Criterion-Based Audit of Hand Hygiene Performance During Caesarean Section at a Referral Hospital in Northern Tanzania: An Uncontrolled Interventional Study

Background: Health care-associated infection (HCAI) is a big challenge in both low- and high-income countries. Around childbirth, infection is one of the main causes of maternal and perinatal morbidity and mortality. Appropriate hand hygiene practice is a simple and cost-effective way of reducing Health-care associated Infections. This study intended to assess the baseline performance and knowledge of proper hand hygiene during caesarean sections and the impact of intervention based on a criterion based audit (CBA) at a tertiary health facility in Tanzania. Methods: A non-controlled, before and after intervention study, by criterion-based audit was carried out. A criterion based checklist was used for direct observations of hand hygiene performance during cesarean section. A self-administered questionnaire was used to assess knowledge on infection prevention. Performance was compared before and after a half-way intervention. Results: At baseline, low quality hand hygiene performance was observed. Significant improvement of hand hygiene performance was observed for a number of criteria. Long nails: performance reduction from 15 (25%) to 3 (5%) (p=0.04), polished nails: from 11 (18%) to 1 (2%) (p=0.04), a score increase in hand wash with water from 43.8 (73%) to 60 (100%) (p=0,001).  After procedure, performance of removing gloves correctly increased from 20 (33%) to 37.8 (66%) (p=0.01). Alcohol based hand-rub use increased performance from 2 (3%) to 21 (35%) (p=0.001). The number of health care workers (HCWs) who didn’t wash hands after procedure with either water or alcohol-based hand-rub was reduced from 35 (58%) to 10 (17%) (p=0.001). After the intervention; poor knowledge among HCWs was reduced from 7 (39%) to 3 (17%) while moderate knowledge was increased from 8 (44%) to 12 (67%). Conclusion: Feedback, discussion of findings, training, visual reminders and distribution of Alcohol Based Hand-Rub as part of a criterion-based audit is a powerful way of improving hand hygiene performance and knowledge in surgical wards.