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GELA Infographic

EDCTP EU This project is part of the EDCTP2 programme
supported by the European Union
For policymakers

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  • Neonatal sepsis, in response to infections such as HAIs, is one of the leading causes of mortality in newborns and infants in low- and middle-income countries (LMICs).
  • The Global Burden of Disease (GBD) Study 2016/2017 estimated that 1.3 million annual incident cases of neonatal sepsis occur worldwide, which results in 203 000 sepsis-attributable deaths, while the estimated incidence of neonatal sepsis in LMICs was 2 824 cases per 100 000 live births in 2021.
  • Hand-hygiene is "a way of cleaning one’s hands that substantially reduces potential pathogens (harmful microorganisms) on the hands” (CDC, 2016). It is considered a vital procedure, especially in healthcare settings where it prevents the spread of infections among patients and healthcare providers.
  • Hand-hygiene practices are effective in reducing HAIs in hospitalised neonates and infants. The benefits of hand-hygiene may, however, be compromised by poor hand-hygiene compliance (HHC) by healthcare workers.

This recommendation applies to:

  • Doctors
  • Nurses
  • Other healthcare workers

We recommend implementing healthcare worker-related multi-component interventions to improve hand-hygiene compliance for infection prevention and control in hospitalised newborn and infants.

Strong recommendation

Benefits outweigh harms for almost everyone. All or nearly all informed patients would likely want this option.

Benefits

  • Hand-hygiene is a simple and effective way of preventing infections in newborns and infants.
  • These interventions increase the likelihood of hand-hygiene compliance.
       
 

Access to hand-hygiene training & education

  • The evidence suggests that healthcare professionals and other staff want more training on hand hygiene, delivered frequently, and also that training may not reach all the groups and settings that need it (training acceptability finding 1, low confidence).
  • It is likely that healthcare professionals and other staff in more remote facilities, and staff with lower levels of education (such as cleaners and hospital attendants), may have more difficulty accessing appropriate training.
  • They may therefore feel less empowered to contribute to infection prevention and control and to improve hand hygiene.

Hand-hygiene reminders and communication

  • The evidence suggests that reminders and posters are seen as useful by most health care workers (reminders acceptability finding 1, low confidence).
  • Health facilities or areas that have fewer resources may have challenges in implementing these interventions and this, in turn, may decrease adherence to hand-hygiene protocols. In addition, staff who speak minority languages or have low literacy levels may not benefit from reminders and posters that are not translated or adapted appropriately.
  • Hand-hygiene reminders are seen as less effective where more junior or non-clinical staff do not feel empowered to be role models or to remind more senior clinical or managerial staff, due to hospital hierarchies (reminders acceptability finding 2, low confidence).
  • This may particularly disadvantage staff categories, such as cleaners and hospital attendants, who may not feel empowered to remind senior clinical staff.

Hand-hygiene compliance monitoring and feedback

  • The acceptability of monitoring and feedback interventions may differ across types of staff or across regions (monitoring acceptability 1, very low confidence). For example, where facilities are very hierarchical, it is possible that junior staff, non-clinical staff or nurses who spend the most time on wards may feel that monitoring is a form of surveillance directed at them specifically. Some forms of electronic monitoring, such as the use of video cameras, may be less acceptable in some population groups.
  • In addition, where facilities are very hierarchical, useful data on compliance and healthcare-acquired infections may not be shared across all levels and categories of staff responsible for implementing good hand hygiene. This would affect their ability to act on and feel empowered by the data collected for monitoring.
Click here to see the full guideline and background evidence for the recommendation