Author:
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-
1.
World Health Organization, 2009. WHO Guidelines on Hand Hygiene in Health Care. Geneva, Switzerland: WHO.
-
2.
Hugonnet S, Perneger TV, Pittet D, 2002. Alcohol-based handrub improves compliance with hand hygiene in intensive care units.Arch Intern Med 162: 1037–1043.
-
3.
Berendes D et al., 2022. Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19. PLOS Water 1: e0000027.
-
4.
Pratt C et al., 2023. Access to and use of hand hygiene resources during the COVID-19 pandemic in two districts in Uganda, January–April 2021.Am J Trop Med Hyg 109: 881–889.
-
5.
Kratzel A et al., 2020. Inactivation of severe acute respiratory syndrome coronavirus 2 by WHO-recommended hand rub formulations and alcohols.Emerg Infect Dis 26: 1592–1595.
-
6.
Tan J, de Kraker M, Pires D, Soule H, Pittet D, 2020. Handrubbing with sprayed alcohol-based hand rub: An alternative method for effective hand hygiene.J Hosp Infect 104: 430–434.
-
7.
McMahon DE, Peters GA, Ivers LC, Freeman EE, 2020. Global resource shortages during COVID-19: Bad news for low-income countries. PLoS Negl Trop Dis 14: e0008412.
-
8.
Tusabe F et al., 2023. Establishment of district-led production of WHO-recommended alcohol-based hand rub (ABHR) during the COVID-19 pandemic: A model for improving access to ABHR during health emergencies. J Water Sanit Hyg Dev 13: 847–856.
-
9.
World Health Organization, 2010. Guide to Local Production: WHO-Recommended Handrub Formulations. Geneva, Switzerland: WHO.
-
10.
Allegranzi B et al., 2013. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: A quasi-experimental study.Lancet Infect Dis 13: 843–851.
-
11.
Tusabe F et al., 2023. Improving access to WHO formulations of alcohol-based hand rub in healthcare facilities: A district-wide approach.Am J Trop Med Hyg 109: 191–200.
-
12.
Bauer-Savage J, Pittet D, Kim E, Allegranzi B, 2013. Local production of WHO-recommended alcohol-based handrubs: Feasibility, advantages, barriers and costs.Bull World Health Organ 91: 963–969.
-
13.
Ndegwa L, Hatfield KM, Sinkowitz-Cochran R, D’Iorio E, Gupta N, Kimotho J, Woodard T, Chaves SS, Ellingson K, 2019. Evaluation of a program to improve hand hygiene in Kenyan hospitals through production and promotion of alcohol-based Handrub—2012–2014.Antimicrob Resist Infect Control 8: 2.
-
14.
Saito H, Inoue K, Ditai J, Wanume B, Abeso J, Balyejussa J, Weeks A, 2017. Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda (“WardGel” study).Antimicrob Resist Infect Control 6: 129.
-
15.
American Society of Anesthesiologists, 2013. Decontaminating the Sanitizer Dispenser, Giving Health Care Workers Their Own Hand Gel Reduces Operating Room Contamination Significantly. Available at: https://www.asahq.org/about-asa/newsroom/news-releases/2013/10/hand-sanitizer-decontamination. Accessed December 22, 2023.
-
16.
Ministry of Health, Republic of Uganda, 2024. Hospitals. Available at: https://www.health.go.ug/hospitals/. Accessed February 10, 2024.
-
17.
CDC, 2023. Clean and Disinfect Alcohol-Based Handrub Containers. Available at: https://www.cdc.gov/global-water-sanitation-hygiene/media/pdfs/334204-A_NCEZID_IG_cleanABHRcontainer-p.pdf. Accessed November 12, 2023.
-
18.
Cronk R, Bartram J, 2018. Environmental conditions in health care facilities in low-and middle-income countries: Coverage and inequalities.Int J Hyg Environ Health 221: 409–422.
-
19.
Guo A, Bowling JM, Bartram J, Kayser G, 2017. Water, sanitation, and hygiene in rural health-care facilities: A cross-sectional study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia.Am J Trop Med Hyg 97: 1033–1042.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 10748 | 10748 | 3175 |
| Full Text Views | 46 | 46 | 21 |
| PDF Downloads | 41 | 41 | 23 |
Cleaning and Disinfection Practices of Reused Alcohol-Based Hand Rub Containers in Health Care Settings: Evidence from Five Rural Districts in Uganda
Fred Tusabe
Fred Tusabe
Infectious Diseases Institute, Makerere University, Kampala, Uganda;
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Kanako Ishida
kanakoi@g.ucla.edu
Kanako Ishida
Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Francis Ocitti
Francis Ocitti
Infectious Diseases Institute, Makerere University, Kampala, Uganda;
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Sauda Yapswale
Sauda Yapswale
Infectious Diseases Institute, Makerere University, Kampala, Uganda;
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Maureen Kesande
Maureen Kesande
Infectious Diseases Institute, Makerere University, Kampala, Uganda;
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Herbert Isabirye
Herbert Isabirye
Infectious Diseases Institute, Makerere University, Kampala, Uganda;
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Judith Nanyondo
Judith Nanyondo
Infectious Diseases Institute, Makerere University, Kampala, Uganda;
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Victoria Trinies
Victoria Trinies
Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Alexandra Medley
Alexandra Medley
Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Mohammed Lamorde
Mohammed Lamorde
Infectious Diseases Institute, Makerere University, Kampala, Uganda;
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David Berendes
David Berendes
Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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ABSTRACT.
Local alcohol-based hand rub (ABHR) production systems in low-resource settings, such as in health care facilities (HCFs) in low- and middle-income countries, frequently reuse containers for storing and dispensing ABHR. Cleaning/disinfection (C/D) of ABHR containers is necessary to safely reuse them and is an integral part of the WHO’s guidelines on local ABHR production. However, HCFs may not be aware of the need for C/D; combined with suboptimal implementation, this poses a risk of contamination of ABHR. As part of district-led ABHR production in HCFs in five rural districts in Uganda, we developed a standard operating procedure (SOP) for C/D of reused ABHR containers and provided on-site training for infection prevention and control personnel. Using in-person surveys, we assessed the availability of C/D supplies and equipment and the self-reported C/D practices before and after the training. At baseline, almost all (n = 90/91) HCFs reported reusing ABHR containers; 8% and 12% of HCFs routinely had all of the key C/D materials needed for adequately cleaning and disinfecting containers using chlorine and thermal disinfection methods, respectively. HCFs that reported adequately cleaning containers per the SOP increased from 3% (n = 2) at baseline to 18% (n = 16) after the training, whereas adequate disinfection increased from 0% (n = 0) to 5% (n = 5). All HCFs that performed disinfection reported using chlorine, and none reported using thermal disinfection. Improving access to C/D supplies, providing routine mentorship, and monitoring ABHR container C/D are needed to further improve C/D practices.
- Supplemental Materials (PDF 1233.6 KB)
Author Notes
Financial support: The implementation and evaluation of the study were funded by the
Disclosures: The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the CDC.
Current contact information: Fred Tusabe, Francis Ocitti, Sauda Yapswale, Maureen Kesande, Herbert Isabirye, Judith Nanyondo, and Mohammed Lamorde, Infectious Disease Institute, Makerere University, Kampala, Uganda, E-mails: ftusabe@idi.co.ug, focitti8@gmail.com, yapswale@gmail.com, mkesande@idi.co.ug, hisabirye@idi.co.ug, jnanyondo@idi.co.ug, and mlamorde@idi.co.ug. Kanako Ishida, Center for Behavioral Health Statistics and Quality (CBHSQ) Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, MD, E-mail: kanakoi@g.ucla.edu. Victoria Trinies, Alexandra Medley, and David Berendes, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: omo3@cdc.gov, muv3@cdc.gov, and uws8@cdc.gov.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization, 2009. WHO Guidelines on Hand Hygiene in Health Care. Geneva, Switzerland: WHO.
-
2.
Hugonnet S, Perneger TV, Pittet D, 2002. Alcohol-based handrub improves compliance with hand hygiene in intensive care units.Arch Intern Med 162: 1037–1043.
-
3.
Berendes D et al., 2022. Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19. PLOS Water 1: e0000027.
-
4.
Pratt C et al., 2023. Access to and use of hand hygiene resources during the COVID-19 pandemic in two districts in Uganda, January–April 2021.Am J Trop Med Hyg 109: 881–889.
-
5.
Kratzel A et al., 2020. Inactivation of severe acute respiratory syndrome coronavirus 2 by WHO-recommended hand rub formulations and alcohols.Emerg Infect Dis 26: 1592–1595.
-
6.
Tan J, de Kraker M, Pires D, Soule H, Pittet D, 2020. Handrubbing with sprayed alcohol-based hand rub: An alternative method for effective hand hygiene.J Hosp Infect 104: 430–434.
-
7.
McMahon DE, Peters GA, Ivers LC, Freeman EE, 2020. Global resource shortages during COVID-19: Bad news for low-income countries. PLoS Negl Trop Dis 14: e0008412.
-
8.
Tusabe F et al., 2023. Establishment of district-led production of WHO-recommended alcohol-based hand rub (ABHR) during the COVID-19 pandemic: A model for improving access to ABHR during health emergencies. J Water Sanit Hyg Dev 13: 847–856.
-
9.
World Health Organization, 2010. Guide to Local Production: WHO-Recommended Handrub Formulations. Geneva, Switzerland: WHO.
-
10.
Allegranzi B et al., 2013. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: A quasi-experimental study.Lancet Infect Dis 13: 843–851.
-
11.
Tusabe F et al., 2023. Improving access to WHO formulations of alcohol-based hand rub in healthcare facilities: A district-wide approach.Am J Trop Med Hyg 109: 191–200.
-
12.
Bauer-Savage J, Pittet D, Kim E, Allegranzi B, 2013. Local production of WHO-recommended alcohol-based handrubs: Feasibility, advantages, barriers and costs.Bull World Health Organ 91: 963–969.
-
13.
Ndegwa L, Hatfield KM, Sinkowitz-Cochran R, D’Iorio E, Gupta N, Kimotho J, Woodard T, Chaves SS, Ellingson K, 2019. Evaluation of a program to improve hand hygiene in Kenyan hospitals through production and promotion of alcohol-based Handrub—2012–2014.Antimicrob Resist Infect Control 8: 2.
-
14.
Saito H, Inoue K, Ditai J, Wanume B, Abeso J, Balyejussa J, Weeks A, 2017. Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda (“WardGel” study).Antimicrob Resist Infect Control 6: 129.
-
15.
American Society of Anesthesiologists, 2013. Decontaminating the Sanitizer Dispenser, Giving Health Care Workers Their Own Hand Gel Reduces Operating Room Contamination Significantly. Available at: https://www.asahq.org/about-asa/newsroom/news-releases/2013/10/hand-sanitizer-decontamination. Accessed December 22, 2023.
-
16.
Ministry of Health, Republic of Uganda, 2024. Hospitals. Available at: https://www.health.go.ug/hospitals/. Accessed February 10, 2024.
-
17.
CDC, 2023. Clean and Disinfect Alcohol-Based Handrub Containers. Available at: https://www.cdc.gov/global-water-sanitation-hygiene/media/pdfs/334204-A_NCEZID_IG_cleanABHRcontainer-p.pdf. Accessed November 12, 2023.
-
18.
Cronk R, Bartram J, 2018. Environmental conditions in health care facilities in low-and middle-income countries: Coverage and inequalities.Int J Hyg Environ Health 221: 409–422.
-
19.
Guo A, Bowling JM, Bartram J, Kayser G, 2017. Water, sanitation, and hygiene in rural health-care facilities: A cross-sectional study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia.Am J Trop Med Hyg 97: 1033–1042.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 10748 | 10748 | 3175 |
| Full Text Views | 46 | 46 | 21 |
| PDF Downloads | 41 | 41 | 23 |