Effective Strategies for Improving Hand Hygiene in Developing Countries

  • Madonna J. Matar
  • Rima A. Moghnieh
  • Lyn S. Awad
  • Souha S. Kanj
Infection Prevention and Safety in Low and Middle Income Countries (C Bardossy, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Infection Prevention and Safety in Low and Middle Income Countries

Opinion statement

Hand hygiene (HH) is the most important infection control intervention that has proved to decrease the risk of hospital-acquired infections in medical care [Jarvis WR, Lancet 344(8933):1311–1312, 1994]. However, ensuring consistent adequate HH in healthcare institutions remains a challenge in many healthcare settings. The World Health Organization (WHO) has launched the SAVE LIVES program targeting HH through a multimodal implementation strategy to improve HH compliance worldwide [Pittet D et al., Infect Control Hosp Epidemiol 30(7):611–622, 2009]. To be successfully implemented, the program needs (1) specific environmental requirements within healthcare institutions, (2) available HH products, (3) establishment of educational programs, (4) creation of tools to assess healthcare worker (HCW) behavioral changes, and (5) managerial empowerment and support of institutional administrations. This review will discuss the HH strategies that have been implemented so far in some developing countries, their implication on healthcare institutions, and the most important challenges encountered in different settings and cultural backgrounds. Of particular importance is the education to improve knowledge and the continuous assessment of behavioral changes. In addition, program leadership and financial support are very important determinant features for successful HH implementation.

Health policy makers should establish a strong HH framework to implement consistently in all healthcare institutions in collaboration with ministries of health, taking into account the socio-economic, behavioral, and technical factors in each developing country.


Hand hygiene Alcohol-based hand rub Multimodal implementation strategy Behavioral changes Developing countries 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not involve any human or animal subjects.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Madonna J. Matar
    • 1
    • 2
  • Rima A. Moghnieh
    • 3
    • 4
  • Lyn S. Awad
    • 5
  • Souha S. Kanj
    • 6
  1. 1.Division of Infectious Diseases and Infection Control ProgramNotre Dame des Secours University HospitalJbeilLebanon
  2. 2.Faculty of Medical SciencesThe Holy Spirit University of KaslikKaslikLebanon
  3. 3.Department of Internal MedicineMakassed General HospitalBeirutLebanon
  4. 4.Faculty of Medical SciencesLebanese UniversityBeirutLebanon
  5. 5.Pharmacy DepartmentMakassed General HospitalBeirutLebanon
  6. 6.Division of Infectious Diseases, Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon

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