A practical guide to alcohol-based hand hygiene infrastructure in a resource-poor pediatric hospital

Abstract

Resource-poor hospitals have many barriers to proper hand hygiene (HH). Alcohol-based HH can compensate for inadequate infrastructure and supplies. We describe the implementation of alcohol-based HH in five high-risk wards of a pediatric hospital in El Salvador. In 5 high-risk wards for nosocomial infections, we evaluated the accessibility, supplies, and cleanliness of the hand-washing sinks at 132 time points. We then installed gel dispensers, identified a local gel supplier, and trained nursing staff to maintain the dispensers. We evaluated user acceptance, costs, and the practice and technique of HH before and after installation. Access and cleanliness were adequate at 18.9% and 11.3% of observation points, and towels and soap were available at 61.3% and 93.18% of points. Placement of 35 gel dispensers increased the ratio of HH stations to beds from 1:6.2 to 1:1.8. Alcohol gel was better tolerated than hand washing among 60 surveyed staff. Installation cost $2558 (US) and the monthly gel supply, $731 (US). HH practice increased from 33.8% to 40.5%; use of correct technique increased from 73.8% to 95.2%. Alcohol gel can address some of the barriers to effective HH at resource-poor institutions, and its cost may be offset by reduction of nosocomial infection.