Factors associated with hand hygiene compliance by healthcare providers and students at the newborn unit of Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

BACKGROUND: Hand Hygiene (HH) is recognized by the Centers for Disease Control as the single most important factor in the prevention of healthcare- associated infections. However, according to the World Health Organization estimates, compliance to HH among HCP is 39% and has not improved despite promotion of the five critical moments of HH. Studies have shown behavior- change theory based interventions, with the Theory of Planned Behaviour (TPB), being likely to yield better compliance as a psychology framework which identifies predictors of HH. OBJECTIVE: To assess the level of and identify the factors associated with compliance with HH practices by HCP and students at the MTRH NBU using the TPB. METHODS:A hospital-based cross-sectional study was conducted in the NBU of MTRH between January 2019 to December 2019.The target population was HCP and students attending to neonates in the NBU and only those who consented were studied. Participants who had any skin condition that prevented them from using either the soap or alcohol- based hand disinfectant provided in the unit at the time of the study were excluded.Consecutive sampling was done for all participants.Data collection tools included the WHO HH observation form followed by a standard TPB questionnaire that assessed Attitude, Subjective Norm and Perceived Behavioural control towards HH. Descriptive statistics for continuous variables and frequency listings for categorical data. Fisher‘s exact and Pearson‘s Chi-Square to test for associations among sociodemographic characteristics and TPB variables with compliance to HH. A p-value of <.05 was considered statistically significant at 95% confidence interval. RESULTS: Seventy-six HCP and students were included. Majority was female, 68.42% (52/76). The overall HH compliance was 26.31% (n=76), (95% CI: 16.87%, 37.68%). Compliance was highest among Paediatricians at 100% (4/4), with the least among students and interns, 0% (0/32). Qualified staff (Paediatricians, Paediatric Surgeons and Nurses) were more compliant (X2 = 11.43; p = .001) and had higher attitude (X2 = 13.69; p = .001) scores than all trainees (Registrars, Interns and Students). Trainees had both a lower desire to know the HH protocol, (X2 = 6.78; p = .009) and lower desire to be seen as responsible by performing HH (X2 = 7.34; p = .007). CONCLUSION: Hand hygiene compliance was lower than the World Health Organization global estimate. A higher median score of attitude among qualified staff was significantly associated with compliance. RECOMMENDATION: Hand hygiene needs to be improved across most cadres. All trainees who attend to neonates should be taught the hand hygiene protocol and the importance of being responsible for their actions in order to improve their attitude towards hand hygiene.