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Cycle 8 (2019 Deadline)
Improving hand hygiene practice among healthcare workers through mhealth and environmental cues in Kampala Metropolitan Area
PI: Richard Kibirango Mugambe (rmugambe@musph.ac.ug), Makerere University School of Public Health
U.S. Partner: Christine Moe, Emory University
Project Dates: April 2020 - November 2022
Project Overview
Water, sanitation, and hygiene (WASH) in healthcare facilities are critical in the provision of quality healthcare. Good WASH infrastructure and practices should reduce healthcare-associated infections, increase trust and uptake of healthcare services, and increase efficiency and improve staff morale. This PEER project addressed two key questions: why healthcare workers don’t adhere to hand hygiene guidelines in Uganda, and what are simple, effective, and inexpensive interventions to enhance hand-hygiene practices among healthcare workers in Uganda. The PI Richard Mugambe and the research team studied the impact of mobile phone WASH text messages and environmental cues on hand hygiene practices among healthcare workers in the Greater Kampala Metropolitan Area.
The researchers determined the barriers and opportunities for enhancing healthcare workers’ hand hygiene practices, tracking outcomes, including the ratio of completed hand hygiene events to hand hygiene opportunities and increased knowledge on hand hygiene practices.
U.S. partner Dr. Christine Moe provided critical assistance in the project by training faculty from the Makerere University School of Public Health and staff from the Ministry of Health on using the specified hand hygiene interventions, monitoring outcomes, and conducting laboratory procedures for determining microbial contamination on the hands of healthcare workers.
Final Summary of Project Activities
The PEER team started with semi-structured interviews with 30 people to discuss barriers and facilitators to healthcare workers hygiene practices. They also observed WASH procedures at selected facilities in the study area. After this initial study, the researchers held a stakeholders’ workshop to share their findings and engage the stakeholders in developing the design principles for the text messages and environmental cue intervention. Among the attendees at this workshop were representatives from Uganda Ministry of Health, the Ministry of Water and Environment, Uganda Protestant Medical Bureau, WaterAid Uganda, and Oxfam Uganda, among others.
The researchers conducted a baseline study in healthcare facilities, collecting both quantitative and qualitative data on infection prevention and control (IPC) and WASH. In addition, they used the WHO hand hygiene observation tool to assess hand hygiene practice among the health workers. The PEER team subsequently implemented both messaging and environmental cues intervention for six months across multiple health facilities, measuring at the halfway point and at the end of the intervention. The researchers found improvements in a variety of measures, including a 14% increase in attending to hand hygiene before handling the patient, a 4% increase in handwashing instead of hand rubbing, and a 14% increase in practicing hygiene after touching the patient.
During the project, the PI helped develop curriculum for a Master’s in Environmental and Occupational Health program, including a component on IPC and WASH in healthcare facilities, as well as a diploma course on IPC. The PI also worked with WaterAid Uganda on additional papers on IPC and WASH in healthcare facilities. Combined with the findings from the PEER project baseline study, this provided part of the critical evidence that informed the WASH guidelines for health facilities in Uganda.
The PI has also received more than $4 million in additional grants to supplement and continue work begun during the PEER project, including grants from the Gates Foundation, the Dutch Research Council, WaterAid Uganda and the Wellcome Trust.
Publications
Tonny Ssekamatte, Richard K. Mugambe, et al. 2022. Using the Behaviour Centered Design to understand the facilitators and deterrents to hand hygiene among healthcare providers in the greater Kampala metropolitan area: Qualitative findings from a formative phase of a cluster-randomized trial. Research Square. https://doi.org/10.21203/rs.3.rs-1604259/v1
Richard K. Mugambe, Jane Sembuche Mselle, Tonny Ssekamatte, Moses Ntanda, John Bosco Isunju, Solomon T. Wafula, Winnifred K. Kansiime, Prossy Isubikalu, David Ssemwanga, Habib Yakubu, and Christine L. Moe. 2021. Impact of mhealth messages and environmental cues on hand hygiene practice among healthcare workers in the greater Kampala metropolitan area, Uganda: study protocol for a cluster randomized trial. BMC Health Services Research 21: 88. https://doi.org/10.1186/s12913-021-06082-3
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