Reducing post-cesarean wound infection at Muhororo Hospital by increasing hand hygiene practice

Post-cesarean wound infection (PCWI) is a common post-operative complication that can negatively affect patients and health systems. Poor hand hygiene practice of health care professionals is a common cause of PCWI. This case study aims to describe how strategic problem solving was used to introduce an alcohol-based hand rub in a district hospital in Rwanda to improve hand hygiene compliance among health care workers and reduce PCWI.

Pre- and post-intervention study design was used to address the poor hand hygiene compliance in the maternity unit. The hospital availed an alcohol-based hand rub and the team provided training on the importance of hand hygiene. A chart audit was conducted to assess the PCWI, and an observational study was used to assess hand hygiene compliance.

The intervention successfully increased hand hygiene compliance of health care workers from 38.2 to 89.7 per cent, p < 0.001, and was associated with reduced hospital-acquired infection rates from 6.2 to 2.5 per cent, p = 0.083.

This case study describes the implementation process of a quality improvement project using the eight steps of strategic problem solving to introduce an alcohol-based hand rub in a district hospital in Rwanda. The intervention improved hand hygiene compliance among health care workers and reduced PCWI using available resources and effective leadership skills.

The results will inform hospitals with similar settings of steps to create an environment that enables hand hygiene practice, and in turn reduces PCWI, using available resources and strategic problem solving.