Hand washing glove use, and avoiding recontamination before aseptic procedures at birth: A multicenter time-and-motion study conducted in Zanzibar

Giorgia Gon (Corresponding Author), Marijn de Bruin, Micheal de Barra, Said M. Ali, Oona M. Campbell, Wendy J. Graham, Mohammed Juma, Stephen Nash, Claire Kilpatrick, Loveday Penn-Kekana, Sandra Virgo, Susannah Woodd

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Objectives To assess the hand hygiene (HH) compliance before aseptic procedures among birth attendants in the10 highest-volume facilities in Zanzibar. We also examined the extent to which recontamination contributes to poor HH; recording exact recontamination occurrences is not possible using the existing World Health Organisation HH audit tool. Methods In this time-&-motion study, three trained coders used the WOMBATv2 software to record the hand actions of all birth attendants present in the study sites. The percentage compliance and 95% confidence intervals for individual HH behaviours and for behavioural sequences during labour and delivery were calculated. Results We observed 104 birth attendants and 781 HH opportunities before aseptic procedures. Compliance to hand rubbing/washing was 24.6% (CI:21.6-27.8). Only 9.6% (CI:7.6-11.9) also donned gloves and avoided glove recontamination. Half of the time when rubbing/washing or glove donning was performed, hands were recontaminated prior to the aseptic procedure. Conclusions In this study, HH compliance by birth attendants was poor before aseptic procedures. To our knowledge this is the first study in a LMIC to show the large contribution to poor HH compliance from hand and glove recontamination before the procedure. Recontamination is an important driver of infection risk from poor HH and should be understood for the purposes of improvement and therefore included in HH monitoring and interventions.
Original languageEnglish
Pages (from-to)149-156
Number of pages8
JournalAmerican Journal of Infection Control
Issue number2
Early online date4 Oct 2018
Publication statusPublished - Feb 2019



  • maternal health
  • newborn health
  • hand hygiene
  • behavioural medicine
  • labour ward
  • Tanzania
  • Hand hygiene
  • Behavioral medicine
  • Newborn health
  • Labor ward
  • Maternal health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Health Policy
  • Epidemiology

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