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The Global Handwashing Partnership

Clean hands are your health: Working for better hand hygiene at Hospital de Barillas

Published: March 18, 2019

Selyvn Rafael Mérida Reyes is in charge of maintenance at the Hospital de Barillas in Huehuetenango, Guatemala, where he has worked for the last six years. He graduated from the Colegio Mixto Asturias in Huehuetenango, Guatemala, where he focused on community development. His work at the hospital started as primarily a source of income, but
Selvyn grew to enjoy working in the hospital, and has contributed to improving hand hygiene as a way to help and serve the community.

At the Hospital de Barillas, Selvyn took part in training from the Ministry of Governance and Ministry of Health. Many of these included charlas, or small training sessions that took place during the course of the normal work day. Selvyn learned that, “when one doesn’t wash their hands, they can get fall ill to certain diseases like amoebas and worms.” He connected this with the poor health outcomes and behaviors he saw in the hospital staff and patients.
He and other hospital staff saw that these illnesses were occurring and wanted to know why. They realized that it was in part due to a lack of proper hand hygiene – that they didn’t wash their hands very well, they had long fingernails, etc. – and began to understand this problem and consider how they could fix it.

Starting a multidisciplinary committee for hand hygiene

Selvyn’s hospital is participating in the USAID Maternal Child Survival Program’s Clean Clinic Approach. The Clean Clinic Approach works with national ministries of health to develop criteria for water, sanitation, and hygiene. By achieving these criteria, health facilities can attain “Clean Clinic” status. Team at individual facilities work to make incremental progress toward Clean Clinic status.

After beginning work with the Clean Clinic Approach, Selvyn was introduced to the importance of proper hand hygiene and how to properly clean hands. These trainings inspired the hospital to increase their focus on hand hygiene. Previosly, they had a few few charlas but did not focus much on hand hygiene.

After the training, Selvyn and his colleagues formed a committee to focus on improving hand hygiene. The committee was comprised of staff from different units (doctors, nurses, maintenance, administration, etc.). This committee leads the hand hygiene initiative and meets monthly.

One of the committee’s first activities was to hold a charla on hand hygiene. Instead of starting with a lecture on hand hygiene, they started with a refacción, a refreshment that is commonly served before meetings in Guatemala. It was easy to see who came and started eating their refacción without washing their hands. This was the perfect opportunity to encourage staff to consider their own hand hygiene practices, and to start a discussion on proper hand hygiene.

The committee talked about the consequences of eating with dirty hands, and the fact that everyone has room for improvement when it comes to hand hygiene. Selvyn and the committee members then reviewed the steps of handwashing, and critical times when hands should be cleaned. Some of the staff did not already know this information. The committee placed reminders on the steps of handwashing at handwashing stations around the hospital.

When the project began, many of the staff was closed off to a handwashing regimen. People washed their hands with soap, but washed very quickly. Many had long fingernails and did not wash thoroughly enough to clean under their nails.

At the start, the committee received some push back from hospital staff. For example, some felt the nine-step process was too much, and they wanted to continue washing their hands quickly with soap. Others did not want to collaborate in the efforts. However, the committee continued their work. The has given eleven charlas to all 94 hospital staff members. At the beginning, they separated staff by responsibilities (doctors, nurses, administration, kitchen, maintenance, drivers, laundry) for charlas in order to have smaller groups so people can understand the messages. Later on, staff were mixed together so everyone could see how their behaviors affect other departments.

The committee established a policy that all hospital staff had to wash their hands properly, to help raise awareness. This was not limited to clinical staff – Selvyn and the committee also considered the important role of food hygiene in patient care. “For example, in the kitchen, women had long fingernails [and only washed quickly with soap]. We began to say that it was bad hygiene to prepare the food like this. They understood and now they cut their fingernails, and follow the nine steps for washing their hands – before preparing food, they wash their hands well, and then they begin to prepare patients’ food.”

Progress at Hospital de Barillas

Prior to implementing the Clean Clinic Approach, Selvyn was not aware of the basic behaviors that were lacking among hospital staff. Through his work, he learned that there is a process of decontamination before working at the clinic. He also learned more about overall personal hygiene, such as when you are in contact with sick people and before eating meals, and that it is important to have a formal process and set routine for washing your hands.

Despite some initial hesitancy from staff, Selvyn has noticed big improvements. After the project was introduced and trainings began, patients came into the hospital and saw staff with clean hands. Although the hospital does not have statistics on the potential health impact of these changes, they have seen major progress in behavior, and Selvyn noticed a difference in people’s attitudes. Selvybn says, “We saw the worst outcomes, but this project has helped us a lot and now colleagues haven’t gotten sick from as many infectious diseases. There’s less contamination now, like when entering the clinic, before leaving the clinic, and after using the bathroom.”

Out of the eleven hospitals working with USAID on the Clean Clinic Approach in Guatemala, Hospital de Barillas has advanced from a 7th place ranking to 4th place. This assessment was based on the quality of hand hygiene in the hospital. They are currently awaiting results from their latest evaluation, where they received preliminary feedback about very good work. Selvyn is extremely proud of what the hospital is accomplishing in hand hygiene.

Continuing and expanding the project

The committee is already thinking about the long-term goals for hand hygiene at Hospital de Barillas. The committee has started planning how many charlas to hold each year in order to continue and reinforce handwashing practices. Selvyn says, “We’ll continue these charlas. It doesn’t matter if they [the staff] get bored, but I won’t get bored and will keep teaching until they know it well.” They also plan to hang posters at each sink around the hospital that have the nine steps for handwashing with drawings, to keep staff aware.

Selvyn and the committee have hopes to expand the project outside of the hospital. They have had conversations with different institutions in the area about the possibility of doing charlas at schools, to teach children of different ages how to wash their hands. Planning within the committee will continue on how to educate different schools and institutes about hand hygiene on a larger scale.

Selvyn closed with advice for others trying to improve hand hygiene. He believes it is a fundamental base to preventing illness in the hospital. The first step is to form a committee, because with no formal committee, there will be no progress. The snack exercise is also a great way to start the conversation, with a creative way to show clear evidence of who washes their hands before eating. He encourage others to get involved – while the outcomes of improved hand hygiene will not be 100%, you can prevent many health problems just by washing your hands.

Editorial Note: This post was written and translated by Allison Elkins. To view the case study in Spanish, click here.

Photos courtesy of Selvyn Merida.

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