. 2020 Dec 3;20:1116. doi: 10.1186/s12913-020-05925-9

Table 2.

Compliance estimates before aseptic procedures during labour or delivery

	Asp (2011) [18]	Buxton (2019) [19]	Changaee (2014) [20]	Cronin (1993) [21]	Danda (2015) [22]	Delaney (2017) [23]	Friday (2012) [24]	Gon (2018) [25]	Hoogenboom (2015) [26]	Mannava (2019) [27]	Phan (2018) [28]	Simbar (2008) [29]	Spector (2012) [30]	Tyagi (2018) [31]	Yawson (2013) [32]
1st Estimate
Outcome definition	Hand washing with soap or hand disinfection	Hand hygiene compliance before aseptic procedures. Hand washing with soap and new gloves applied without potential recontamination^c.	Unclear. Desirable hand washing. Estimated % was compliance with desirable status defined as 68–100% score. Unclear if soap necessary	Number of midwives who hand scrubbed with Dettol or soap and water	Whether each midwife washed her hands at least once. Unclear if with soap	Hand hygiene compliance measured by independent observers during non-intervention days. Hand washing with soap and water or alcohol rub	Unclear. Hand hygiene compliance at the facility level. Unclear if soap necessary and if handrub allowed.	Hand hygiene compliance before aseptic procedures. Steps included hand washing with alcohol-based hand rub or wash hands with soap and water, avoided recontamination and donning gloves^c.	Hand washing of at least one of the birth attendant present. Unclear if with soap	Hand hygiene compliance. Unclear if with soap	Hand hygiene compliance is the ratio of the number of performed actions to the number of opportunities. Presumably, soap & water or handrub necessary^c.	Hand washing; Unclear if with soap	Hands washed with clean water and soap, and clean gloves worn for admission vaginal examination. Proportion of each birth practice successfully delivered	Hand hygiene compliance. Hand washing with soap and water or waterless alcohol-based hand rub^c.	Hand hygiene compliance (% of times performed hand hygiene of all observed moments when required). Presumably, soap& water or handrub necessary^c.
Opportunity type	Before contact with patient during delivery	Before aseptic procedures during labour and delivery (including vaginal examination)	Second stage of labour; unclear if before or after what type of contact	Before delivery	Before procedures in the labour and postnatal ward	Before delivery	Before examining patients	Before aseptic procedures during labour and delivery	Before or after delivery	Before gloving for delivery	5 types of WHO hand hygiene opportunities in the delivery suite e.g. before patient contact	Second stage of labour; unclear if before or after what type of contact	Before delivery	Before delivery	Before aseptic/clean procedures in the labour and emergency room
Numerator	1	7	Unclear	0	14	374	30^a	75	15	300	142	Unclear	41^a	80^a	31^a
Denominator	52	201	Unclear	18	37	1027	63	781	20	371	507	Unclear	388	235	116
Compliance %	1.9%^a	4.0%	11.5%	0%^a	37.8%^a	36%	48%	9.6%	75.0%^a	81.0%	28.0%^a	< 20.0%^b	10.6%^a	34.0%	27.0%
N individuals	52 women	31 women	200 women	18 women	37 midwives	1277 deliveries	Unclear	104 birth attendants	20 women	371 women	Unclear	96 women	Unclear	235 deliveries	Unclear
N facilities	2	6	9	Unclear	2	15	63	10	1	101	1	2	1	35	1
Cadre/ intervention	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	Before the intervention	NA	Before the intervention	NA	Doctors
2nd Estimate
Outcome definition		As above		Hands were washed; unclear if with soap			As above			As above			As above	As above	As above
Opportunity type		Before vaginal examination		Before wound care for episiotomy and vaginal tears			Before putting on gloves			Before touching delivery area surfaces and equipment			Before vaginal examination	Before per-vaginal examination	Before aseptic/clean procedures in the labour and emergency room
Numerator		6		4			32^a			289			5.3^a	92^a	4^a
Denominator		121		4			63			371			405	242	18
Compliance %		5.0%		100%^a			51.0%			78.0%			1.3%	38.0%	21.2%
N individuals		31 women		4 women			Unclear			371 women			Unclear	Unclear	Unclear
N facilities		6		Unclear			63			101			1	35	1
Cadre/intervention		NA		NA						NA			Before the intervention	NA	Nurses
3rd Estimate
Outcome definition				Hands were washed; unclear if with soap
Opportunity type				Cord care; unclear if before/after
Numerator				9
Denominator				22
Compliance %				40.9%^a
N individuals				22 newborns
N facilities				Unclear
Cadre/intervention				NA

^aEstimates imputed by systematic review author

^bLess than 20% was considered a level that is “not acceptable”. No exact estimate provided – estimated from Fig. 1 of Simbar et al.

^cFollowed WHO guidelines 2009 “WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care is Safer Care” or “Hand Hygiene Technical Reference Manual”