Infection Prevention and Control in North-East Nigeria: An Assessment ofHand Hygiene in Health Care Facilities in Protracted Crisis EnvironmentFebruary 2019

Abstract

Introduction: Hand hygiene is the single most effective action to prevent the spread of Healthcare-Associated Infections and Antimicrobial Resistance among health care workers and patients. The lack of effective hand hygiene and materials for hand hygiene is a major problem for patient safety in health care facilities. We conducted this survey in February 2019 to assess the situation of hand hygiene in health care facilities in Borno State, the epicenter of insurgency in North-East Nigeria. Method: An interviewer-administered questionnaire was used to assess the situation of hand hygiene from 103 health care facilities selected from across Borno State. The questionnaire used was adopted from the WHO Hand Hygiene Self-Assessment Framework at the facility level. It had five sections (System change, training, and education, evaluation and feedback, reminders in the workplace, institutional safety climate for hand hygiene) and 27 indicators framed as questions with “yes” or “no” response. Each health facility’s response was scored, calculated and expressed as a proportion of the total score of 500. Based on the score obtained, each facility was assigned to one of four categories ranging from inadequate, basic, intermediate to advanced hand hygiene level. Results: One hundred and three health facilities were involved in the assessment. Eighty-nine (86.4%) were public, government-owned health care facilities. The highest participation was from the central zone of the state with 43 (41.7%) while the northern zone of the state recorded the lowest participation 25 (24.3%). Central zone participation was 43 (41.7%). Seventy-eight (75.8%) of the total health facilities had inadequate hand hygiene levels, 21 (20.4%) had basic hand hygiene levels, 4 (3.8%) had intermediate hand hygiene level and none (0%) had advanced hand hygiene level. Summary statistics (mean ± SD, Median: IQR) for the five sections showed the following; System change (availability of soap, running water, single-use hand towels)-19 ± 21, 15: 30; education and training (on hand hygiene)-10.3 ± 15.0, 0: 3.0; evaluation and feedback (assess availability of water, soap, towel, and hand hygiene compliance)-13.0 ± 17.4, 0: 25; reminders in the workplace (posters and leaflets)-19.2 ± 21.0, 20: 15 and institutional safety climate for hand hygiene (functional hand hygiene teams, patient involvement in hand hygiene and regular communication)-14 ± 25.0,0:20. The overall scores summary statistics were 75.6 ± 78.5, 55: 125. Conclusion: This assessment revealed gross inadequacies in hand hygiene practice and hand hygiene promotion in government-owned Primary Health Care Facilities in Borno state. There is a need to scale up efforts to improve hand hygiene practices and hand hygiene promotion activities in the State to enhance the quality of care and minimize the incidence of Healthcare-Associated Infections.