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

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