Introduction

This tutorial addresses hand hygiene in neonatal units, forming part of our quality improvement initiative to reduce neonatal sepsis.Neonatal sepsis is a major cause of death in newborns across Africa—most of it is hospital-acquired and preventable. The most effective and affordable method to reduce these infections is proper hand hygiene by healthcare workers.

Why It Matters

• Approximately 300,000 newborns die each year in Africa from neonatal sepsis.
• Around one-third of all neonatal deaths are due to sepsis.
• In nearly all cases, the source of infection is the hospital environment, particularly healthcare workers’ hands.
• Although mothers are often blamed, data shows that the primary risk comes from us—the staff and the equipment we use.

How Infections Spread

Pathogens move from:

• Contaminated surfaces (e.g. incubators, beds, desks, stethoscopes, door handles)
• Contaminated body fluids (e.g. faeces, blood)
• One baby to another, via healthcare workers’ hands

Even the clean-looking surfaces in a busy neonatal unit are often colonised by pathogenic bacteria. Once these bacteria enter the baby's body—especially through IV lines, respiratory support, or skin breaks—they can cause severe infection.

Preventing Transmission: Core Methods

When to Clean Hands

• On entry to the neonatal unit: wash with soap and water
• After using the bathroom, handling nappies, or exposure to bodily fluids: wash hands
• On entry to a cubicle: use alcohol or chlorhexidine rub
• Before touching a baby: use hand rub
• After touching a baby: use hand rub

The last thing your hands touch before a baby should be hand rub.
The first thing after touching a baby should be hand rub again.\

Avoid touching contaminated surfaces (e.g. stethoscopes, incubators) after sanitising and before patient contact.

Gloves

Even when we use gloves, we must still practice hand hygiene before putting the gloves on- and after taking them off. This is very important. Do not think that because you wore gloves, you don’t need to clean your hands.

Evidence of Impact

A well-run hand hygiene program in Ghana led to a 73% reduction in neonatal sepsis deaths.This level of impact shows how critical hand hygiene is—it is the cheapest, simplest, and most effective intervention we can offer.

What Else Needs to Happen

• Ensure soap, water, and disposable towels are always available
• Ensure hand rub (alcohol or chlorhexidine) is available at:
          -Every cubicle entrance
          -Every baby’s bedside
• Build a culture of accountability:
          -Practice hand hygiene even when tired, busy, or alone
           -Remind each other kindly, regardless of hierarchy
          -A cleaner should be empowered to remind a senior clinician—or even a minister—to sanitise their hands

Our Goal

We aim for >90% compliance with hand hygiene protocols. Once this target is consistently achieved, we can move to the next stage in our campaign against neonatal infections.

Final Thoughts

This is not just a policy—it is a matter of life and death. We have the power, with our own hands, to either cause harm or protect life.Let’s choose wisely, consistently, and together.
Here are some links….WHO how to wash hands…https://www.youtube.com/watch?v=IisgnbMfKvI