A quasi experiment to implementing standard multimodal strategy to improve hand hygiene behavior in a healthcare facility in central Saudi Arabia


A quasi experiment to implementing standard multimodal strategy to improve hand hygiene behavior in a healthcare facility in central Saudi Arabia


Ashraf E. Saad,1 Al-Wasila T. Al-Natig,2 Mostafa M. Sadek,3,4 Raouf M. Afifi55,6

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


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 3rd – and 4th 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.


Keywords:  Hand hygiene, quasi experiment, healthcare facility, central Saudi Arabia.

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Ashraf E. Saad, Al-Wasila T. Al-Natig, Mostafa M. Sadek, Raouf M. Afifi. A quasi experiment to implementing standard multimodal strategy to improve hand hygiene behavior in a healthcare facility in central Saudi Arabia.International Research Journal of Public Health, 2019; 3:28


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