Hand hygiene compliance among healthcare workers at a tertiary maternity hospital in Sierra Leone: a cross-sectional study

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BACKGROUND: Maternal and neonatal mortality remains a global health problem, with infections accounting for a significant proportion of this burden. Major predisposing factors include poor aseptic techniques and contaminated hands of healthcare workers (HCWs). Hand hygiene (HH) is the most effective and simplest infection prevention and control (IPC) measure to minimise infection transmission. This study aimed to assess HH compliance and identify barriers among HCWs at a tertiary hospital in Sierra Leone. METHODS: This hospital-based cross-sectional study utilised a standardised World Health Organization (WHO) HH observation form to assess HH compliance among HCWs in the labour ward of the Princess Christian Maternity Hospital (PCMH). A root cause analysis was also used to determine the barriers to HH compliance. Data analysis was conducted using Microsoft Excel, with findings presented in frequencies and proportions. RESULTS: A total of 404 HH opportunities were observed at the labour ward. The overall HH compliance rate was 32%, and HH compliance for nurses, midwives, doctors, and nursing students was 37%, 34%, 27%, and 0%, respectively. Based on the WHO "5 moments" for HH compliance, the highest adherence was observed for moment 3 (83%), followed by moment 4 (68%). Conversely, moment 2 had the lowest compliance (6%). Identified barriers to HH compliance included organisational concerns, availability of IPC materials and equipment, staffing, environmental factors, cultural influences, and existing practices. CONCLUSION: HH compliance among HCWs at PCMH was found to be low. To enhance HH practices and patient safety, promoting HH practices through investing in IPC supplies, strategic placement of workplace reminders, training, mentorship, and coaching should be prioritised.

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