Barriers and levers to hand hygiene practices among Nigerian healthcare workers : a mixed methods research study

This research explores the barriers and levers to hand hygiene practices among Nigerian healthcare workers (HCWs). The overall aim was to determine the hand hygiene compliance rate, understand the barriers and levers to hand hygiene practices and validate the barriers and levers to hand hygiene instrument (BALHHI) for Nigerian HCWs. A convergent mixed methods research approach was employed.In study one, a systematic review of 27 hand hygiene studies from Sub-Saharan African (SSA) countries was conducted. An overall hand hygiene compliance rate among HCWs in SSA was estimated to be 21.1%. The main barriers identified included heavy workload, infrastructural deficit and poorly positioned hand hygiene facilities.In study two, a ward infrastructure survey and hand hygiene observations of HCWs in surgical wards were conducted using the WHO ward infrastructure survey and modified hand hygiene observation tool, respectively. Hand hygiene resources were found to be insufficient, overall hand hygiene compliance rate was 29.1% and compliance was less than 40% across all professional groups.In study three, BALHHI was validated through three rounds of psychometric testing – face validity, construct validity and test-retest reliability. This resulted in a 10-item instrument with good psychometric properties.In study four, a survey of barriers and levers to hand hygiene among surgical HCWs was conducted using BALHHI. Knowledge deficit was the greatest barrier. All three domains of the Theoretical Domains Framework (TDF) and 10 items remaining on the instrument were also considered as barriers to hand hygiene.In study five, barriers and levers to hand hygiene practices among surgical HCWs were explored using semi-structured interviews. Knowledge deficit was the biggest barrier followed by infrastructural deficit.This thesis has demonstrated the significance of using a mixed methods research approach and use of theory in research going by the rich findings of this research. Prioritising adequate funding of health systems in SSA countries is critical to enhancing patient safety

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

Background: Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. Methods: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. Results: There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. Conclusions: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed

Barriers to hand hygiene practices among healthcare workers in Sub-Saharan African countries: a narrative review

Review question:What are the barriers to hand hygiene practices among healthcare workers in Sub-Sahara African countries

Evaluating the impact of a ward environment with 20 single occupancy rooms and two four-bedded bays on patient and staff experiences and outcomes in an acute NHS Trust: A mixed methods study protocol.

Introduction Traditionally, wards in acute care hospitals consist predominately of multi-occupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals, with the United Kingdom (UK) National Health Service (NHS) advocating for single room provision in all new hospital builds. There is limited evidence on the impact of a ward environment incorporating mostly single and some multi-occupancy bays on patient care and organisational outcomes. Methods and analyses This study will assess the impact of a newly designed 28-bedded ward environment, with 20 single rooms and two four-bedded bays, on patient and staff experiences and outcomes in an acute NHS Trust in East England. The study is divided into two work packages (WP) – WP1 is a quantitative data extraction of routinely collected patient and staff data, while WP2 is a mixed methods process evaluation consisting of one-to-one, in-depth, semi-structured interviews with staff, qualitative observations of work processes on the ward and a quantitative data evaluation of routinely collected process evaluation data from patients and staff. Ethics and dissemination Ethical approval was obtained from the UK Health Research Authority (IRAS ID: 334395). Study findings will be shared with key stakeholders, published in peer-reviewed high impact journals, and presented at relevant conferences. Strengths and Limitations of this Study • A multi-method study using innovative and interdisciplinary approaches to explore the impact of a new ward environment on patient and staff experiences and outcomes. • Using a mixed methods approach provides an opportunity to gain rich and meaningful data from patients and staff over three different clinical areas. • Study findings will inform future hospital design at the research setting and potentially, other NHS Trusts. • Being a single site study and the sampling technique in qualitative interviews may limit transferrability and applicability of study findings

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

Background: Healthcare associated infections are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. Objective: To understand barriers and facilitators to hand hygiene in a hospital in Nigeria. Methods: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. Results: There were individual and institutional factors constituting barriers or facilitators: i) knowledge, skills, and education, ii) perceived risks of infection to self and others, iii) memory, iv) the influence of others and v) skin irritation. Institutional factors were i) environment and resources and ii) workload and staffing levels. Conclusions: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed

An Observational Study of Hand Hygiene Compliance of Surgical Healthcare Workers in a Nigerian Teaching Hospital

Background: Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission. Surgical site infections are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients. Objective: This study aimed to assess and offer context to the hand hygiene resources available in a Nigerian teaching hospital through ward infrastructure survey, and to determine the hand hygiene compliance rate among surgical healthcare workers (HCWs) in a Nigerian teaching hospital through hand hygiene observations. Methods: Ward infrastructure survey was conducted in the two adult surgical wards of the hospital using the World Health Organisation (WHO) hand hygiene ward infrastructure survey form. Hand hygiene observations were monitored over seven days in the surgical wards using a modified WHO hand hygiene observation form. Results: Hand hygiene resources were insufficient, below the WHO recommended minimum standards. Seven hundred hand hygiene opportunities were captured. Using SPSS version 24.0, we conducted a descriptive analysis of audit results, and results were presented according to professional group, seniority, and hand hygiene opportunities of the participants. Overall hand hygiene compliance was 29.1% and compliance was less than 40% across the three professional groups of doctors, nurses, and healthcare assistants. Conclusion: Hand hygiene compliance rates of the surgical HCWs are comparable to those in other Sub-Saharan African countries as well as in developed countries

The barriers and facilitators to hand hygiene practices in Nigeria: a qualitative study

Background: Healthcare associated infections are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. Objective: To understand barriers and facilitators to hand hygiene in a hospital in Nigeria. Methods: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. Results: There were individual and institutional factors constituting barriers or facilitators: i) knowledge, skills, and education, ii) perceived risks of infection to self and others, iii) memory, iv) the influence of others and v) skin irritation. Institutional factors were i) environment and resources and ii) workload and staffing levels. Conclusions: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed

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

Background: Healthcare associated infections are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. Objective: To understand barriers and facilitators to hand hygiene in a hospital in Nigeria. Methods: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. Results: There were individual and institutional factors constituting barriers or facilitators: i) knowledge, skills, and education, ii) perceived risks of infection to self and others, iii) memory, iv) the influence of others and v) skin irritation. Institutional factors were i) environment and resources and ii) workload and staffing levels. Conclusions: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed

An Observational Study of Hand Hygiene Compliance of Surgical Healthcare Workers in a Nigerian Teaching Hospital

Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission (Devnani et al., 2011). The frequency of HCAI, especially in high-riskpatients in developing countries is 2 to 3 times greaterthan in developed countries (Allegranzi et al., 2017). Higher prevalenceof HCAIin developing countries hasbeen credited to a range of factors (e.g.,reuse of instruments, scarcity of basic facilities) including low compliance to infection control measures (Rosenthal, 2011).Surgical site infections (SSI) are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients (Allegranzi et al., 2017). SSI are a significant cause of post-surgical morbidity and mortality (Chu et al., 2015).In Nigeria, a systematic review and meta-analysis estimated SSI cumulative incidence rate at 14.5% (Olowo-Okere et al., 2019)