Abstract
Health-care-associated infections (HCAIs) are a major global safety concern for patients, health- care professionals and public health particularly in developing countries where access to hand washing facilities is limited due to infrastructure. Alcohol-based hand sanitizer offers a viable alternative where water sources are unreliable or insufficient. However, in resource-limited settings, the introduction of alcohol-based hand sanitizer has been slow due to economic, manufacturing and procurement challenges compounded by the lack of evidence as to its acceptability in varying organizational cultures. This case study describes the process of producing, educating, distributing, scaling up and monitoring the impact of a quality improvement project to locally produce alcohol based hand sanitizer using the formula provided by the World Health Organization in a district hospital in Rwanda. During a 10-month implementation, hand sanitizer was made available to all departments of the hospital and all hospital staff received training on the proper use and ordering of the product. The overall hand hygiene compliance using any method significantly increased from 59% pre intervention to 67% post intervention (P < 0.001). Specifically, the use of hand sanitizer for hygiene significantly increased from 46% to 58% (P < 0.001). By producing hand sanitizer in-house, the hospital saved 71% when compared to purchasing commercial products. The use of hand sanitizer is not a replacement for running water in the hospital. However, with the lack of proper infrastructure, making hand sanitizer available is an acceptable alternative to improve the infection prevention and control standard. The production of hand sanitizer within a health care facility is cost effective and is feasible to integrate into existing operations. The team is working with the Rwandan Ministry of Health to introduce the program to all public hospitals as a national program.
Highlights
Health-care-associated infections (HCAIs) are a major global safety concern for patients, health-care professionals and public health with an estimated 1.4 million plus people at any time worldwide suffering from HCAIs in health-care facilities [1]-[3]
This paper describes the process of implementing the local production of hand sanitizer using a World Health Organization (WHO) formula at a district-level maternity hospital in Rwanda and examines the impact on hand hygiene adherence
The success was contributed to the availability of hand sanitizer, as the results showed hand-hygiene compliance increased with the use of hand sanitizer, not with hand washing
Summary
Health-care-associated infections (HCAIs) are a major global safety concern for patients, health-care professionals and public health with an estimated 1.4 million plus people at any time worldwide suffering from HCAIs in health-care facilities [1]-[3]. Despite the proof that proper hand-hygiene practice combats HCAIs [8] [11]-[27], compliance among health care workers has historically been very low, averaging worldwide 39% [5] [11] [18]-[24]. The compliance rates were generally lower and varied hugely in many mid- to low-income countries, ranging from 6% to 38% [19] [25]-[28]. This variation is largely attributed to the infrastructural limitations, including insufficient hand washing stations, irregular water supply and shortage of hand washing products [19]-[29]
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