Implementation of Multimodal Hand Hygiene Improvement Strategies in Government Hospitals

Abstract

The World Health Organization (WHO) has developed multimodal hand hygiene improvement strategies to support hospitals to improve hand hygiene among health care workers to reduce hospital-acquired infection. This descriptive research aimed to study the implementation of these multimodal strategies, obstacles, and supports to promote hand hygiene in government hospitals, including university hospitals, regional hospitals, and general hospitals. The participants were 59 infection control nurses who implement multimodal hand hygiene improvement strategies. The data collection instrument was the Hand Hygiene Self-Assessment Framework questionnaire developed by the WHO. The questionnaire consisted of five key components including: system change for hand hygiene, training and education, evaluation and feedback, reminders in the workplace, and promotion of an institutional safety climate. This instrument was back translated and tested by test-retest. The reliability of the questionnaire was 0.98. The questionnaire also asked about obstacles and support. Data were analyzed by using descriptive statistics and by grouping answers.

               The results showed that most of the participants (61.02%) implemented multimodal hand hygiene improvement strategies at an intermediate level, followed by basic and advanced levels (22.03% and 16.95%, respectively). Fifty percent of the university hospitals had an advanced level of implementation. Most of the regional hospitals and the general hospitals (57.14% and 67.57%, respectively) had an intermediate level. The highest score for key component implementation was the system change for hand hygiene (median score, 90.00), followed by reminders in the workplace, training and education, evaluation and feedback and institutional safety climate for hand hygiene, respectively (median score, 72.50, 60.00, 60.00 and 50.00). All participants encountered obstacles when implementing hand hygiene improvement programs. Personnel were the first obstacle (e.g. lack of awareness and workload), followed by management (e.g. no punishment and monitoring supervision), facilitative equipment (e.g. insufficient towels or papers) and budget, respectively. All of the participants needed support. The largest need was environment and equipment support (e.g. towels or papers and alcohol-based hand sanitizer), followed by support from staff (e.g. monitoring supervision, good role models) and management, respectively. 

The findings of this study suggest that the government hospitals should improve implementation of multimodal hand hygiene strategies by addressing obstacles and supporting efforts to promote hand hygiene and reduce hospital-acquired infection.