Ghana: Hand hygiene among health care practitioners in the face of COVID -19

By Ahedor Jessica

Mary Eyram Ashinyo, Deputy Director of Quality Assurance at the Ghana Health Service

Hand hygiene (washing hand with soap and water, hand rub with ethanol and sanitizer) is one of the basic but critical procedures in infection prevention and control, IPC. Researchers have established that the hand is one of the fastest mediums by which human -to-human infection transmission happens.

As the human hand has continual contact with the environment on daily basis, it is also used to scratch the itching part of the body and serve the mouth with food and drugs, making it crucial to always keep the hand clean. But in Ghana, hand hygiene practices among health care practitioners remain a challenge.

In study by Alfred Edwin Dawson of University of Ghana, Department of Biostatistics and Community Health, the most commonly identified barriers to hand hygiene by health workers in Ghana is limited resources and lack of knowledge on times to perform hand washing or rubbing.

Published in the journal of infection in developing countries in 2015 on hand hygiene among health care practitioners reveal that hand hygiene resources were deficient in all 15 service centers studied. The results indicated that 9.2% to 57% of doctors and 9.6% to 54% of nurses complied with care -related hand hygiene practices.  Compliance however, improved when the perceived risk is high at the emergency and wound dressing/treatment rooms and labour wards. Except for the neonatal intensive care unit (NICU) where the highest level of compliance was recorded always among health workers in Ghana.

Charles Wills Kekeli, a medical practitioner at Greater Accra Regional Hospital in Accra, could relate to this phenomenon saying the unavailability of basic resources—water, soap, ethanol, sanitizers and gloves causes non-adherence. However, he admitted there are some level of negligence by health care practitioners whenever they perceive their level of exposure is of low risk category.  “Sometimes we perform sessions without gloves or performing hand hygiene because of unavailability of basic resources. Sometimes, too, we feel like our exposure to the patient will cause nothing.’’ As part of Global Hand Washing Partnership, “forming hand hygiene habits is being able to undertake the procedure in hand hygiene intrinsically without involving the decision-making parts of the brain.”

Mary Eyram Ashinyo, Deputy Director of quality Assurance at the Ghana Health Service, says health care systems must ensure strict adherence to monitoring and evaluation practices to enhance infection prevention and control. “We sense more risk now than ever among health care practitioners.  Managers and directors at the various levels of health care systems in the country must ensure best practices in hand hygiene; she said.”

However, faced with COVID-19 pandemic, where key resources for hand hygiene for hospitals in Ghana is readily available there is a shift in the protocol in hand hygiene practices—practitioners are more conscious.  

Elorm Hillary Otchi, a consultant at Africa Institute of Healthcare Quality, Safety and Accreditation in weighing the impact of COVID-19 says, hand hygiene has optimally increased among practitioners and they must sustain it. He urged government to empower local production of hand hygiene resources even beyond COVID-19. “One positive thing about the pandemic is that it has soared the local production of hand hygiene resources in the fight against the virus and it must be maintained.’’

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