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Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review

Ataiyero, Yetunde; Dyson, Judith; Graham, Moira


Yetunde Ataiyero

Judith Dyson

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Dr Moira Graham
Lecturer in Public Health / Graduate Research Director in the School of Health and Social Work


Background: Hand hygiene (HH) is the primary measure in the prevention of healthcare associated infections though from published studies,compliance of healthcare workers to HH guidelines is low. There is currently no review on HH compliance rate in developing countries,specifically Sub-Saharan Africa (SSA) or the barriers to compliance. We therefore, through a narrative review sought to identify HH compliance rate and the barriers to compliance in SSA region. Methods:From three databases,we performed a systematic search of peer-reviewed studies from SSA,conducted among healthcare workers,published in English language and between 2005 and 2017.Only studies that reported HH compliance and/or barriers were included. Results:A total of 278 articles were identified and final sample of 27 analyzed in full length.Overall HH compliance rate was 21.1% and doctors had better compliance irrespective of the type of patient contact.The main barriers identified were heavy workload, infrastructural deficit (e.g. lack of water, soap and hand sanitizers) and poorly positioned facilities. Conclusion: HH compliance is poor among SSA healthcare workers.There is need for more reports of HH compliance in SSA and studies need to report the process of observation to allow replication of methods.Barriers identified in this review are consistent with the findings of studies conducted elsewhere however it appears that heavy workload, infrastructural deficit and poorly positioned facilities are more likely in developing countries.


Ataiyero, Y., Dyson, J., & Graham, M. (2019). Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. American Journal of Infection Control, 47(5), 565-573.

Journal Article Type Article
Acceptance Date Oct 1, 2018
Online Publication Date Nov 20, 2018
Publication Date 2019-05
Deposit Date Nov 6, 2018
Publicly Available Date Oct 27, 2022
Print ISSN 0196-6553
Electronic ISSN 1527-3296
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 47
Issue 5
Pages 565-573
Keywords Hand hygiene; Barriers; Facilitators; Sub-Sahara Africa; Healthcare Workers
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