Impact of hand hygiene intervention: a comparative study in health care facilities in Dodoma region, Tanzania using WHO methodology

Compliance with guidelines on hand hygiene (HH) is pivotal to prevent and control health-care associated infections and contributes to mitigating antimicrobial resistance. A baseline assessment in Dodoma region, Tanzania in March 2018 showed inadequate HH levels across health care facilities. We evaluated the impact of training in HH as part of a water, sanitation and hygiene (WASH) interventions of "Maji kwa Afya ya Jamii" (MKAJI) project. A comparative HH assessment was conducted in June 2019 involving health care facilities under MKAJI project (n = 87 from which 98 units were assessed) vs non-MKAJI facilities (n = 85 from which 99 units were assessed). Irrespective of MKAJI interventional status, baseline assessment in March 2018 were compared to re-assessment in June 2019 in all health care facility units (unpaired comparison: 261 vs 236 units, respectively), and in facilities assessed in both surveys (paired comparison: 191 versus 191 units, respectively). The 'WHO HH Self-Assessment Framework Tool, 2010' with five indicators each counting 100 points was used. The cumulative scores stratified each health facility's unit into inadequate (0-125), basic (126-250), intermediate (251-375) or advanced (376-500) HH level (score). The HH compliance rates were also assessed and compared. The overall post-intervention median HH score [interquartile range (IQR)] was 187.5 (112.5-260). MKAJI health facilities had significantly higher median HH scores (IQR) [190 (120-262.5)] compared with non-MKAJI facilities [165 (95-230); p = 0.038]. Similarly, the HH compliance rate of ≥51% was significantly higher in MKAJI than non-MKAJI facilities [56.1% versus 30.3%; chi2 = 13.39, p