Effectiveness and sustainability of the WHO multimodal hand hygiene improvement strategy in the university hospital Bouaké, Republic of Côte D'ivoire in the context of the COVID-19 pandemic

ABSTRACT

Introduction: Healthcare worker adherence to proper Hand Hygiene (HH) practices and access to alcohol-based hand-rub (ABHR) remains limited in many low-resource settings. An effective HH improvement strategy is a critical element of infection prevention and control (IPC) programmes, as seen in the ongoing COVID-19 pandemic. The project PASQUALE aimed to establish the WHO multimodal HH strategy at the University Hospital Bouaké, Côte d'Ivoire. Objectives: The project PASQUALE aimed to establish the WHO multimodal HH strategy at the University Hospital Bouaké, Côte d'Ivoire. Methods: The improvement of HH knowledge and HH compliance was assessed in a before-and-after intervention study. The intervention consisted of a HH training for staff of all departments regardless of their participation in the initial assessment and the introduction of local production of ABHR. Assessment of HH knowledge and compliance was performed 12 months before (06/2018), right after the intervention (10/2019) and at a ten months interval (08/2020), whereby knowledge was assessed through a self-administered questionnaire and HH compliance through direct observations. Results: Baseline knowledge score was 14/25, increased significantly to 17/25 upon the first and decreased to 13/25 in the second assessment. HH compliance showed a significant increase from 12.7% to 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. An average of 74.4L ABHR per month were produced from 07/2019 until 03/2020, when the first COVID-19 infection was confirmed in Côte d'Ivoire, and 138L per month from 04/2020 onwards. Monthly consumption of ABHR in the same time increased from 76 to 125L. Conclusion: The implementation of the WHO HH improvement strategy led to sustained improvements in HH compliance without relying on costly interventions. This study emphasized that the implementation of the strategy is feasible and has effectively contributed to the IPC response during the COVID-19 pandemic.