Has Hand Hygiene Compliance in Two Tertiary Care Hospitals, Freetown, Sierra Leone, Improved in 2023 Following Operational Research in 2021?

In 2021, an operational research study in two tertiary hospitals, Freetown, showed poor hand hygiene compliance. Recommended actions were taken to improve the situation. Between February-April 2023, a cross-sectional study was conducted in the same two hospitals using the WHO Hand Hygiene tool to assess hand hygiene practices and compare hand hygiene compliance with that observed between June-August 2021. In Connaught hospital, overall hand hygiene compliance improved from 51% to 60% (P<0.001), and this applied to both handwash actions with soap and water and alcohol-based-hand-rub: significant improvements were found in all hospital departments and amongst all healthcare worker cadres. In 34 Military Hospital (34MH), overall hand hygiene compliance decreased from 40% to 32% (P<0.001), with significant decreases observed in all departments and amongst nurses and nursing students. The improvements in Connaught Hospital were attributed to more hand hygiene reminders, better handwash infrastructure and more frequent supervision assessments compared with 34MH where interventions were less well applied, possibly due to extensive hospital reconstruction at the time. In conclusion, improved distribution of hand hygiene reminders, better handwash infrastructure and frequent supervision assessments are effective, and need to be strengthened, scaled-up and combined with other innovative ways to promote good hand hygiene practices.