Barriers and Opportunities for Sustainable Hand Hygiene Interventions in Rural Liberian Hospitals

Lucy K. Tantum, John R. Gilstad, Fatorma K. Bolay, Lily M. Horng, Alpha D. Simpson, Andrew G. Letizia, Ashley R. Styczynski, Stephen P. Luby and Ronan F. Arthur
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Lucy K. Tantum: School of Medicine, Stanford University, Stanford, CA 94305, USA
John R. Gilstad: School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
Fatorma K. Bolay: National Public Health Institute of Liberia, Monrovia 1000, Liberia
Lily M. Horng: School of Medicine, Stanford University, Stanford, CA 94305, USA
Alpha D. Simpson: Q&A, Inc., Monrovia 1000, Liberia
Andrew G. Letizia: Naval Medical Research Center, Silver Spring, MD 29010, USA
Ashley R. Styczynski: School of Medicine, Stanford University, Stanford, CA 94305, USA
Stephen P. Luby: School of Medicine, Stanford University, Stanford, CA 94305, USA
Ronan F. Arthur: School of Medicine, Stanford University, Stanford, CA 94305, USA

IJERPH, 2021, vol. 18, issue 16, 1-16

Abstract: Hand hygiene is central to hospital infection control. During the 2014–2016 West Africa Ebola virus disease epidemic in Liberia, gaps in hand hygiene infrastructure and health worker training contributed to hospital-based Ebola transmission. Hand hygiene interventions were undertaken post-Ebola, but many improvements were not sustainable. This study characterizes barriers to, and facilitators of, hand hygiene in rural Liberian hospitals and evaluates readiness for sustainable, locally derived interventions to improve hand hygiene. Research enumerators collected data at all hospitals in Bong and Lofa counties, Liberia, in the period March–May 2020. Enumerators performed standardized spot checks of hand hygiene infrastructure and supplies, structured observations of hand hygiene behavior, and semi-structured key informant interviews for thematic analysis. During spot checks, hospital staff reported that handwashing container water was always available in 89% ( n = 42) of hospital wards, piped running water in 23% ( n = 11), and soap in 62% ( n = 29). Enumerators observed 5% of wall-mounted hand sanitizer dispensers ( n = 8) and 95% of pocket-size dispensers ( n = 53) to be working. In interviews, hospital staff described willingness to purchase personal hand sanitizer dispensers when hospital-provided supplies were unavailable. Low-cost, sustainable interventions should address supply and infrastructure-related obstacles to hospital hand hygiene improvement.

Keywords: hand hygiene; infection prevention and control; sustainability; hospital safety; mixed methods; Liberia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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