Improving Infection Control through Hand Hygiene at Tygerberg Academic Hospital



Tygerberg is an academic hospital linked to the University of Cape Town in the Western Cape province of South Africa. It has a well established infection prevention and control (IPC) team led by the head of the department of infection prevention and control. A number of quality assurance and IPC managers attended a training-of-trainers workshop on the infection control assessment tool (ICAT) and continuous quality improvement (CQI) approach conducted by the US Agency for International Development-funded Strengthening Pharmaceutical Systems Program in May 2009. After the workshop and during their deliberations, the Tygerberg IPC team identifiedawareness on good hand hygiene practice as one of the focus areas to prevent infection in the hospital

An assessment was administered in nine wards using the ICAT module to determine hand hygiene practices and availability of equipment and supplies. Two team members observed the number of patient contacts, the type of health care worker (medical doctors, nurses, etc.) that had contact with the patient, type of contact (invasive/non-invasive), type of hand hygiene prior and after patient contact e.g. hand washing, alcohol rub or none.
  • A comparison of the baseline and follow up assessments showed marked improvements in the proportion of staff who practised hand hygiene as recommended before and after patient contact.
  • In the ICU, the proportion of staff who used alcohol rubs prior to patient contact increased from 35 percent to 73 percent, while the use  in the medical ward improved from 7 percent to 43 percent
  • The proportion of staff members who did not practise any hand hygiene prior to patient contact decreased from 48 percent to 21 percent in the ICU and from 79 percent to 43 percent in the medical ward.
  • The use of alcohol rubs after patient contact in the medical ward and the ICU increased by 26 percent and 18 percent respectively.
  • Nonadherence to hand hygiene after patient contact decreased by 7 percent and 26 percent in the ICU and medical ward, respectively
Self assessment and continuous quality improvement comprise a simple and sustainable approach that yields quantifiable results.

Hand hygiene is a proven, low-cost intervention to prevent the spread of infection. On-going implementation of such low cost interventions may be acost-effective way to reduce hospital acquired infections at hospitals in resource-limited settings.


Report Author(s): 
Ntengu, M., Fontein, P., Joseph, G., Jefferies, D., Mocke, M., Vos, R.
Management Sciences for Health
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