CHAPTER ONE

INTRODUCTION

1.1       Background to the study

The World Health Organization (WHO) first global patient safety challenge, launched in October 2005 and aimed at reducing healthcare-associated infection worldwide, identified the promotion of hand hygiene practices in health care as a priority measure and the entry point to improve infection control in Member States. In April 2006, the WHO World Alliance for Patient Safety issued the Advanced Draft of the WHO Guidelines on Hand Hygiene in Health Care. A key element of the implementation strategy is a very innovative concept, “My five moments for hand hygiene” by WHO. These five moment that call for the use of hand hygiene include the moment before touching a patient and before performing aseptic and clean procedures, after being at risk of exposure to body fluids, after touching patient, and after touching patient surroundings. It integrates the indications for hand hygiene in five essential moments during the sequence of healthcare delivery and facilitates understanding and appropriate practice performance. According to WHO recommendations for guideline preparation, a test phase of the Advanced Draft guidelines was undertaken by using the implementation strategy and tools in eight pilot healthcare settings in seven countries representing all WHO regions worldwide. The objectives of this testing were: to provide local data on the resources required to carry out the recommendations; to generate information on feasibility, validity, reliability, and cost effectiveness of the interventions; and to adapt and refine proposed implementation strategies. Other healthcare settings around the world volunteered to participate autonomously in the test phase and provided WHO with feedback on implementation.

Worldwide, hand Hygiene (HH) among healthcare workers, especially nurses, is the main preventive intervention to control healthcare acquired infections (HCAIs). [Allegranzi B, 2009]. Although the techniques involved in HH are simple, compliance with hand hygiene (CwHH) recommendations is poor [Cheng HC, 2019], particularly in Intensive Care Units (ICUs), where CwHH ranges from 64% in high income settings to as low as 9% in low income settings [. Lambe KA, 2019]. In a systematic review of studies on CwHH in hospitals in industrialized countries, the CwHH was estimated to be 40% which was even lower in ICUs [Erasmus V, 2010]. Globally, HAIs affect approximately two million people annually with 5% to 10% requiring hospitalization [Apanga S, 2014], and these are twice high in low and middle income countries (LMICs) than High Income Countries [Apanga S, 2011]. Despite the scarcity of data on HAIs in LMICs, prevalence of HAIs in Sub-Saharan Africa have been reported to range from 1.6% to 28.7% with a prevalence of 13.4%, 11.4% and 8% in Botswana, Malawi and South Africa respectively. HAIs pose a major threat to the safety of patients, guardians, and HCWs [Hearn P, 2017], with surgical site infections, urinary tract infections, pneumonia, and bloodstream infections being the common HAIs in LMICs [Nejad S.B, 2011]. It is estimated that approximately 50% of the HAIs are transmitted through the hands of HCWs while on duty [Martín-Madrazo C, 2009]; which is of significant concern as this is preventable. Studies have evidenced the importance of hand washing in disease reduction, with systematic reviews showing that hand washing with soap alone reduces diarrhea incidence by 30–47% [Curtis V, 2021]. Additionally, hand hygiene has been proven to control HAIs when conducted effectively at critical times [Ellingson K, 2014]. Thus, the WHO promotes the “My five moments of hand hygiene” which encourage HCWs to clean their hands before patient contact, before an aseptic procedures, after exposure to body fluid, after patient contact, and after contact with patient’s surroundings. However, adherence to hand hygiene among HCWs remains low with an average of 38.7% globally [WHO, 2021]. Cameroon is no exception as the hand hygiene adherence rate was reported to be 23% at a major referral hospital among clinicians and medical students [Kamange L, 2021]. This indicates that HAIs remain a public health burden in Cameroon health care facilities. However, little is known about hand hygiene adherence and its associated factors among HCWs.

1.2       Problem Statement Setting

In most hospitals today, the prevalence of most disease is as a result of improper hand hygiene procedure carryout by nurses and other medical personnel. Although the techniques involved in HH are simple, compliance with hand hygiene (CwHH) recommendations is poor particularly in Intensive Care Units. Globally, HAIs affect approximately two million people annually with 5% to 10% requiring hospitalization. Because of improper hygiene it is easy for disease to be transmitted from patient to nurse and from nurse to another patient. Proper practice of hand hygiene by health care workers (HCWs) significantly reduces nosocomial infections and it is important in the prevention of disease occurrence in our community. Nurses are supposed to wash their hands before and after leaving the patient wards or administering care to a patient. Previous studies have primarily assessed hand hygiene adherence in healthcare setting using semi structured interviews or observations separately as data collection tools and they did not compare self-reported to actual behaviors. However, the combination of both the semi structured interviews and observations have been successfully used to assess hand hygiene practice in community settings. Thus, using both semi structured interviews and observations to understand hand hygiene practice in health care settings could strengthen the quality of data collected to inform design of interventions to improve hand hygiene behavior among the HCWs. This study aimed to assess the five moment of hand hygiene amongst nurses in Limbe Regional Hospital Cameroon.

1.3 Significance of the Study

The outcome of this study will be important in the following ways:

Healthcare workers have an important role to play in the implementation of hand hygiene practices. This study will help healthcare workers better understand the importance of constantly practicing hand hygiene according to the WHO five moments of hand hygiene.

Admitted patients have weak immune systems due to already existing medical conditions, the study will help reduce the risk of patients developing hospital acquired infection as a result of poor hygiene practices.

There is a high chance of spreading drug resistant micro-organisms from the hospital in to the community. These study will also help create awareness on the importance of practicing hand hygiene by individuals in the community.

1.4 Research Questions

What is the knowledge level of nurses on the WHO 5 moments of hand washing  in the Limbe Regional Hospital ?

What is the attitude of of nurses on the WHO 5 moments of hand washing in the Limbe regional hospital?

What is the practice of WHO 5 moments of hand washing by nurses in the Limbe Regional hospital?

1.5 Research objective

1.5.1 General objectives

To investigate knowledge, attitude and practice of the WHO 5 moments of hand washing by nurses in the Limbe Regional hospital.

1.5.2 Specific objectives

To determine nurses’ level of knowledge on the WHO 5 moments of hand washing at the Limbe Regional hospital

To evaluate nurses altitude towards the WHO 5 moment of hand washing at Limbe Regional hospital.

To analyze nurses’ practice of WHO 5 moment of hand washing at Limbe Regional hospital.