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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)
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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

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