Implementing Hand Hygiene Programs in Hospitals with Limited Resources

Abstract

Health care-associated infections can affect up to a third of all patients in low- and middle-income countries and represent a serious financial burden. Nevertheless, their control by means of hand hygiene faces various obstacles in this context such as the lack of adequately chlorinated water supplies, poor access to alcohol-based hand rub, lack of proper regulations and guidelines, and the scarcity of data on the impact of the hand hygiene programs on health care-associated infections in this setting. Notwithstanding the foregoing, there have been numerous efforts to implement strategies to improve hand hygiene. Outstanding among these is the World Health Organization strategies, which have been successfully implemented taking into account local context and resources. In addition to the WHO strategy is that of the International Nosocomial Infection Control Consortium (INICC) which implies hand hygiene guidelines for implementation exclusively in low- and middle-income countries. Moreover, various hospitals and health care facilities have developed their own multimodal strategies by using available resources with considerable success. There have been multiple efforts to implement hand hygiene programs around the world taking into account international strategies, while adapting them to local circumstances. This paper reviews these efforts to face the threat posed by HCAI in low- and middle-income countries.