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Open AccessArticle

Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards

London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK
University of Kent, Higher Education Access Tracker, Catenrbury CT2 7NZ, UK
Department of Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
Public Health Laboratory-Ivo de Carneri, Chake Chake, Pemba, Zanzibar 9820, Tanzania
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, 6525 GA Nijmegen, The Netherlands
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(4), 1438;
Received: 21 January 2020 / Revised: 18 February 2020 / Accepted: 19 February 2020 / Published: 24 February 2020
(This article belongs to the Section Health Care Sciences & Services)
Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately. View Full-Text
Keywords: hand hygiene; determinants; birth hand hygiene; determinants; birth
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Gon, G.; Virgo, S.; de Barra, M.; Ali, S.M.; Campbell, O.M.; Graham, W.J.; Nash, S.; Woodd, S.L.; de Bruin, M. Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards. Int. J. Environ. Res. Public Health 2020, 17, 1438.

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