Improving attendant hand hygiene in the paediatrics department: a quality improvement initiative

Abstract

Background: Healthcare-associated infections remain a major cause of morbidity and mortality in paediatric inpatient settings. While hand hygiene interventions have traditionally focused on healthcare workers, patient attendants and caregivers represent a potential but under-addressed source of pathogen transmission. This project assessed whether a low-cost, behaviourally informed intervention could improve hand hygiene compliance among paediatric patient attendants in a tertiary-care hospital setting.

Methods: This prospective, before-and-after quality improvement initiative was conducted in paediatric wards of a government tertiary-care hospital in India. Baseline and post-intervention data were collected using brief, anonymized self-reported assessments of attendant hand hygiene behaviour. The intervention consisted of multilingual educational posters and improved access to alcohol-based hand sanitizer dispensers, implemented using plan–do–study–act cycles. The primary outcome was the proportion of attendants reporting sanitizer use before touching the child. Sanitizer consumption was monitored as a supporting process measure.

Results: At baseline, 47.7% (31/65) of attendants reported using sanitizer before patient contact. Following the intervention, compliance increased to 71.4% during the initial nursery-focused phase and was sustained after expansion to the entire paediatric ward, with pooled post-intervention compliance of 70.6% (137/194). The difference between pre- and post-intervention compliance was statistically significant. Ward-level sanitizer consumption increased progressively during the post-intervention period.

Conclusions: Improving access to hand hygiene resources combined with simple visual messaging was associated with sustained improvements in reported hand hygiene compliance among paediatric patient attendants.