Implementing a multi-faceted framework for proprietorship of hand hygiene compliance in a network of South African hospitals: leveraging the Ubuntu philosophy. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Brink, A.J.; Messina, A.P.; Maslo, C.; Swart, K.; Chunnilall, D.; van den Bergh, D.
• Is Part Of: Journal of hospital infection. Volume 104:Issue 4(2020)
• Page Start: 404
• Page End: 413
• Publication Date: 2020-04
• Subjects: Hand hygiene -- Model -- Compliance -- Multi-modal intervention -- World Health Organization Hand Hygiene Self-Assessment Framework (HHSAF); Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2019.11.004
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: Given the lack of hospital-wide ownership and shortage of nurses, the ideal model for large-scale implementation of hand hygiene (HH) behaviour change in low- and middle-income countries is unknown. Aim: The aim of the multi-modal strategy was to engender hospital accountability for HH compliance. Methods: The quasi-experimental study was conducted in 50 South African hospitals (November 2015 to July 2017) and involved five overlapping phases: executive governance and corporate behaviour change; group-wide systematic situational analysis; development of an electronic-assisted direct-observed data collection and analysis application; launch and implementation; and accountable governance. Measurement of intra- and inter-hospital variance to six HH opportunities was calculated and data compliance dashboards were e-mailed weekly to hospital leadership teams to provide feedback of recorded HH compliance and behaviour to frontline teams. Baseline comparison (July 2016) of compliance was compared versus post-implementation (July 2017). Findings: Baseline HH compliance of ≤60% was documented for 16% (8/50) of hospitals, whereas overall, 48% (24/50) of hospitals demonstrated a significant improvement ( P < 0.01). Over the 13-month observation period, 523, 422 observations were recorded with a mean rate of 277 ± 223 observations per 1000 patient-days. The group mean composite compliance improved by 7.8% ( P < 0.01) from 77.4% ± 12.8 to 85.2% ± 8.8 between July 2016 and July 2017, respectively. Conclusion: Implementation of a multi-faceted HH model in a large, diverse group of South African hospitals translated into changes in the organizational systems and accountability, standardized HH compliance management and feedback that led to HH proprietorship.