World Health Organization Country Office, Freetown, Sierra Leone.
Ministry of Health, Freetown, Sierra Leone.
BMC Health Serv Res. 2024 Aug 16;24(1):940. doi: 10.1186/s12913-024-11368-3.
Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers.
A longitudinal hospital-based intervention study was conducted in accordance with the WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3-5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures.
Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml).
The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.
酒精免洗洗手液（ABHR）是手部卫生（HH）的金标准，也是感染预防和控制（IPC）策略的基石。然而，有几个因素会影响卫生工作者对 ABHR 的有效使用。本研究评估了一种本地生产的 ABHR 产品的耐受性和可接受性，以及卫生工作者的 HH 行为。
按照世界卫生组织（WHO）评估 ABHR 耐受性和可接受性的标准化方案（方法 1）进行了一项纵向医院为基础的干预研究。在塞拉利昂的 4 家医院中，有 60 名卫生工作者在 30 天的时间内接受了 3 次观察（第 1、3-5 和 30 天），由经过培训的观察员进行。感兴趣的结果包括使用主观和客观措施评估的皮肤耐受性和产品可接受性。
客观和主观评估均显示该产品具有很强的皮肤耐受性和高接受性。在所有 3 次访问中，经过培训的观察员评估的皮肤耐受性评分均<2，在≥97%的参与者中，超过了世界卫生组织的基准评分（BMS<2，在≥75%）。参与者对整体皮肤完整性的自我评估在第 2 次访问（97%）和第 3 次访问（98%）中得分>4（BMS>4，在≥75%）。主要的可接受性标准在第 3 次访问时增加到 95%（颜色）和 88%（气味）（BMS>4，在≥50%）。尽管接受度高，但该产品的干燥效果仍较低，在第 2 次和第 3 次访问时分别为 52%和 58%（BMS>4，在≥75%）。HH 行为呈阳性（n=53，88%），其中超过一半（n=38，63%）的人几乎在每个 HH 时刻都进行 HH。ABHR 的平均用量明显较高（76.1 毫升，标准差±35），尤其是护士（平均 80.1 毫升）和医生（平均 74.0 毫升）。
由世界卫生组织制定的本地生产的 ABHR 被卫生工作者很好地耐受和接受。这些发现支持在资源有限的环境中持续使用基于证据、具有成本效益的手部卫生干预措施。高用量的手部消毒剂和频繁的 HH 行为是明显的 HH 行为。建议进一步研究优化产品配方以减少皮肤干燥，并调查 ABHR 消耗与手部卫生依从性之间的关联。
