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Title

Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa
Authors
Allegranzi, Benedetta
Sax, Hugo
Bengaly, Loséni
Richet, Hervé
Minta, D. K.
Chraiti, M. N.
Sokona, F. M.
Gayet-Ageron, Angèle
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Published in Infection Control and Hospital Epidemiology. 2010, vol. 31, no. 2, p. 133-141
Abstract 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 ([Formula: see text]). 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 ([Formula: see text]), 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.
Keywords Cross Infection/prevention & control — Guideline Adherence — Handwashing/ methods — Health Personnel — Humans — Hygiene — Infection Control/methods/organization & administration — Infectious Disease Transmission, Professional-to-Patient/prevention & control — Mali — Program Evaluation — Referral and Consultation — World Health Organization
Identifiers
PMID: 20017633
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Structures
Faculté de médecine / Section de médecine fondamentale / Département de médecine génétique et développement
Research groups Epidémiologie clinique (115)
Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière (330)
Citation
(ISO format) 		ALLEGRANZI, Benedetta et al. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. In: Infection Control and Hospital Epidemiology, 2010, vol. 31, n° 2, p. 133-141. doi: 10.1086/649796 https://archive-ouverte.unige.ch/unige:9284

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Deposited on : 2010-07-12

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