Description
Introduction: Hand hygiene is crucial in health care to avoid the transmission of diseases and antibiotic resistance. Little is known about hand hygiene in health care settings affected by protracted conflicts and hence, experiencing an influx of internally displaced people. We present baseline findings of a cluster randomized controlled trial, with the aim to characterize current hand hygiene practices of primary health care workers in Mali and Burkina Faso.
Methods: This cluster randomized controlled trial with two parallel arms took place in 48 health care facilities in Mali and Burkina Faso. Baseline data were collected in June 2023, before covariate-constrained randomization. We collected data from health care workers using i. covert structured observations, ii. a self-reported survey about hygiene-related behavioural factors and iii. hand-rinse samples to assess the presence of Escherichia Coli. The primary outcome of this study is the observed handwashing rate with the numerator being the number of times the health care workers performed correct hand hygiene actions (i.e. handwashing with soap, hand sanitiser or proper glove use) and the denominator being the number of times the health care worker had a hand washing opportunity, defined by the WHO (i.e. before and after touching a patient, before aseptic procedures, after body fluid exposure and after touching the patient’s environment). We analysed the baseline data using descriptive statistics.
Results: We collected data on 309 health care workers from 48 facilities. Observed adherence to the moments of hand hygiene was low with a mean proportion of 4% of participants performing any correct hygiene action. Furthermore, Escherichia Coli were present on the hands of 47% of health care workers with a mean number of 135 Colony Forming Units per person (standard deviation (SD) = 311). In contrast, self-reported adherence to hand hygiene was high, with 86% (SD = 0.3) of participants reporting performing correct hand hygiene across the five WHO moments.
Discussion: Hand hygiene practices in both countries are insufficient for a good quality of care, rendering the risk of transmitting infectious diseases very high. The added population pressure on health care due to internally displaced people, combined with weak infrastructure provokes an even more precarious situation. In addition, by using different methods for data collection, our study demonstrates the importance of more objective measures than self-reported surveys to assess hand hygiene practices in health care.
Conclusion: Hand hygiene practices in both countries have to be improved to avoid the spread of health care-associated infections. We propose specific training for behaviour change combined with an improvement in infrastructure and maintenance, supported by policy makers.
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