Criterion-Based Audit of Hand Hygiene Performance During Caesarean Section at a Referral Hospital in Northern Tanzania: An Uncontrolled Interventional Study

Citation: 
Enna Sengoka Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Christian Medical Center, Moshi, Tanzania Lærke Rasmussen Bjelke Alle` 22,01,20, 2200, Copenhagen, Denmark Marycelina Msuya Kilimanjaro Christian Medical University College, Moshi, Tanzania Godfrey Kisigo Kilimanjaro Clinical Research Institute, Moshi, Tanzania Bjarke Lund Sørensen Kilimanjaro Clinical Research Institute, Moshi, Tanzani Jaffu Chilongola Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania Eusebius Maro Kilimanjaro Christian Medical Center, Moshi, Tanzania
Publication year: 
2019

Background: 

Health care-associated infection (HCAI) is a big challenge in both low- and high-income countries. Around childbirth, infection is one of the main causes of maternal and perinatal morbidity and mortality. Appropriate hand hygiene practice is a simple and cost-effective way of reducing Health-care associated Infections. This study intended to assess the baseline performance and knowledge of proper hand hygiene during caesarean sections and the impact of intervention based on a criterion based audit (CBA) at a tertiary health facility in Tanzania.

Methods: 

A non-controlled, before and after intervention study, by criterion-based audit was carried out. A criterion based checklist was used for direct observations of hand hygiene performance during cesarean section. A self-administered questionnaire was used to assess knowledge on infection prevention. Performance was compared before and after a half-way intervention.

Results:

  At baseline, low quality hand hygiene performance was observed. Significant improvement of hand hygiene performance was observed for a number of criteria. Long nails: performance reduction from 15 (25%) to 3 (5%) (p=0.04), polished nails: from 11 (18%) to 1 (2%) (p=0.04), a score increase in hand wash with water from 43.8 (73%) to 60 (100%) (p=0,001).  After procedure, performance of removing gloves correctly increased from 20 (33%) to 37.8 (66%) (p=0.01). Alcohol based hand-rub use increased performance from 2 (3%) to 21 (35%) (p=0.001). The number of health care workers (HCWs) who didn’t wash hands after procedure with either water or alcohol-based hand-rub was reduced from 35 (58%) to 10 (17%) (p=0.001). After the intervention; poor knowledge among HCWs was reduced from 7 (39%) to 3 (17%) while moderate knowledge was increased from 8 (44%) to 12 (67%).

Conclusion:

  Feedback, discussion of findings, training, visual reminders and distribution of Alcohol Based Hand-Rub as part of a criterion-based audit is a powerful way of improving hand hygiene performance and knowledge in surgical wards.