Improving Hand Hygiene to Reduce Healthcare Associated Infections in Neonatal Wards: WHO Multimodal Strategy, Rwanda

ABSTRACT Background: Healthcare-associated infections (HAIs) are major causes of preventable neonatal morbidity and mortality. Suboptimal hand hygiene (HH) compliance among healthcare workers (HCWs) remains a key, modifiable driver of infection transmission. At the University Teaching Hospital of Kigali (CHUK), neonatal HAI incidence increased from 16% in 2023-2024 to 24% in July 2024-January 2025, whereas HH compliance was 39.7% without neonatal ward specific improvement program. Purpose: Improve HH compliance among HCWs by ≥50% and reduce neonatal HAI incidence by ≥10% through implementation of the WHO Multimodal HH Improvement Strategy (MMHHIS). Methods: An 18-week pre–post quality-improvement project guided by the Plan–Do–Study–Act model (October 2025-January 2026) in neonatal wards (neonatology/neonatal intensive care unit [Neo/NICU], Neonatal Surgery). Intervention included system change, staff training (N = 60), contextual workplace reminders, weekly audits with structured feedback (3494 opportunities), and leadership engagement. Process measures included knowledge scores and infrastructure compliance, outcomes included HH compliance and HAI rates. Results: HCWs' HH knowledge improved from 64.07% to 86.40%. All 13 infrastructure elements were achieved and sustained with 100% compliance. HH compliance increased from 31.9% to 88.0%. Neonatal HAI rates decreased from 10.1% to 3.9% (61.4% relative reduction) in Neo/NICU and from 42.6% to 24.4% (42.7% reduction) in Neonatal Surgery. Implications for Practice: WHO MMHHIS is feasible, effective in improving compliance and reducing HAIs and scalable approach within CHUK and similar settings. Implications for Research: Additional research on long-term sustainability and cost-effectiveness across settings.