Research Article: Hands washing, glove use, and avoiding recontamination before aseptic procedures at birth: A multicenter time-and-motion study conducted in Zanzibar

Date Published: February 1, 2019

Publisher: Mosby

Author(s): Giorgia Gon, Marijn de Bruin, Mícheál de Barra, Said M. Ali, Oona M. Campbell, Wendy J. Graham, Mohammed Juma, Stephen Nash, Claire Kilpatrick, Loveday Penn-Kekana, Sandra Virgo, Susannah Woodd.


•To our knowledge, this is the first study to systematically examine recontamination after hand hygiene in a low- and middle-income country.•Hand hygiene compliance before aseptic procedures was low (9.6%) among birth attendants in Zanzibar.•Birth attendants did not avoid recontamination half of the time after hand rubbing/washing or glove donning.•Recontamination should be investigated further to inform better behavior-change strategies.

Partial Text

Anonymized data at the opportunity level are available in Appendix F, from

In this time-and-motion study of 104 birth attendants across the 10 highest-volume labor wards in Zanzibar, we observed 781 HH opportunities before aseptic procedures. Compliance with hand rubbing/washing occurred in a quarter of opportunities, but in only 9.6% of opportunities attendants also donned gloves and avoided hand and glove recontamination before the procedure, in accordance with WHO guidelines.16 Half the time, attendants either rubbed/washed hands or donned gloves that they subsequently touched unclean surfaces with, thus potentially recontaminating their hands and contributing substantially to poor HH compliance. The variation in behavior was much larger within individuals than between individuals, suggesting that these behaviors are not habitual.

We thank the Ministry of Health of Zanzibar for their participation and engagement in this study. A special thanks to Rukaiya M. Said, Mwanafatima Ali Mohammed, Bijuma Mkubwa Abdallah, and Asya Hati Vuai who collected all the data. We also thank Marina Daniele for participating in the consultation exercise aimed at refining the definition of opportunity. Finally, we thank Daniel Powell and David Macleod for their support in data management.




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