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Kibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, Augusto O, Owiso G, Ndegwa L, Luvsansharav UO, Bancroft E, Rabinowitz P, Lynch J, Njoroge A. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrob Resist Infect Control 2022; 11:56. [PMID: 35379327 PMCID: PMC8981833 DOI: 10.1186/s13756-022-01093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hand hygiene (HH) is central in prevention of health care-associated infections. In low resource settings, models to improve HH compliance are needed. We implemented a continuous quality improvement (CQI) program targeting HH in two hospitals in Kenya.
Objective To determine the impact of the HH CQI program and identify factors associated with HH compliance between 2018 and 2019. Methods A CQI project targeting the improvement of hand hygiene was implemented, including training and mentorship. Data were collected monthly between April 2018 and December 2019 in Thika and Kitale Hospitals. Healthcare workers trained on Infection Prevention and Control (IPC) observed and recorded HH opportunities and subsequent compliance among staff, including nurses, clinicians, and auxiliary staff, using the World Health Organization’s “My Five Moments for Hand Hygiene” tool. Covariates were explored using mixed-effects logistic regression with random department-level intercepts. Results Hand hygiene compliance improved from 27% at baseline to 44% after 21 months. Indication/moment for HH was significantly associated with compliance. Adjusting for site, professional category and department, compliance was higher after a moment of body fluid exposure (aOR 1.43, 95% CI 1.17–1.74, p value < 0.001) and lower before an aseptic procedure (aOR 0.12, 95% CI 0.08–0.17, p value < 0.001) compared to after patient contact. Wearing of gloves often replaced proper HH in surgical departments, which although not significant, had lower compliance compared to departments for internal medicine (aOR 0.93, 95% CI 0.85–1.02). Adjusted HH compliance from all quarters improved from baseline, but comparing each quarter to the previous quarter, the improvement fluctuated over time. Conclusion Training and mentorship on the importance of HH for all moments is needed to improve overall HH compliance. CQI with regular monitoring and feedback of HH performance can be an effective approach in improving HH compliance in public hospitals in Kenya.
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Affiliation(s)
- Jemima Kibira
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Loyce Kihungi
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Mary Ndinda
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Evelyn Wesangula
- Department of Patient and Healthcare Worker Safety, Ministry of Health, Nairobi, Kenya
| | - Catherine Mwangi
- Infection Prevention and Control Department, Thika Level 5 Hospital, Kiambu, Kenya
| | - Faith Muthoni
- Infection Prevention and Control Department, Kitale County Referral Hospital, Trans-Nzoia, Kenya
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, USA
| | - George Owiso
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Linus Ndegwa
- Division of Global Health Protection (DGHP), Center for Global Health (CGH), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Elizabeth Bancroft
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - John Lynch
- Department of Medicine, University of Washington, Seattle, USA
| | - Anne Njoroge
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya. .,Department of Global Health, University of Washington, Seattle, USA.
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Abstract
Purpose - Interdisciplinary healthcare education and collaboration facilitates healthcare quality improvement (QI). Education challenges include cost, logistics and defining the optimum staff-engaging method. The purpose of this paper is to determine the optimum QI educational model and measure its impact using plan-do-study-act (PDSA) cycles. Design/methodology/approach - The authors established an on-site interdisciplinary QI learning collaborative: weekly 30-minute learning sessions close to the working environment; a learning materials Twitter repository; and junior doctor-led QI work streams aligned with surgical directorate quality goals supported by a mentorship network. Delivery style (lectures, workshops and QI project reporting) and learning session content was planned weekly using PDSA cycles and modified using participant feedback (score 0-10). All surgical directorate QI work streams were measured before and at nine months. Findings - From May 2014 to February 2015, there were 32 learning sessions with 266 scores (median 12 weekly, range 5-21). Workshop delivery scored the highest (mean score 9.0), followed by live project reports (mean score 8.8). The surgical QI work streams increased threefold from four to 12, including six junior doctor-led projects. Practical implications - By proactively acting upon feedback, the authors centralised QI measurement and tailored learning sessions to staff needs. Building sustainability involves continually refining learning curriculum and QI work streams, and expanding the mentorship network. Originality/value - The collaborative was established at no additional cost. Twitter is used to promote meetings, facilitate conversations and act as a learning repository. The mentorship framework builds QI and coaching expertise.
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Affiliation(s)
| | - Paul Rafferty
- Faculty of Leadership and Quality in Healthcare, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland AND Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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