ABSTRACT
Introduction: Healthcare worker adherence to proper Hand Hygiene (HH) practices and access to alcohol-based hand-rub (ABHR) remains limited in many low-resource settings. An effective HH improvement strategy is a critical element of infection prevention and control (IPC) programmes, as seen in the ongoing COVID-19 pandemic. The project PASQUALE aimed to establish the WHO multimodal HH strategy at the University Hospital Bouaké, Côte d'Ivoire. Objectives: The project PASQUALE aimed to establish the WHO multimodal HH strategy at the University Hospital Bouaké, Côte d'Ivoire. Methods: The improvement of HH knowledge and HH compliance was assessed in a before-and-after intervention study. The intervention consisted of a HH training for staff of all departments regardless of their participation in the initial assessment and the introduction of local production of ABHR. Assessment of HH knowledge and compliance was performed 12 months before (06/2018), right after the intervention (10/2019) and at a ten months interval (08/2020), whereby knowledge was assessed through a self-administered questionnaire and HH compliance through direct observations. Results: Baseline knowledge score was 14/25, increased significantly to 17/25 upon the first and decreased to 13/25 in the second assessment. HH compliance showed a significant increase from 12.7% to 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. An average of 74.4L ABHR per month were produced from 07/2019 until 03/2020, when the first COVID-19 infection was confirmed in Côte d'Ivoire, and 138L per month from 04/2020 onwards. Monthly consumption of ABHR in the same time increased from 76 to 125L. Conclusion: The implementation of the WHO HH improvement strategy led to sustained improvements in HH compliance without relying on costly interventions. This study emphasized that the implementation of the strategy is feasible and has effectively contributed to the IPC response during the COVID-19 pandemic.
ABSTRACT
Introduction: In response to the COVID-19 pandemic, the WHO launched a strategic preparedness and response plan, outlining public health measures to support countries worldwide. Objectives: Our study aimed to assess the level of preparedness of health care workers (HCWs) towards COVID-19 and strenghten HCWs knowledge and perception of the SARS-COV-2 pandemic and its related Infection prevention and control (IPC) measures in Faranah, Guinea. Methods: We conducted a cross-sectional pre- and post-intervention study between april 2020 and march 2021. This consisted of a baseline assessment, in-person training, an immediate post-training follow-up and a three months follow-up. Participants were HCWs from the Faranah Regional Hospital (HRF) and two health care centres (HCC). The assessment was carried-out using a questionnaire developed based on WHO recommendations. Data was analysed using STATA Version 17. Results: There was no significant difference in the overall mean knowledge score during baseline (32.67 ± 5.81) and second follow-up (33.96 ± 4.04 p < 0.467). Subgroup analysis found significant improvement in knowledge for the HCC, but not for the hospital, comparing baseline (29.35 ± 6.89) and second follow-up (34.38 ± 3.89, p < 0.007). Overall, there was significant improvement in knowledge among Auxiliary Nurses in the HCC (baseline 28.21 ± 6.68, follow-up 33.87 ± 4.26 p < 0.010), while no significant improvement was observed in other profession groups in both HRF and HCC. Assessment of perception towards Covid-19 pandemic revealed that 48.6% of participants responded feeling helpless regarding the pandemic at baseline, while only 12.9% responded this way after second follow-up. Conclusion: The study highlighted optimal level of preparedness towards COVID-19 and its IPC measures among HCWs in both HRF and HCC as reflected by the good knowledge score noted in both baseline and follow-ups. Knowledge was further strengthened in the HCC-relatively low resourced facilities as compared to HRF, as shown by improvement in knowledge after training. Furthermore, IPC training was a key component in improving certain perceptions HCW's had towards COVID-19.
ABSTRACT
Introduction: The Multimodal WHO Hand Hygiene (HH) Strategy is a widely used and well recognized approach. However, the evidence on the sustainability in low-resource settings is still scarce. The WHO strategy was implemented at the Regional Hospital of Faranah (HRF), but context specific challenges developed. Objectives: We aimed to promote HH culture by addressing these challenges and implementing appropriate solutions. Methods: Over a period of 3 years, the project team used quantitative and qualitative methods to assess HH improvement. Local staff was trained and instructed to track the development, identify barriers and find solutions to build a sustained HH culture. Results: Four main barriers were identified and addressed by targeted measures. 1) The lack of staff for local production was overcome by implementing a train the trainer approach. The initially trained pharmacist trained four other team members. To further strengthen the production team, a national solution of training and sending staff is proposed by the HRF. 2) Difficulties in obtaining production ingredients in high quality were addressed by purchasing large quantities and the establishment of a storage room in the hospital pharmacy. 3) To prepare for sustainable local production, the return, recycling and exchange of empty bottles was planned by opening a register of distribution. 4) To stop the decrease in knowledge and compliance over time, a HH championship every 6 months was initiated. All hospital departments were invited to participate and staff assessed via the WHO knowledge questionnaires and HH observations. Furthermore, refresher trainings and demonstrations of HH were given in daily staff meetings. Conclusion: To build HH culture is feasible in low-resource hospitals such as the HRF. However, context specific challenges require locally designed solutions such as the introduction of recycling systems for ABHR bottles, organizing HH championships, or promoting daily staff trainings to maintain the improvement on HH practises and creating a HH culture. This development of a HH culture and its sustainable local production helped the HRF to respond to the current COVID-19 pandemic.