ward patients for the anonymous collection of infection incidence data. The ethics committee considered this data collection as standard ward practice and waived off individual consent. This was in line with international guidelines on clinical audit and evaluations of normal clinical care which do not require individual consent from patients as they should be part of normal clinical care.Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overall Hand Hygiene (HH) Compliance Before and After Intervention. x-axis: study week (Week 1-12: Baseline, Week 13-24: Intervention). y-axis: HH compliance rate (%). light blue line: HH compliance rate
Fig. 2
Fig. 2
Hand Hygiene (HH) Compliance by Department. x-axis: study week (Week 1-12: Baseline, Week 13-24: Intervention). y-axis: HH compliance rate (%). red line: Pediatrics. green line: Surgery. blue line: OBGYN
Fig. 3
Fig. 3
Hand Hygiene (HH) Compliance by Profession. x-axis: study week (Week 1-12: Baseline, Week 13-24: Intervention). y-axis: HH compliance rate (%). blue line: Physicians. red line: Nurses. green line: Nurse Assistants. purple line: Midwives. light blue line: Students

References

    1. Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73(4):305–315. doi: 10.1016/j.jhin.2009.04.019.
    1. World Health Organization . WHO guidelines on hand hygiene in health care: first global patient safety challenge: clean care is safer care. Geneva: World Health Organization; 2009.
    1. Bauer-Savage J, Pittet D, Kim E, Allegranzi B. Local production of WHO-recommended alcohol-based handrubs: feasibility, advantages, barriers and costs. Bull World Health Organ. 2013;91(12):963–969. doi: 10.2471/BLT.12.117085.
    1. Global Health Security Agenda. Global Health Security Agenda: Action Packages. 2014. . Accessed 11 Mar 2017.
    1. World Health Organization. Global Action Plan on Antimicrobial Resistance. World Health Organization; 2015. . Accessed 19 Aug 2017.
    1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020: Healthcare-Associated Infections. ODPHP; 2010. . Accessed 21 Mar 2017.
    1. Allegranzi B, Nejad SB, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–241. doi: 10.1016/S0140-6736(10)61458-4.
    1. Nthumba PM, Stepita-Poenaru E, Poenaru D, et al. Cluster-randomized, crossover trial of the efficacy of plain soap and water versus alcohol-based rub for surgical hand preparation in a rural hospital in Kenya. Br J Surg. 2010;97(11):1621–1628. doi: 10.1002/bjs.7213.
    1. Aiken AM, Karuri DM, Wanyoro AK, Macleod J. Interventional studies for preventing surgical site infections in sub-Saharan Africa - a systematic review. Int J Surg. 2012;10(5):242–249. doi: 10.1016/j.ijsu.2012.04.004.
    1. Japan Ministry of Health, Labour and Welfare. Japanese Pharmacopoeia Seventeenth Edition: Official Monographs D to K. 2016. . Accessed 14 Mar 2017.
    1. Suchomel M, Kundi M, Pittet D, Weinlich M, Rotter ML. Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efficacy. Am J Infect Control. 2012;40(4):328–331. doi: 10.1016/j.ajic.2011.06.012.
    1. Center for Disease Control and Prevention . CDC/NHSN surveillance definitions for specific types of infections 2014. 2014.
    1. World Health Organization. HH - Observation Tool. 2009. . Accessed 21 Mar 2017.
    1. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med. 2003;29(4):530–538. doi: 10.1007/s00134-003-1662-x.
    1. Goldstein B, Giroir B, Randolph A. International consensus conference on Pediatric sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2005;6(1):2–8.
    1. World Health Organization. Health care-associated infections: Fact Sheet. . Accessed 24 Aug 2016.
    1. Abdella NM, Tefera MA, Eredie AE, Landers TF, Malefia YD, Alene KA. Hand hygiene compliance and associated factors among health care providers in Gondar University hospital, Gondar, North West Ethiopia. BMC Public Health. 2014;14(1):1–7. doi: 10.1186/1471-2458-14-96.
    1. Owusu-Ofori A, Jennings R, Burgess J, Prasad PA, Acheampong F, Coffin SE. Assessing hand hygiene resources and practices at a large African teaching hospital. Infect Control Hosp Epidemiol. 2010;31(8):802–808. doi: 10.1086/654005.
    1. Holmen IC, Seneza C, Nyiranzayisaba B, Nyiringabo V, Bienfait M, Safdar N. Improving hand hygiene practices in a rural Hospital in sub-Saharan Africa. Infect Control Hosp Epidemiol. 2016;37(7):834–839. doi: 10.1017/ice.2016.71.
    1. Lankford MG, Zembower TR, Trick WE, Hacek DM, Noskin GA, Peterson LR. Influence of role models and hospital design on the hand hygiene of health-care workers. Emerg Infect Dis. 2003;9(2):217–223. doi: 10.3201/eid0902.020249.
    1. Gillespie R. Manufacturing knowledge: a history of the Hawthorne experiments. New York: Cambridge University Press; 1993. .
    1. Singer M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287.
    1. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315(8):762–774. doi: 10.1001/jama.2016.0288.
    1. Govindan S, Iwashyna TJ. Inpatient notes: Sepsis-3 for hospitalists—sepsis without SIRS. Ann Intern Med. 2016;165(4):HO2. doi: 10.7326/M16-1507.
    1. Braykov NP, Morgan DJ, Schweizer ML, et al. Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study. Lancet Infect Dis. 2014;14(12):1220–1227. doi: 10.1016/S1473-3099(14)70952-1.
    1. Stewardson AJ, Sax H, Gayet-Ageron A, et al. Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-centre, cluster randomised controlled trial. Lancet Infect Dis. 2016;16(12):1345–1355. doi: 10.1016/S1473-3099(16)30256-0.
    1. Pittet D, Panesar SS, Wilson K, et al. Involving the patient to ask about hospital hand hygiene: a National Patient Safety Agency feasibility study. J Hosp Infect. 2011;77(4):299–303. doi: 10.1016/j.jhin.2010.10.013.
    1. Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010;85(1):53–62. doi: 10.4065/mcp.2009.0248.

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