Tackling Hand Hygiene in Roatán, Honduras

By Alexis Stanley, IGHS master’s student

May 5, 2019 marks World Hand Hygiene Day, an effort of the WHO Clean Care for All–It’s in Your Hands and CDC Clean Hands Count campaigns to stimulate engagement around “clean care for all” and quality “health for all.” This day is geared towards improving healthcare provider adherence to hand hygiene recommendations.

Alexis Stanley
Alexis Stanley

Hand hygiene is considered the cornerstone of infection control and prevention, a vital and practical approach with demonstrated impact on patient safety and quality of care for any health system. Cleaning one’s hands can substantially reduce potential pathogens being spread among patients and health care personnel.

According to a recent report released by UNICEF and World Health Organization, WASH in Health Care Facilities, 1 in 4 health care facilities do not have basic water services, impacting around 2 billion people globally. The report also finds that 1 in 5 health care facilities have no sanitation service, which impacts 1.5 billion people.

This UNICEF/WHO Joint Monitoring Program for Water Supply, Sanitation and Hygiene (JMP) report, the first comprehensive global assessment of water, sanitation, hygiene (WASH) in health care facilities, also found many health centers lack basic infrastructure for hand hygiene and safe separation and disposal of health care waste. These services play a critical role in preventing healthcare-associated infections, reducing the spread of antimicrobial resistance and providing safe, quality care for patients.

But when water access and the availability of alcohol-based hand sanitizing solutions are out of reach in resource-strained settings, how are these health facilities expected to meet these infection control recommendations and guidelines?

My master’s capstone research project at Public Hospital Roatán may begin to provide some answers to these questions.

Last month at Public Hospital Roatán, all six sinks within the hospital had no running water for close to 28 days. The hospital is located on the island of Roatán, the largest of the Bay Islands of Honduras approximately 30 miles off the coast of the mainland in the Caribbean Sea. The island sits along the Mesoamerican Barrier Reef System, the second largest barrier reef in the world, and the local economy relies heavily on fishing and tourism. Each year, hundreds of thousands of tourists visit the Bay Islands on cruise ships. Despite the steady flow of tourism on the island, a large sector of the population cannot consistently afford bottled water, electricity and other basic necessities.

Public Hospital Roatán is the only public hospital on the island for a population of around 50,000 inhabitants. As Honduras’ smallest medical district, the Bay Islands receive the smallest allotment of government health care funding, and the 30-mile geographical separation from specialty centers on the mainland exacerbate health issues. The approximately 140 health care providers at the hospital will be the target population for my research.

In collaboration with Berkeley-based nonprofit Global Healing, the implementation of an infection control educational training program was introduced at Public Hospital Roatán in fall 2018. This new educational awareness and training program is led by Honduran infectious disease specialist Dr. Elham Mandegari, who facilitates both the didactic and practical infection control modules for hospital staff. I will be working under the supervision of Dr. Mandegari in the program’s post-training assessment and initial evaluation phase.

My capstone research aims to assess the impact of an educational intervention on the rates of hand hygiene compliance among healthcare providers at Public Hospital Roatán through quantitative and qualitative components. I feel fortunate for the opportunity to work and connect with the community my family has ties to on the island. My paternal great grandmother was born in Roatán and my father grew up in the nearest mainland port city of La Ceiba. I look forward to connecting with healthcare providers at Public Hospital Roatán to gain better insight into how hand hygiene is being practiced and observe the daily reality of what is available within this setting.

Check out Alexis Stanley’s takeover of our Instagram May 6 to 10 to learn more about her research.