Effect of using portable alcohol-based handrub on nurses’ hand hygiene compliance and nasal carriage of staphylococcus aureus in a low-income health setting

• Published in: American journal of infection control 2020-05, Vol.48 (5), p.473-479
• Main Authors: Nyamadzawo, Amos, Nishio, Junko, Okada, Shinobu, Nyamakura, Rudo
• Format: Article
• Language: English
• Subjects: Adult; Colonization; Cross Infection - prevention & control; Ethanol; Female; Guideline Adherence - statistics & numerical data; Hand Hygiene - methods; Hand Hygiene - standards; Hand hygiene observation; Hand Sanitizers - chemistry; Hand Sanitizers - therapeutic use; Humans; Longitudinal Studies; Male; Nose - microbiology; Nursing Staff, Hospital - standards; Nursing Staff, Hospital - statistics & numerical data; Staphylococcus aureus - drug effects; Waterless hand hygiene; Zimbabwe
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2020.02.007

•Provision of portable alcohol-based handrub significantly improved nurses’ hand hygiene compliance in resource limited health care settings.•Improvement in hand hygiene compliance was also associated with reduction in S. aureus nasal colonization prevalence.•Nurses’ knowledge on the importance of hand hygiene in the clinical area was adequate irrespective of resource unavailability in the health care setting.•Improving availability of hand hygiene resources is the most effective intervention to increase nurses’ hand hygiene compliance in resource-limited health care settings. Low hand-hygiene compliance (HHC) in low-income countries due to deficient hand hygiene resources may increase nasal carriage of S. aureus, a causative agent of health care-associated infections. The study aimed to assess the effect of using locally available portable alcohol-based handrub (ABHR) regarding nurses’ HHC and nasal carriage of S. aureus. Nonrandomized interventional design. Seventy-two (72) of 86 nurses were provided with portable ABHR to use during patient care (intervention group). The remaining 14 nurses constituted the control group. Evaluation was done via HHC observation per WHO 5-moments of HH, determining S. aureus nasal carriage prevalence and HH guideline knowledge assessment via a self-response questionnaire. In the intervention group, HHC improved from 48.9% to 67.7% (P < .001) especially for hand-hygiene before and after patient contact. Hand-hygiene by handrubbing improved from 16 to 105 moments. There was positive feedback to portable ABHR use from nurses. S. aureus nasal carriage significantly decreased from 30.6% to 21% (P < .031). Negative carriage of S. aureus was significantly associated with increase in HHC (P < .001). Despite the low preintervention HHC, nurses showed considerably high levels of knowledge on relevance of hand hygiene. Portable ABHR use was associated with improved HHC and reduced S. aureus nasal carriage prevalence. As nurses’ knowledge of HH guidelines was high, provision of portable ABHR compensated for deficient facility HH resources resulting in improved HHC, which effected reduction in nasal carriage of S. aureus among nurses.