Author(s)

Ashraf E. Saad¹, Al-Wasila T. Al-Natig², Mostafa M. Sadek^3,4, Raouf M. Afifi^5,6*

¹Department of Preventive Medicine, Armed Forces Hospital at Wadi Al-Dawasir, Riyadh, KSA.
²Infection Prevention and Control Unit, Armed Forces Hospital at Wadi Al-Dawsir, Riyadh, KSA.
³Sadeklab Laboratories, Alexandria, Egypt.
⁴Formly, Microbiology and Public Health Department, Military Medical Academy, Alexandria, Egypt.
⁵Community Health Research Institute, International Management-Health Services, Indianapolis, IN, USA.
⁶Health Research Institute, SA Consultancy and Training, Cairo, Egypt.

Background: Hand hygiene (HH) compliance of healthcare workers (HCWs) remains suboptimal despite standard multimodal promotion, and evidence for the effectiveness of novel interventions is urgently needed. Aim: Improve HCWs’ HH compliance toward minimizing healthcare associated infection (HCAI) risk in Wadi Al Dawasir Hospital (WDH), central Kingdom of Saudi Arabia (KSA). Methodology: A quasi experimental approach was adopted to achieve study aim. The HCWs’ behavior of HH during the duration between 2015 and 2016 was evaluated before and after a HH educational plan based on the World Health Organization (WHO) “Multimodal HH Improvement Strategy” (MMHHIS). The HCWs’ compliance in response to HH indications represented by the WHO’s “My 5-Moments for HH” and the type of HH action taken, whether hand washing (HW) or hand-rubbing (HR) were analyzed. Results: The number of opportunities observed of HH performance accounted 230 in 2015 (pre-education), and 237 in 2016 (post-education). The HCWs’ HH compliance rate in the pre-education phase did not vary by the 5-moment indications [χ²(df 4) = 0.01, p = 0.98]. Conversely, the compliance rate after HH education was higher than non-compliance across all 5-moment indication opportunities (ranged between 57.0% up to 88.9%) [χ²(df 1) = 18.25, p < 0.001]. Only the 3^rd and 4^th 5-moment indications (“after body fluid exposure” and “after patient contact,” respectively) were met with a significant HH improvement [χ²(df 1) = 8.98, p = 0.003; and χ²(df 1) = 16.3, p < 0.0001, respectively]. An overall improvement of HH compliance from 49.1% to 69.6% was significantly achieved as a result of submission to the selected HH educational plan (Z = −4.38, p = 0.001). Only physicians and nurses showed a significant “within-profession” improvement in HH compliance after education, compared to that before education (Z = −3.51, p = 0.001, Z = −2.48, p = 0.013, respectively). Conclusions: Applying a HH education plan based on standardized multimodal HH strategy proved effective in improving the HH compliance of the hospital’s staff. An ongoing observation policy within a HH-resourceful environment assures a sustainable and sound HCWs’ HH behavior.

Quasi Experiment, Multimodal Strategy, Hand Hygiene, Healthcare Facility, Central Saudi Arabia

Saad, A. , Al-Natig, A. , Sadek, M. and Afifi, R. (2019) A Quasi Experiment to Implement Multimodal Strategy to Improve Hand Hygiene Behavior in a Healthcare Facility in Central Saudi Arabia. Advances in Infectious Diseases, 9, 49-63. doi: 10.4236/aid.2019.91005.