Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-03T00:45:27.484Z Has data issue: false hasContentIssue false
  • English
  • Français

Successful Implementation of the World Health Organization Hand Hygiene Improvement Strategy in a Referral Hospital in Mali, Africa

Part of: WILLIAM JARVIS AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Benedetta Allegranzi ,
Hugo Sax ,
Loséni Bengaly ,
Hervé Riebet ,
Daouda K. Minta ,
Marie-Noelle Chraiti ,
Fatoumata Maiga Sokona ,
Angele Gayet-Ageron ,
Pascal Bonnabry  and
Didier Pittet
...Show all authors
Benedetta Allegranzi
Affiliation:
World Health Organization Patient Safety, Geneva, Switzerland
Hugo Sax
Affiliation:
World Health Organization Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Loséni Bengaly
Affiliation:
Hôpital du Point G, Bamako
Hervé Riebet
Affiliation:
World Health Organization Patient Safety, Geneva, Switzerland
Daouda K. Minta
Affiliation:
Hôpital du Point G, Bamako
Marie-Noelle Chraiti
Affiliation:
World Health Organization Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Fatoumata Maiga Sokona
Affiliation:
World Health Organization Office in Mali, Bamako
Angele Gayet-Ageron
Affiliation:
University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Pascal Bonnabry
Affiliation:
University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Didier Pittet*
Affiliation:
World Health Organization Patient Safety, Geneva, Switzerland World Health Organization Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland(didier.pittett@hcuge.ch)
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country.

Design.

A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention.

Setting.

University Hospital, Bamako, Mali.

Participants.

TWO hundred twenty-four healthcare workers.

Methods.

The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up.

Results.

Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P < .001). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly (P < .05), and perception surveys showed a high appreciation of each strategy component by staff.

Conclusions.

Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 2 , February 2010 , pp. 133 - 141
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.World Health Organization. WHO guidelines for hand hygiene in health care. Geneva: World Health Organization, 2009.Google Scholar
2.Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381–386.CrossRefGoogle ScholarPubMed
3.O'Boyle, CA, Henly, SJ, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am J Infect Control 2001;29:352–360.CrossRefGoogle ScholarPubMed
4.Pittet, D. The Lowbury lecture: behaviour in infection control. J Hosp Infect 2004;58:1–13.CrossRefGoogle ScholarPubMed
5.Pittet, D, Simon, A, Hugonnet, S, Pessoa-Silva, CL, Sauvan, V, Perneger, TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004;141:1–8.CrossRefGoogle ScholarPubMed
6.Pessoa-Silva, CL, Posfay-Barbe, K, Pfister, R, Touveneau, S, Perneger, TV, Pittet, D. Attitudes and perceptions toward hand hygiene among healthcare workers caring for critically ill neonates. Infect Control Hosp Epidemiol 2005;26:305–311.CrossRefGoogle ScholarPubMed
7.Ahmed, QA, Memish, ZA, Allegranzi, B, Pittet, D. Muslim health-care workers and alcohol-based handrubs. Lancet 2006;367:1025–1027.CrossRefGoogle ScholarPubMed
8.Whitby, M, Pessoa-Silva, CL, McLaws, ML, et al.Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007;65:1–8.CrossRefGoogle ScholarPubMed
9.Sax, H, Uckay, I, Richet, H, Allegranzi, B, Pittet, D. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol 2007;28:1267–1274.CrossRefGoogle ScholarPubMed
10.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.Google Scholar
11.Lam, BC, Lee, J, Lau, YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114:e565–e571.CrossRefGoogle Scholar
12.Won, SP, Chou, HC, Hsieh, WS, et al.Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004;25:742–746.CrossRefGoogle Scholar
13.Johnson, PD, Martin, R, Burrell, LJ, et al.Efficacy of an alcohol/chlor-hexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183:509–514.CrossRefGoogle Scholar
14.Harrington, G, Watson, K, Bailey, M, et al.Reduction in hospitalwide incidence of infection or colonization with methicillin-resistant Staphylococcus aureus with use of antimicrobial hand-hygiene gel and statistical process control charts. Infect Control Hosp Epidemiol 2007;28:837–844.CrossRefGoogle ScholarPubMed
15.Pessoa-Silva, CL, Hugonnet, S, Pfister, R, et al.Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics 2007;120:e382–e390.Google Scholar
16.Grayson, ML, Jarvie, LJ, Martin, R, et al.Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful state wide roll-out. Med J Aust 2008;188:633–640.CrossRefGoogle Scholar
17.Pittet, D, Donaldson, L. Clean care is safer care: a worldwide priority. Lancet 2005;366:1246–1247.CrossRefGoogle Scholar
18.World Health Organization. The Global Patient Safety Challenge 2005-2006 “Clean Care is Safer Care.” Geneva: World Health Organization, 2005. Available at: http://www.who.int/patientsafety/events/05/GPSC _Launch_ENGLISH_FINAL.pdf. Accessed August 10, 2009.Google Scholar
19.Allegranzi, B, Pittet, D. Healthcare-associated infection in developing countries: simple solutions to meet complex challenges. Infect Control Hosp Epidemiol 2007;28:1323–1327.CrossRefGoogle ScholarPubMed
20.World Health Organization. Implementation Toolkit. Available at: http://www.who.int/gpsc/5may/tools/en/index.html. Accessed August 10,2009.Google Scholar
21.Pittet, D, Allegranzi, B, Storr, J. The WHO Clean Care is Safer Care programme: field-testing to enhance sustainability and spread of hand hygiene improvements. J Infect Public Health 2008;1:4–10.CrossRefGoogle ScholarPubMed
22.World Health Organization Statistical Information System (WHOSIS). Available at: http://www.who.int/whosis/en/index.html. Accessed August 10, 2009.Google Scholar
23.European Directorate for the Quality of Medicines and Healthcare. Relative density. In: European Pharmacopeia. 5th ed. Strasbourg: Council of Europe; 2005:28–29.Google Scholar
24.European Directorate for the Quality of Medicines and Healthcare. Alcohol measurement tables. In: European Pharmacopeia. 5thed. Strasbourg: Council of Europe; 2005:553–564.Google Scholar
25.Macchia, T, Mancinelli, R, Gentili, S, Lugaresi, EC, Raponi, A, Taggi, F. Ethanol in biological fluids: headspace GC measurement. J Anal Toxicol 1995;19:241–246.Google Scholar
26.European Directorate for the Quality of Medicines and Healthcare. Microbiologic control of non-sterile products: viable total aerobic colony counts. In: European Pharmacopeia. 5th ed. Strasbourg: Council of Europe; 2005:175–181.Google Scholar
27.Sax, H, Allegranzi, B, Chra'iti, M-N, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009 (in press).Google Scholar
28.Sax, H, Uçkay, I, Larson, E, Boyce, J, Pittet, D. “My five moments for hand hygiene”—a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.Google Scholar
29.Pittet, D, Harbarth, S, Ruef, C, et al.Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 1999;20:37–42.CrossRefGoogle ScholarPubMed
30.Sax, H, Hugonnet, S, Harbarth, S, Herrault, P, Pittet, D. Variation in nosocomial infection prevalence according to patient care setting: a hospital-wide survey. J Hosp Infect 2001;48:27–32.CrossRefGoogle ScholarPubMed
31.Sax, H, Pittet, D. Interhospital differences in nosocomial infection rates: importance of case-mix adjustment. Arch Intern Med 2002;162:2437–2442.Google Scholar
32.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Ara J Infect Control 2008;36:309–332.Google Scholar
33.Levy, P, Lemeshow, S. Sampling of populations: methods and applications. 2nd ed. New York: John Wiley & Sons; 1991.Google Scholar
34.Allegranzi, B, Pittet, D. Preventing infections acquired during health-care delivery. Lancet 2008;372:1719–1720.Google Scholar
35.Shears, P. Poverty and infection in the developing world: healthcare-related infections and infection control in the tropics. J Hosp Infect 2007;67:217–224.CrossRefGoogle ScholarPubMed
36.Raka, L. Lowbury Lecture 2008: infection control and limited resources—searching for the best solutions. J Hosp Infect 2009;72:292–298.Google Scholar
37.Ponce-de-Leon-Rosales, S, Macias, AE. Global perspectives of Infection Control. In: Wenzel, RP, ed. Prevention and control of nosocomial infections. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar
38.Huskins, WC, O'Rourke, EJ, Rhinehart, E, Goldmann, DA. Infection control in countries with limited resources. In: Mayhall, CG, ed. Hospital epidemiology and infection control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.Google Scholar
39.Lynch, P, Rosenthal, VD, Borg, MA, Eremin, SR. Infection control: a global view. In: Jarvis, WR, ed. Hospital infections. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.Google Scholar
40.Rosenthal, VD, McCormick, RD, Guzman, S, Villamayor, C, Orellano, PW. Effect of education and performance feedback on handwashing: benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31:85–92.Google Scholar
41.Duerink, DO, Farida, H, Nagelkerke, NJD, et al.Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital. J Hosp Infect 2006;64:36–43.CrossRefGoogle Scholar
42.World Health Organization. Essential environmental health standards in health care. Geneva: World Health Organization; 2008.Google Scholar
43.Pittet, D, Allegranzi, B, Sax, H, et al.Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability. Infect Control Hosp Epidemiol 2007;28:1344–1351.Google Scholar
44.Jumaa, PA. Hand hygiene: simple and complex. Int J Infect Dis 2005;9:3–14.Google Scholar
45.Donowitz, LG. Handwashing technique in a pediatric intensive care unit. Am J Dis Child 1987;141:683–685.Google Scholar
46.Pittet, D, Allegranzi, B, Sax, H, et al.Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641–652.Google Scholar
47.Pittet, D. Promotion of hand hygiene: magic, hype, or scientific challenge? Infect Control Hosp Epidemiol 2002;23:120–126.Google Scholar