Sequential Low Cost Interventions Double Hand Hygiene Rates among Medical Teams in a Resource Limited Setting. Results of a Hand Hygiene Quality Improvement Project Conducted at University Teaching Hospital of Kigali (chuk), Kigali, Rwanda.

OBJECTIVE To assess the impact of multimodal low-cost interventions on hand hygiene practices among medical teams. DESIGN A four week prospective observational study. SETTING Medical wards of the University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda. SUBJECTS Medical teams comprising students, residents and consultant physicians. INTERVENTIONS During week one, baseline hand sanitising rate (HSR)--the percentage of hand hygiene opportunities during which hands were sanitised- was recorded. On week two, alcohol based handrubs (ABHRs) were provided and placed strategically on every ward. For week three and four respectively, hand hygiene posters (HHPs) were placed at entry sites of each ward at eye level and subsequently at the head of each patient's bed. MAIN OUTCOME MEASURES Post-intervention HSR was recorded weekly during morning ward rounds. The differences between pre-intervention and post-intervention HSRs as well as end-of-study pre- and post-contact HSR were assessed for significance using Pearson chi square test. RESULT A total of 780 HHOs were covertly observed throughout the study. Baseline HSR was 24.8%. During week 2, there was a non-significant increase in HSR (26.6% vs. 24.8%, p = 0.66). Overall, hand sanitising rates doubled from 24.8% to 50.6% following all study interventions (p < 0.001). There was a significant increase in post-patient contact and pre-patient contact HSRs with rates improving from 25.2% to 58% and 24.5% to 43% respectively (P < 0.01). CONCLUSION Our study showed that low-cost interventions involving ensuring availability of ABHRs and posting HHPs significantly increased HSRs among medical teams but post-intervention rates were suboptimal.