Effectiveness of WHO's multimodal hand hygiene strategy on compliance and knowledge in a University Hospital in Morocco

Background: Hand hygiene is the most efficient practice for healthcare-associated infection prevention. This study aimed to assess compliance with hand hygiene and knowledge of healthcare workers before and after implementation of a multimodal hand hygiene strategy designed by the World Health Organization (WHO). Methods: Compliance with hand hygiene was measured by direct observation before and after implementation of the strategy, according to the “my five moments of hand hygiene” concept. The intervention consisted of setting up alcohol-based hand rub dispensers in patient rooms and liquid soap dispensers on all room’s sinks, training and educational sessions for healthcare workers, and posting reminders in workplace. Knowledge of healthcare workers about hand hygiene was assessed using WHO hand hygiene knowledge questionnaire. Results: The overall hand hygiene compliance was 33.3% at baseline and increased to 49.8% at follow-up (p<.05). Nurses showed better compliance with hand hygiene after the intervention (53.5%) than physicians and nursing assistants (50% and 43.5% respectively). Compliance with hand hygiene improved for all indications after the intervention (P <.05) except for “before touching a patient” and “after contact with patient surroundings”. Healthcare workers knowledge improved significantly from 60 (interquartile range, 48-68) before training to 72 (interquartile range, 64-80) after training (P<.05). Conclusion: Implementing the WHO multimodal hand hygiene strategy can result in a significant improvement in hand hygiene compliance and knowledge among healthcare workers.