Promotion of handwashing as a measure of quality of care and prevention of hospital-acquired infections in Eritrea: the Keren study

Abstract

A complex interplay of cognitive, socio-economic and technical factors may determine hand-washing practice among hospital-based health workers, particularly doctors, regardless of the location of the country or hospital they work in.

Objectives: To assess quality of care with respect to handwashing practice as a routine measure of infection prevention in Keren hospital, a provincial referral hospital, second largest in Eritrea; with a view to putting in place quality standards and effective means of monitoring and evaluation. Design: Qualitative study with a participatory and iterative/dynamic design. Methods: Semi-structured interviews and focus group discussions were held with 34 members of the hospital staff; and a total of 30 patients in the medical, surgical and obstetric wards were interviewed. Direct observation of handwashing practice and facilities were also employed. Results: Although only 30% of health workers routinely washed their hands between patient contact, the study revealed genuine interest in training and the need to reward good practice in order to motivate health workers. Educational intervention and technical training resulted in significant improvements in health workers\' compliance with hospital infection prevention standards. Patient satisfaction with health workers\' hygiene practices also improved significantly. Conclusion: Hospital-based health workers\' handwashing practice needs to improve globally. There is no room for complacency, however, in Eritrea (as indeed in other African countries) where public health services need to keep patients\' welfare at heart; particularly with respect to women in childbirth, as mothers continue to bear the lion\'s share of post-war rebuilding of lives, livelihoods, and the country as a whole.