How to go beyond the WHO strategy and build a hand hygiene culture in the regional hospital of Faranah

ABSTRACT

Introduction: The Multimodal WHO Hand Hygiene (HH) Strategy is a widely used and well recognized approach. However, the evidence on the sustainability in low-resource settings is still scarce. The WHO strategy was implemented at the Regional Hospital of Faranah (HRF), but context specific challenges developed. Objectives: We aimed to promote HH culture by addressing these challenges and implementing appropriate solutions. Methods: Over a period of 3 years, the project team used quantitative and qualitative methods to assess HH improvement. Local staff was trained and instructed to track the development, identify barriers and find solutions to build a sustained HH culture. Results: Four main barriers were identified and addressed by targeted measures. 1) The lack of staff for local production was overcome by implementing a train the trainer approach. The initially trained pharmacist trained four other team members. To further strengthen the production team, a national solution of training and sending staff is proposed by the HRF. 2) Difficulties in obtaining production ingredients in high quality were addressed by purchasing large quantities and the establishment of a storage room in the hospital pharmacy. 3) To prepare for sustainable local production, the return, recycling and exchange of empty bottles was planned by opening a register of distribution. 4) To stop the decrease in knowledge and compliance over time, a HH championship every 6 months was initiated. All hospital departments were invited to participate and staff assessed via the WHO knowledge questionnaires and HH observations. Furthermore, refresher trainings and demonstrations of HH were given in daily staff meetings. Conclusion: To build HH culture is feasible in low-resource hospitals such as the HRF. However, context specific challenges require locally designed solutions such as the introduction of recycling systems for ABHR bottles, organizing HH championships, or promoting daily staff trainings to maintain the improvement on HH practises and creating a HH culture. This development of a HH culture and its sustainable local production helped the HRF to respond to the current COVID-19 pandemic.