Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey.
BACKGROUND
Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions.


OBJECTIVE
To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy.


METHODS
The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities.


RESULTS
More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%).


CONCLUSIONS
Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities.
Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, USA. Electronic address: lhorng@stanford.edu.
L M
LM
Horng
Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
L
L
Unicomb
Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
M-U
MU
Alam
Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
A K
AK
Halder
Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
A K
AK
Shoab
Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
P K
PK
Ghosh
WaterAid Bangladesh, Dhaka, Bangladesh.
A
A
Opel
WaterAid Bangladesh, Dhaka, Bangladesh.
M K
MK
Islam
Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, USA.
S P
SP
Luby
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001459:Bangladesh; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000517:prevention & control; D003906:Developing Countries; D005260:Female; D063373:Hand Hygiene / Q000379:methods*; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D055815:Young Adult
Bangladesh; Family caregiver; Hand hygiene; Healthcare facility; Healthcare worker
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