Promotion of hand hygiene strengthening initiative in a Nigerian teaching hospital: implication for improved patient safety in low-income health facilities.

BACKGROUND Health care-associated infection remains a significant hazard for hospitalized patients. Hand hygiene is a fundamental action for ensuring patient safety. OBJECTIVE To promote adoption of World Health Organization Hand Hygiene Guidelines to enhance compliance among doctors and nurses and improve patient safety. METHODS The study design was a cross sectional intervention in a Federal Teaching Hospital South-eastern Nigeria. Interventions involved training/education; introduction of hand rub; and hand hygiene reminders. The impact of interventions and hand hygiene compliance were evaluated using World Health Organization direct observation technique. RESULTS The post-intervention hand hygiene compliance rate was 65.3%. Hand hygiene indications showed highest compliance rate 'after body fluid exposure' (75.3%) and 'after touching a patient' (73.6%) while the least compliance rate was recorded 'before touching a patient' (58.0%). Hand hygiene compliance rate was significantly higher among nurses (72.9%) compared to doctors (59.7%) (χ(2)=23.8, p<0.05). Hand hygiene indication with significantly higher compliance rate was "before clean/aseptic procedure" (84.4%) (χ(2)=80.74, p<0.05). Out of the 815 hand hygiene practices recorded 550 (67.5%) were hand rub action. CONCLUSIONS hand hygiene campaigns using the World Health Organization tools and methodology can be successfully executed in a tertiary health facility of a low-income setting with far reaching improvements in compliance.