Healthcare workers’ perceptions of health worker-related interventions to improve compliance with hand hygiene recommendations for infection prevention and control in hospitalised neonates and infants in Sub-Saharan Africa: a synthesis of two qualitative evidence syntheses

Hand hygiene (HH) reduces infections in hospitalised neonates and infants. The benefits of HH may be compromised by poor compliance by healthcare workers (HCW). We carried out a synthesis of two qualitative evidence syntheses (QES) to explore HCWs' perceptions of interventions to improve HH compliance (HHC) by health workers to prevent infections in hospitalised neonates and infants in Sub-Saharan Africa. We identified one existing QES - Chatfield 2017 - but identified gaps related to settings, scope and date of last search. To address these gaps, we carried out a new QES focused on studies from secondary and tertiary hospitals in Sub-Saharan Africa, published since 2015. We searched CINAHL, Embase, PubMed and African Journals Online. We carried out a thematic analysis and applied GRADE-CERQual to assess our confidence in the findings. We thereafter developed a novel approach to synthesise the findings of the two QES, using the qualitative evidence domains of the GRADE Evidence-to-decision framework. Finally, we reassessed our confidence GRADEings for each synthesised finding. Our synthesis of QES encompasses 37 publications (35 from Chatfield and 2 from our QES). It highlights that HH training and education, and reminders and communication interventions are acceptable to HCWs. However, they feel that the content, scope and/or target audience of these interventions should be enhanced to improve HHC (e.g. to include all staff and practical training). Findings on the acceptability of audit and feedback interventions are mixed, suggesting variations across settings. Our synthesis also highlights key institutional and environmental factors that can enhance HHC interventions.