Implementing a multifaceted framework for proprietorship of hand hygiene compliance in a network of South African hospitals – Leveraging the Ubuntu philosophy

Abstract Background Given the lack of hospital-wide ownership and shortage of nurses the ideal model for large-scale implementation of hand hygiene (HH) behaviour change (BC) in low-middle-income countries is unknown. Aim The aim of the multimodal strategy was to engender hospital accountability for HH compliance. Methods The quasi-experimental study was conducted in 50 South African hospitals (November 2015 - July 2017) and involved five overlapping phases: Executive governance and corporate BC, group-wide systematic situational analysis, development of an electronic-assisted direct-observed data collection and analysis application, launch and implementation and accountable governance. Measurement of intra- and inter-hospital variance to six HH opportunities was calculated and data compliance dashboards were emailed weekly to hospital leadership teams in order to provide feedback of recorded HH compliance and behaviour to frontline teams. Baseline comparison (July 2016) of compliance were compared versus post-implementation (July 2017). Results Baseline HH compliance of ≤ 60% was documented for 16% (8/50) of hospitals whilst overall, 48% (24/50) of hospitals demonstrated a significant improvement (p Conclusions Implementation of a multifaceted HH model in a large diverse group of SA hospitals translated into changes in the organizational systems and accountability, standardized HH compliance management and feedback that lead to HH proprietorship.