title: Promotion of handwashing as a measure of quality of care and prevention of hospital-acquired infections in Eritrea: the Keren study.
abstract: A complex interplay of cognitive, socio-economic and technical factors may determine hand-washing practice among hospital-based health workers, particularly doctors, regardless of the location of the country or hospital they work in.
  
  
  OBJECTIVE
  To assess quality of care with respect to handwashing practice as a routine measure of infection prevention in Keren hospital, a provincial referral hospital, second largest in Eritrea; with a view to putting in place quality standards and effective means of monitoring and evaluation.
  
  
  METHODS
  Qualitative study with a participatory and iterative/dynamic design.
  
  
  METHODS
  Semi-structured interviews and focus group discussions were held with 34 members of the hospital staff; and a total of 30 patients in the medical, surgical and obstetric wards were interviewed. Direct observation of handwashing practice and facilities were also employed.
  
  
  RESULTS
  Although only 30% of health workers routinely washed their hands between patient contact, the study revealed genuine interest in training and the need to reward good practice in order to motivate health workers. Educational intervention and technical training resulted in significant improvements in health workers' compliance with hospital infection prevention standards. Patient satisfaction with health workers' hygiene practices also improved significantly.
  
  
  CONCLUSIONS
  Hospital-based health workers' handwashing practice needs to improve globally. There is no room for complacency, however, in Eritrea (as indeed in other African countries) where public health services need to keep patients' welfare at heart; particularly with respect to women in childbirth, as mothers continue to bear the lion's share of post-war rebuilding of lives, livelihoods, and the country as a whole.
authors.affiliation: Nursing and Quality of Health Care Services, Ministry of Health, Asmara, Eritrea.
authors.forename: Rigbe
authors.initials: R
authors.lastname: Samuel
authors.forename: Astier M
authors.initials: AM
authors.lastname: Almedom
authors.forename: Giotom
authors.initials: G
authors.lastname: Hagos
authors.forename: Stephanie
authors.initials: S
authors.lastname: Albin
authors.forename: Alice
authors.initials: A
authors.lastname: Mutungi
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D004496:Education, Continuing; D019017:Eritrea; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D017060:Patient Satisfaction; D010564:Personnel, Hospital / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D019984:Quality Indicators, Health Care