The purpose of the study is to determine the effect of implementation of the WHO’s Multimodal Hand Hygiene Improvement Strategy among healthcare workers of a tertiary teaching hospital in a developing country. The setting is located at the largest hospital in southern Iran and consists of 1000 beds in 54 wards. The independent variable of the study is the Multimodal Hand Hygiene Improvement Strategy implemented by the World Health Organization. The WHO’s strategy consists of five key elements including: system change to ensure access of healthcare workers to hand hygiene facilities with emphasis on availability of alcohol-based hand rub formulations at the point of care; ongoing training and education; evaluation of practices and feedback; reminders at the workplace; and providing a climate of safety through institution (Farhoudi et al, 2016). The dependent variable is the effectiveness of the WHO’s Multimodal Hand Hygiene Improvement Strategy and the compliance of hand hygiene before and after the interventions. The entire project included five steps: (1) facility preparedness, (2) baseline evaluation, (3) implementation, (4) follow-up evaluation, and (5) ongoing planning and review cycle (Farhoudi et al, 2016). The sample size for the study included 14 wards that were randomly selected and includes all professions in the hospital. The sampling method used can be described as simple random sampling for each of the 54 wards had the chance of being included in the study. The data collection method used was direct observation. Hand hygiene compliance was evaluated by two general medical doctors who were working as infection prevention and control practitioners and received additional training. The data collection measures were based on the following hand hygiene moments: before patient contact, before aseptic procedure, after body fluid exposure risk, after patient contact, and after contact with patient surroundings. Statistical tests used included ordinal measurement of hand hygiene indications, and the chi-square test of compliance rates before and after intervention. The study kept the collected data anonymous and confidential. The key findings indicated that the compliance rate improved from 29.8% to 70.98% of hand hygiene. Another key finding revealed poor hand hygiene compliance among medical doctors specifically, although the study included all professions. The study limitations included: time shortages for each session, a limited number of healthcare workers of a ward that were observed, and not more than two healthcare workers were to be observed simultaneously. The study’s strength was that implementing the WHO hand hygiene program significantly improved hand hygiene compliance among healthcare workers.
Overall, the article, “Impact of WHO Hand Hygiene Improvement Program Implementation: A Quasi-Experimental Trial,” was composed of an appropriate research design that flowed with the proposed research purpose. The reliability of the study was consistent, and the validity provided accuracy. The results of the study were presented objectively and showed significant improvement in hand hygiene compliance among healthcare workers with the implementation of the World Health Organization Multimodal Hand Hygiene Improvement Strategy. Recommendations for future research was stated to further investigate reasons of noncompliance among medical doctors. In conclusion, this study is believed to be a model for countries with low compliance rates and higher HCAIs worldwide.
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