The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: "There are so many barriers ... the barriers are limitless."

Barriers to hand hygiene practice among healthcare workers in health centres of Kirkos and Akaki Kality sub-cities, Addis Ababa, Ethiopia: a qualitative study

Background

Hand hygiene is an easy step to reduce healthcare-acquired infections, and improve patient safety. Major progress in facility accessibility was made during the coronavirus disease 2019 (COVID-19) pandemic, and this led to greater adherence to hand hygiene practices. However, handwashing practices have now returned to the pre-COVID-19 era. Most of the studies that have investigated hand hygiene adherence are quantitative. As such, this study aimed to explore barriers to hand hygiene practice in the health centres of Kirkos and Akaki Kality sub-cities in Addis Ababa, Ethiopia.

Methods

Twenty-four healthcare professionals employed at the aforementioned health centres were interviewed using the key informant interview method. Data were analysed using a qualitative content analysis technique.

Results

Based on the findings, there were three main categories of barriers to hand hygiene practice: barriers related to individuals (including three sub-categories: lack of knowledge and skill, improper attitude, and poor attention and negligence of healthcare workers); leadership barriers (including two sub-categories: lack of dedicated staff and low attention of leaders); and institutional barriers (including three sub-categories: inappropriate infrastructure and lack of resources, shortage of water, and high work load and staff turnover).

Conclusion

There were several reasons why hand hygiene guidance was not followed. Hand hygiene barriers can be minimized by displaying colour-coded notice boards, making washing facilities easily accessible, monitoring the availability of soap, offering training, and providing accurate evidence about the need to enhance hand hygiene.

Uncovering the obstacles: a comprehensive analysis of barriers to hand hygiene adherence among healthcare providers: a systematic review

BACKGROUND

Hand hygiene is the most effective and feasible infection prevention and control measure within the healthcare facilities. Despite the ease and simplicity of the technique, the adherence rate among health professionals remains suboptimal. Hence, developing targeted interventions to improve adherence requires a clear understanding of these obstacles. Therefore, this systematic reviews of existing literature aims to fully understand the context specific barriers of hand hygiene to answer why barriers persisted despite the interventions to maintaining hand hygiene practices among healthcare providers.

METHODS

This systematic review was conducted to synthesize existing evidence according to the Joanna Briggs Institute (JBI) qualitative studies review methodology on qualitative studies publish between the year 2010 and 2024. The study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline (PRISMA) and the protocol for the study was published on PROSPERO (CRD42024573753) before commencing the study.

RESULT

The review included twenty eight studies that are conducted in different regions of the world representing six of the continents. The study identified four interconnected themes of barriers with many subthemes. Behavioural barriers and organizational barriers were the most highlighted themes within the review. Physical barriers were one of the significant themes, where unavailability and inconvenience of hand hygiene resources gain the most attention by study participants across the studies. The fourth theme was societal/interpersonal barriers characterized by negative social influence and unsupportive colleagues.

CONCLUSION

The study highlights that the barriers to hand hygiene adherence among healthcare professionals are intertwined and complex, with the main interplaying among behavioural, societal/interpersonal, physical, and organizational barriers. The findings underscore that the intertwined nature of these barriers requires a multifaceted approach involving the relevant stakeholders to improve hand hygiene adherence among healthcare providers.

What we learned from the infection control and what we need in the future: A quantitative and qualitative study on hospital infection prevention and control practitioners (HIPCPs) in Tianjin, China

BACKGROUND

In December 2022, the epidemic prevention and control policy was upgraded, and China entered a different stage of epidemic control. This study aims to identify implications for better infection control and health care supply during the epidemic.

METHODS

A longitudinal quantitative and qualitative study was performed based on 2 comprehensive questionnaire surveys among 497 hospital infection prevention and control practitioners (HIPCPs) before and during the epidemic peak in Tianjin, China.

RESULTS

The workload (8.2 hours vs 10.14 hours, P = 0) and self-reported mental health problems (23.5% vs 61.8%, P < .05) among the HIPCPs increased significantly in the peak period. Ward reconstruction and resource coordination were the most needed jobs in hospital infection control, and rapidly increased medical waste during the epidemic needs to be considered in advance. Community support for health care personnel and their families, maintaining full PPE to reduce simultaneous infection of medical staff, and clinical training of infectious diseases for medical staff, especially doctors, in advance are the most important things we learned.

CONCLUSION

Although it has been 4 years since the first outbreak of coronavirus disease 2019, more improvements should be made to prepare for the next epidemic of potential diseases.

Factors responsible for student nurses' use of non-sterile gloves: An exploratory qualitative study

Background

Disposable non-sterile gloves are part of the personal protective equipment (PPE) to be considered to protect oneself from the risk of infection. They have subsequently become the topic of concern related to increased use, inappropriate use, and potentially increasing the risk of cross-infection and environmental impact of plastic waste.

Aim/objective

This study aimed to explore the views of pre-registration student nurses about non-sterile glove use in clinical practice and to identify the factors that impact student nurses' decision on whether to wear non- sterile gloves.

Methods

Using a social constructivist approach, the study was organised in a higher education institution. Semi-structured interviews were conducted with second year student nurses, utilising a theoretical domains framework (TDF).

Findings/Results

The key findings showed that students had limited awareness of the national infection prevention and control best practice procedures. The primary influential factors for non-sterile gloves use behaviour were personal protection, the type of care interventions required and the observations of peers and role models.

Discussion

The study found limited awareness on the importance of infection prevention and control precautions, including the correct procedure for donning, and doffing of personal protection equipment, along with a lack of confidence to challenge non-compliance.

Effects of organizational and individual factors on nurses' practice of central line-associated bloodstream infection prevention

BACKGROUND

This study explored rarely investigated organizational factors (resource support and organizational culture) in conjunction with well-established individual factors (demographic characteristics, knowledge, and awareness) that impact nurses' practice of central line-associated bloodstream infection (CLABSI) prevention.

METHODS

Self-reported questionnaire data were collected from 173 nurses recruited from departments that use central venous catheters (ie, intensive care units, emergency rooms, hemodialysis rooms, and oncology wards) in tertiary hospitals in South Korea. Multiple regression analyses were performed to examine the effects of individual and organizational factors.

RESULTS

Organizational culture (ß = 0.350) had the greatest association with CLABSI prevention practice, followed by awareness (ß = 0.328) and department (ß = -0.217; all ps < 0.01). These variables explained 41.1% of the variance in CLABSI prevention practice (F = 20.996, P < .001). Higher self-reported CLABSI prevention practice was associated with a favorable organizational culture and higher awareness. Emergency room nurses' CLABSI prevention practice was notably inferior as compared to nurses in other departments.

DISCUSSION

Organizational culture is the most significant factor affecting nurses' practice of CLABSI prevention.

CONCLUSIONS

An organizational culture with environmental improvements and resource support as well as infection prevention education and awareness-building programs should be fostered.

Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon

BACKGROUND

Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital.

METHODS

It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance.

RESULTS

5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml).

CONCLUSIONS

Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.