The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study

Abstract

•This study sought to understand barriers and facilitators to hand hygiene in surgical wards of a Nigerian hospital, as these wards have the highest occurrence of Health care associated infections in Nigeria.•A theoretically underpinned qualitative approach to the assessment of barriers to hand hygiene practices is more effective in establishing a comprehensive understanding than a non-theoretical approach.•This study concurs with existing literature relating to barriers and facilitators to hand hygiene in sub-Saharan African countries and offers additional detail, nuances and barriers and facilitators not previously reported.•Future research should consider and compare the barriers and facilitators to hand hygiene practice across different practitioner groups and in different hospital environments in Sub Saharan Africa countries. BackgroundHealth care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria.MethodsA theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards.ResultsThere were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels.ConclusionsOur study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed. Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed.

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