World Health Organization Patient Safety, Geneva, Switzerland.
Infect Control Hosp Epidemiol. 2010 Feb;31(2):133-41. doi: 10.1086/649796.
To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country.
A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention.
University Hospital, Bamako, Mali. Participants. Two hundred twenty-four healthcare workers.
The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up.
Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P < .001). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly (P < .05), and perception surveys showed a high appreciation of each strategy component by staff.
Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.
评估世界卫生组织手部卫生改善策略在一个低收入非洲国家的可行性和效果。
2006 年 12 月至 2008 年 6 月进行的前后对照研究，基线评估期为 6 个月，干预开始后随访 8 个月。
马里巴马科大学医院。参与者：224 名医护人员。
干预措施包括引入一种本地生产的酒精擦手液；监测手部卫生依从性；提供绩效反馈；教育员工；在工作场所张贴提醒；并根据世界卫生组织多模式手部卫生改善策略促进机构安全氛围。在基线和随访时评估手部卫生基础设施、依从性、医护人员的知识和看法以及擦手液的消耗情况。
在干预前，手部卫生基础设施存在严重缺陷。本地擦手液的生产和质量控制被证明是可行的、负担得起的和令人满意的。在随访时，擦手已成为近乎唯一的手部卫生技术（93.3%）。依从性从基线时的 8.0%提高到随访时的 21.8%（P<.001）。所有专业类别和医学专业均观察到改善，且独立于干预措施（优势比，2.50；95%置信区间，1.8-3.5）。知识显著提高（P<.05），并且员工对每个策略组成部分的看法调查显示出高度评价。
多模式手部卫生促进在低收入国家是可行且有效的。擦手液的可及性对于其成功至关重要。这些发现促使马里政府在全国范围内扩大干预措施。这一经验代表了发展中国家患者安全的重大进步。
