J Prim Care Gen Pract 2018 Volume 1 Issue 1 8 http://www.alliedacademies.org/journal-primary-care-general-practice/ Research Article Background Hospital acquired infections (HAIs) are a major and growing concern for health care workers (HCWs) and the patients they treat [1]. HAIs affect 5% to 15% of inpatients of regular wards, and up to 50% in intensive care units in developed countries [1]. A systematic review reported the prevalence of HAIs in developing countries at 15.5 per 100 patients, a higher proportion than in developed countries [2]. The presence of pathogenic bacteria in health settings puts both the patient and HCW at risk of serious illness and even possible death [3]. The World Health Organisation (WHO) has produced universal guidelines on HAI reduction which emphasise the practice of hand hygiene among others [4,5]. However, due to insuffcient fnancing, overcrowding and shortage of HCWs, urban health facilities in lower income countries face challenges in operationalising these guidelines, and Zambia is not an exception [6,7]. Hand hygiene (HH) involves the use of water and soap or alcohol-based hand rub or any other product, to prevent the transmission of infections from one person to the other [8]. HAIs among HCWs and patients. The WHO encourages HCWs to practice hand hygiene at fve key times, including before touching a patient, after body fuid exposure and after touching the patient [5]. While complete compliance with hand hygiene guidelines is the ideal, actual rates remain low [9]. For example, at a teaching hospital in Ghana, a cross sectional observational study across 15 service provision points was performed for a period of three weeks to explore HH compliance amongst HCW. The study reported 9-54% HH compliance among doctors and 10-57% among nurses [10]. Barriers to HH practices in developing countries often include limited availability of soap and water, busy work schedule, forgetfulness and the continuous use of gloves [11,12]. In Zambia, little is known about HH practice among HCW in hospital/clinic settings. However, this is important as other studies have shown that microbiological contamination is high [13] and there is relatively limited awareness on infection prevention [14]. Understanding HH determinant factors in a low-income country like Zambia, provides a basis for intervention development in similar health care settings globally. This study quantifed HH practice and explored its determinants qualitatively using the framework provided by Behaviour Centred Design (BCD). The BCD framework explains Objective: Hand washing with soap and regular application of hand sanitising gel are simple and effective methods for reducing transmission of hospital acquired infections (HAIs) in health settings. However, such practices are generally poor amongst health care workers (HCW) globally. This study documents hand hygiene practices and their determinants amongst HCWs in four peri-urban health facilities in Zambia. Methods: Eighteen observation sessions, nine semi-structured interviews and three focus group discussions with health care providers in four high patient-load public health facilities were conducted. Framework analysis helped identify predominant themes which were pre-categorised using the determinants provided by the Behaviour Centred Design (BCD) framework. Results: Of the 780 hand hygiene opportunities observed across all four health facilities, HCWs washed their hands with soap only 8 times (1%). Hand washing was especially motivated by the fear of infection with apparently, or potentially, infectious patients and especially of more deadly conditions like cholera. Barriers included the large patient load which heightened HCWs’ sense of urgency and fairness in seeing clients quickly rather than spending time washing hands and, the discomfort of standing up to reach the hand washing station. Limited, inconveniently located or broken sinks and the absence of soap were additional barriers to hand washing with soap. Conclusions: A holistic approach including communication on risk to patients, provision of hardware, resource allocation for hand hygiene and regular monitoring of hand hygiene practices are all needed to address barriers to good practice. Abstract An observational study of hand hygiene behaviours among healthcare workers in four peri-urban health facilities in Zambia Jenala Chipungu 1* , Isabel Scott Moncrieff 2 , Lavuun Verstraete 3 , Nicolas Osbert 3 , Swathi Manchikanti 3 , Cheryl Rudd 1 , Val Curtis 2 , Roma Chilengi 1 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia 2 London School of Hygiene and Tropical Medicine, London, UK 3 United Nations International Children’s Education Fund (UNICEF) Zambia Accepted on May 17, 2018 Keywords: Hand hygiene, hospital acquired infections, behaviour centred design, health care workers, health facilities.