Observational Study of Hand Hygiene Compliance at a Trauma Hospital in Iraqi Kurdistan

Ines Moued, Rawand M. Haweizy, Lawand S. Miran, Mustafa G. Mohammed, Johan von Schreeb and Andreas Älgå
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Ines Moued: Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
Rawand M. Haweizy: College of Medicine, Hawler Medical University, Erbil 44001, Iraq
Lawand S. Miran: West Erbil Emergency Hospital, Erbil 44001, Iraq
Mustafa G. Mohammed: Emergency Management Center, Erbil 21412, Iraq
Johan von Schreeb: Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
Andreas Älgå: Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

J, 2021, vol. 4, issue 4, 1-9

Abstract: Healthcare-associated infections, commonly caused by poor hand hygiene, represent a significant source of disease and economic burden for healthcare systems, especially those in resource-limited settings. The few existing studies on hand hygiene compliance in resource-limited hospital settings suggest that compliance is insufficient. The difference in compliance rates between units in resource-limited trauma hospitals is largely unknown. We aimed to assess hand hygiene compliance rates among healthcare workers at a trauma hospital in Iraqi Kurdistan and compare the levels of compliance between the emergency room (ER), the intensive care unit (ICU), and the acute care ward (ACW). We carried out overt observations in 2018 using the validated World Health Organization ‘five moments for hand hygiene’ observational tool. We observed a total of 622 hand hygiene opportunities performed by 149 healthcare workers. Hand hygiene compliance was defined as handwashing with soap and water or the use of alcohol-based hand rub, in accordance with the ‘five moments for hand hygiene’ concept. Overall, the hand hygiene compliance rate was found to be 6.8% (95% confidence interval 5.0–9.1). Compliance was significantly lower in the ER (1.0%), compared with the ICU (8.1%) ( p = 0.0012), and the ACW (11.1%) ( p < 0.0001). In all three units, the availability of alcohol-based hand rub and handwashing sinks was insufficient in relation to the number of patient beds. We conclude that the overall level of hand hygiene compliance was low, with the lowest level of compliance in the ER. Our findings call for improved resource allocation and strengthened hand hygiene routines. These relatively simple measures could potentially lower the incidence of healthcare-associated infections and improve the mortality and morbidity of patients in already overburdened healthcare systems.

Keywords: hand hygiene compliance; healthcare-associated infection; trauma care (search for similar items in EconPapers)
JEL-codes: I1 I10 I12 I13 I14 I18 I19 (search for similar items in EconPapers)
Date: 2021
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