"I have never seen any doctor washing hands." Barriers to Hand Hygiene Compliance of Healthcare Staff in Haemodialysis Units of South Africa

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"I have never seen any doctor washing hands." Barriers to Hand Hygiene Compliance of Healthcare Staff in Haemodialysis Units of South Africa

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Co-author 1

Siyanda A Ngema ngemasa@tut.ac.za Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa *

Co-author 2

Lwazi S Zwane Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 3

Thabiso L Bale balethabiso@gmail.com Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 4

Tendani S Ramukumba ramukumbats@tut.ac.za Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

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Introduction

Healthcare-associated infection (HAI) remains a significant threat to the safety of patients and healthcare staff. HAIs also cause a strain on healthcare systems globally. Hand hygiene remains a cornerstone of infection prevention and control (IPC) in healthcare settings globally. Despite the role HH plays in infection prevention, there is a paucity of qualitative studies exploring the practices and adherence of HH in dialysis environments. The current study explored healthcare workers' perceptions and practices regarding hand hygiene compliance in South African haemodialysis units.

Methods

A contextual, exploratory, descriptive, qualitative design was adopted for this study conducted in haemodialysis facilities in Gauteng, South Africa. Twenty-four purposive qualitative semi-structured interviews were conducted with dialysis nurses and clinical technologists. In total, all 24 interviews were analysed using thematic analysis to identify the perceptions, practices and views of participants regarding self-reported hand hygiene compliance and adherence until data saturation was reached. The validity of the data was assessed by two independent researchers examining the analysis process.

Results

Five themes emerged: (1) infrastructure barriers (cold water, insufficient supplies of gloves and aprons), (2) multidisciplinary teams’ non-compliance with hand hygiene protocols, (3) a knowledge-practice gap despite training, (4) workload and resource constraints leading to shortcuts, and (5) behavioural lapses where healthcare staff working in haemodialysis facilities substitute appropriate technique with quicker alternatives leading to non-adherence. Participants demonstrated awareness of correct hand hygiene practices; however, they acknowledged poor adherence due to environmental, organisational, and behavioural factors.

Conclusion

Although globally acknowledged as a core component of infection prevention and control, several factors contribute to hand hygiene compliance in haemodialysis units of South Africa. The haemodialysis units must pay attention to barriers preventing employees from complying with desired infection prevention measures. Improving hand hygiene compliance requires a multifaceted approach that addresses infrastructure challenges, hierarchical barriers to enforcing compliance across all healthcare staff levels, adequate staffing, and sustained behavioural change interventions beyond one-time training. Further research is required, and future interventional studies should involve implementing science and behaviour modification methods to better understand the challenges and facilitators of hand hygiene practices needed in haemodialysis units.

Kewords