Effective Strategies for Improving Hand Hygiene in Developing Countries

Abstract

Hand hygiene (HH) is the most important infection control intervention that has proved to decrease the risk of hospital-acquired infections in medical care [Jarvis WR, Lancet 344(8933):1311–1312, 1994]. However, ensuring consistent adequate HH in healthcare institutions remains a challenge in many healthcare settings. The World Health Organization (WHO) has launched the SAVE LIVES program targeting HH through a multimodal implementation strategy to improve HH compliance worldwide [Pittet D et al., Infect Control Hosp Epidemiol 30(7):611–622, 2009]. To be successfully implemented, the program needs (1) specific environmental requirements within healthcare institutions, (2) available HH products, (3) establishment of educational programs, (4) creation of tools to assess healthcare worker (HCW) behavioral changes, and (5) managerial empowerment and support of institutional administrations. This review will discuss the HH strategies that have been implemented so far in some developing countries, their implication on healthcare institutions, and the most important challenges encountered in different settings and cultural backgrounds. Of particular importance is the education to improve knowledge and the continuous assessment of behavioral changes. In addition, program leadership and financial support are very important determinant features for successful HH implementation. Health policy makers should establish a strong HH framework to implement consistently in all healthcare institutions in collaboration with ministries of health, taking into account the socio-economic, behavioral, and technical factors in each developing country.