#44: Hand Hygiene during the COVID-19 Pandemic in Three Pediatric Oncology Units in Hispaniola Island
Authors: Gassant Pascale Yola , Fleury Marie Immacula , Santana Genara , Gil María Dolores , Morel Manauri H , Contreras Johanny , Rivera Karina , Castillo María , Happ Brooke , Vázquez Milka , Homsi Maysam R , Caniza Miguela A 
Published: June 2021

Abstract

Background
Hand hygiene (HH) is a basic measure to prevent the spread of infections in healthcare settings. We describe HH practices and resources in three pediatric oncology units (POUs) in Haiti and the Dominican Republic that comprise the Hispaniola Project (HP1: Santiago; HP2: Santo Domingo; HP3: Port-au-Prince). This project, started in January 2019, is a quality improvement initiative in infection care and prevention in pediatric oncology. The POUs are main referral centers for pediatric oncology on the island, HP1 (24 inpatient beds) and HP2 (18 beds) are housed within large public pediatric hospitals; HP3 (17 beds) is housed in a mother/child hospital.

Methods
Data related to HH resources and practices are intermittently collected as part of ongoing surveillance activities at Hispaniola Project sites; standardized data collection forms track infrastructure, supplies, compliance, and training. At regular intervals, the POUs conduct the World Health Organization (WHO) hand hygiene self-assessment framework (HHSAF) to assess the level (inadequate, basic, intermediate, advanced) of their units. Additionally, the POUs monitor HH compliance indirectly via alcohol gel (AG) consumption in liters, measured monthly. HP1 and HP3 also use direct observation to monitor HH compliance.

Results
From baseline to September 2020, the WHO HHSAF scores increased from 65 (Inadequate) to 210 (Intermediate) at HP1, 260 (Intermediate) to 363 (Intermediate) at HP2, and 260 (Intermediate) to 270 (Intermediate) at HP3. Despite constraints imposed by COVID-19, all 3 participating POUs remained at the intermediate level (scoring 260–375). HH infrastructure, including the sink:bed and AG:patient ratios remained stable from January 2020 to present. The AG:patient ratios were 1:3, 1:1 and 10:13 at HP1, HP2, and HP3 respectively. The sink:bed ratios were 1:6, 1:5 and 5:13 at HP1, HP2 and HP3 respectively. Indirect compliance (AG consumption) was first measured in January 2020 at HP1 and has remained relatively stable from June to present. At HP2, AG consumption increased from January to February but decreased throughout the year due to lack of AG which was replaced by soap and water. AG consumption at HP3 increased from January to March, with some variation throughout the year but generally at higher levels than in 2019. Direct HH observation data are limited; however, an increased number of observations at HP1 and increased compliance rates were noted for HP1 and HP3 between January and September 2020. As the pandemic emerged, all 3 POUs increased training of staff, patients, and caretakers. Between January and April, 8 training sessions were held for 349 attendees including 235 healthcare workers (HCWs) at HP1; 13 sessions were held for 443 attendees including 61 HCWs at HP2; 15 sessions were held for 288 attendees including 87 HCWs at HP3. Since these early efforts, a smaller number of sessions with fewer attendees have been held.

Conclusion
During the COVID-19 pandemic, the importance of HH practice was reinforced for HCWs, patients, and caretakers. As organizations and individuals, it is essential to ensure the continuation and sustainability of HH improvement as a strategy to ensure safe healthcare even after the threat of COVID-19 has subsided.