# Impact of WHO multimodal strategy on hand hygiene in a Tunisian hospital: quasi-experimental study

## TL;DR

A study in a Tunisian hospital found that the WHO multimodal strategy slightly improved hand hygiene compliance but had no significant impact on healthcare workers' knowledge.

## Contribution

This study evaluates the WHO multimodal strategy's impact on hand hygiene in a Tunisian hospital using a quasi-experimental design.

## Key findings

- Hand hygiene compliance increased significantly from 19.9% to 23.6% after the intervention.
- Knowledge of healthcare-associated infection causes improved slightly but not significantly (34% to 40.3%).
- Compliance with optimal hand hygiene prerequisites slightly decreased, especially among physicians.

## Abstract

The World Health Organization (WHO) multimodal strategy is a globally recognized framework designed to improve hand hygiene (HH) knowledge and compliance among healthcare workers (HCWs). Aim: Assess efficacy of WHO multimodal strategy on healthcare workers’ knowledge and compliance on hand hygiene in a teaching hospital in Tunisia.

A quasi-experimental study with a pre- and post-intervention design was conducted. Baseline data were collected over 4 weeks, followed by a 3-month intervention period and a 4-week post-intervention assessment. To assess knowledge, a Validated WHO questionnaire was used on pre- and post-intervention (scores: 0–100%). To assess HH compliance, the WHO “Five Moments” framework observation was used. Chi-square tests evaluated categorical variables. A p-value <0.05 was considered statistically significant.

Knowledge of major causes responsible for healthcare associated infections passed from 34 to 40.3% (p= 0.19). Awareness of recommended duration of Alcohol-based hand rub or soap and water increased globally (41.8% vs. 49.3%, p=0.29). Concerning HH compliance, global rate significantly increased from 19.9 to 23.6% (p < 10–3). Whereas, the HH compliance rate with optimal respect of the prerequisites was marked by a slight drop overall (from 37.2 to 35.5%, p=0.12), and this drop was particularly noticeable among physicians (from 42.2 to 39.4%).

This study did not conclude on the efficacy of WHO HH strategy on HCWs knowledge. Whereas, a significantly increased HH compliance rate was globally observed.