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Effective Strategies for Improving Hand Hygiene in Developing Countries

  • Infection Prevention and Safety in Low and Middle Income Countries (C Bardossy, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

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.

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References and Recommended Reading

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

  1. Burke JP. Infection control—a problem for patient safety. N Engl J Med. 2003;348(7):651–6. https://doi.org/10.1056/NEJMhpr020557.

    Article  PubMed  Google Scholar 

  2. Vincent JL. Nosocomial infections in adult intensive-care units. Lancet. 2003;361(9374):2068–77. https://doi.org/10.1016/S0140-6736(03)13644-6.

    Article  PubMed  Google Scholar 

  3. Pittet D. Clean hands reduce the burden of disease. Lancet. 2005;366(9481):185–7. https://doi.org/10.1016/S0140-6736(05)66886-9.

    Article  PubMed  Google Scholar 

  4. Jarvis WR. Handwashing—the Semmelweis lesson forgotten? Lancet. 1994;344(8933):1311–2.

    Article  PubMed  CAS  Google Scholar 

  5. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme Lancet. 2000;356(9238):1307–12.

    PubMed  CAS  Google Scholar 

  6. Kilpatrick CPD. WHO SAVE LIVES: Clean your hands global annual campaign. A call for action: 5 May 2011. Infection. 2011;39(2):93–5. https://doi.org/10.1007/s15010-011-0106-8.

    Article  PubMed  CAS  Google Scholar 

  7. Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001;7(2):234–40. https://doi.org/10.3201/eid0702.700234.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Loffler H, Kampf G, Schmermund D, Maibach HI. How irritant is alcohol? Br J Dermatol. 2007;157(1):74–81. https://doi.org/10.1111/j.1365-2133.2007.07944.x.

    Article  PubMed  CAS  Google Scholar 

  9. Kampf G, Loffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int. 2009;106(40):649–55. https://doi.org/10.3238/arztebl.2009.0649.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pittet D, Allegranzi B, Boyce J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol. 2009;30(7):611–22. https://doi.org/10.1086/600379.

    Article  PubMed  Google Scholar 

  11. Pittet D, Donaldson L. Clean Care is Safer Care: the first global challenge of the WHO World Alliance for Patient Safety. Infect Control Hosp Epidemiol. 2005;26(11):891–4. https://doi.org/10.1086/502513.

    Article  PubMed  Google Scholar 

  12. Magiorakos AP, Leens E, Drouvot V, May-Michelangeli L, Reichardt C, Gastmeier P et al. Pathways to clean hands: highlights of successful hand hygiene implementation strategies in Europe. Euro Surveill. 2010;15(18).

  13. Kilpatrick C. Save lives: clean your hands. A global call for action at the point of care. Am J Infect Control. 2009;37(4):261–2. https://doi.org/10.1016/j.ajic.2009.02.001.

    Article  PubMed  Google Scholar 

  14. Nations TU. The World Economic Situation and Prospects. 2014. https://www.un.org/development/desa/dpad/document_gem/global-economic-monitoring-unit/world-economic-situation-and-prospects-wesp-report/page/2/. Accessed 02 Sep 2017.

  15. • WHO. African Countries Statments. www.who.int/infection-prevention/countries/hand-hygiene/EN_PSP_GSPC1-AFRO_Country/en/. Accessed 24 Aug 2017. This webpage showed the statements of African countries in addressing mainly healthcare-associated infections.

  16. •• WHO. Countries or areas running hand hygiene campaigns. www.who.int/gpsc/national_campaigns/country_list/en/. Accessed 24 Aug 2017. This webpage lists the countries and areas from all over the world that have been running their own hand hygiene campaigns.

  17. • Abrampah NM, Montgomery M, Baller A, Ndivo F, Gasasira A, Cooper C, et al. Improving water, sanitation and hygiene in healthcare facilities, Liberia. Bull World Health Organ. 2017;95(7):526–30. https://doi.org/10.2471/BLT.16.175802. This study describes the efforts made to improve the quality of health services in Liberia, focusing on the development and implementation of a package to improve water and sanitation infrastructures and hygiene practices during and after the epidemic; however, results and improvements were not measured because they were very busy with Ebola outbreak containment.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis. 2013;13(10):843–51. https://doi.org/10.1016/S1473-3099(13)70163-4.

    Article  PubMed  Google Scholar 

  19. Gichuhi AW, Simon SM, Nyangena E, Otieno-Ayayo ZN. Health care workers adherence to infection prevention practices and control measures: a case of a level four district hospital in Kenya. Am J Nurs Sci. 2015;4(2):39–44. https://doi.org/10.11648/j.ajns.20150402.13.

    Article  Google Scholar 

  20. •• Chun JY, Seo HK, Kim MK, Shin MJ, Kim SY, Kim M, et al. Impact of a hand hygiene campaign in a tertiary hospital in South Korea on the rate of hospital-onset methicillin-resistant Staphylococcus aureus bacteremia and economic evaluation of the campaign. Am J Infect Control. 2016;44(12):1486–91. https://doi.org/10.1016/j.ajic.2016.07.009. This study proved that a hand hygiene campaign consistent with the WHO multimodal hand hygiene improvement strategy has been implemented in a tertiary hospital in South Korea increased the compliance rate, decreased the incidence of healthcare MRSA bacteremia, and was also cost saving.

    Article  PubMed  Google Scholar 

  21. Hongsuwan M, Srisamang P, Day NPJ, Limmathurotsakul, Cooper BS. Impact of a multimodal hand hygiene improvement intervention in a 1000-bed hospital in NE Thailand: a stepped wedge clustered randomized controlled trial. Antimicrob Resist Infect Control. 2015;4(Suppl 1):O19. https://doi.org/10.1186/2047-2994-4-S1-O19.

    Article  PubMed Central  Google Scholar 

  22. Gurley ES, Islam M, Nahar N, Sultana R, Hossain M, Homaira N, Parveen S, et al. Behaviour change intervention to reduce caregivers’ exposure to patients’ oral and nasal secretions in Bangladesh. Int J Infect Control. 2013;9(2). https://doi.org/10.3396/ijic.v9i2.017.13.

  23. • Visan FA, Zakaria A, Castro J, Alhasanat O, Ismail KA, Ansari NA et al. SWITCH: Al Wakra Hospital journey to 90% hand hygiene practice compliance, 2011–2015. BMJ Qual Improv Rep. 2017;6(1). https://doi.org/10.1136/bmjquality.u211699.w4824. This study stresses on teamwork to reach any goal; the improvement in hand hygiene compliance highlighted not just interventions towards training and education but also behavioral motivation and physical allocations of hand hygiene appliances and equipment.

  24. Al Salman JM, Hani S, de Marcellis-Warin N, Isa SF. Effectiveness of an electronic hand hygiene monitoring system on healthcare workers’ compliance to guidelines. J Infect Public Health. 2015;8(2):117–26. https://doi.org/10.1016/j.jiph.2014.07.019.

    Article  PubMed  Google Scholar 

  25. Mahfouz AA, Al-Zaydani IA, Abdelaziz AO, El-Gamal MN, Assiri AM. Changes in hand hygiene compliance after a multimodal intervention among health-care workers from intensive care units in Southwestern Saudi Arabia. J Epidemiol Glob Health. 2014;4(4):315–21. https://doi.org/10.1016/j.jegh.2014.05.002.

    Article  PubMed  Google Scholar 

  26. Bukhari S, Hussain WM, Banjar A, Almaimani WH, Karima TM, Fatani MI. Hand hygiene compliance rate among healthcare prof. Saudi Med J. 2011;32(15):515–9.

    PubMed  Google Scholar 

  27. Alloubani AMd, Taktak WJ, Hussein AA, Al Zanoun RM, Rabadi HM, Joyce T. Improving compliance of hand hygiene practices among intensive care unit employees in AL-Istishari Hospital in Jordan. Am J Med Med Sci. 2014;4(5). https://doi.org/10.5923/j.ajmms.20140405.01.

  28. •• Moghnieh R, Soboh R, Abdallah D, El-Helou M, Al Hassan S, Ajjour L, et al. Health care workers’ compliance to the My 5 Moments for Hand Hygiene: comparison of 2 interventional methods. Am J Infect Control. 2017;45(1):89–91. https://doi.org/10.1016/j.ajic.2016.08.012. This study compares two interventions, the incentive-based and the audit-feedback; it points out that incentive-driven intervention helped in boosting compliance; however, it did not achieve sustainability as seen in the audit-feedback, which is essential in order to maintain and to increase hand hygiene compliance rates. The authors concluded that using a combination of both strategies might help boosting hand hygiene compliance with one (incentive-driven) and sustaining such response (audit and feedback).

    Article  PubMed  Google Scholar 

  29. •• Farhoudi F, Sanaei Dashti A, Hoshangi Davani M, Ghalebi N, Sajadi G, Taghizadeh R. Impact of WHO hand hygiene improvement program implementation: a quasi-experimental trial. Biomed Res Int. 2016;2016:7,026,169. https://doi.org/10.1155/2016/7026169. This study performed in 14 wards of a tertiary teaching hospital in Iran has proved once again that the implementation of the WHO’s Multimodal Hand Hygiene Improvement Strategy is the most powerful preventive measure against healthcare-associated infections (29.8 to 70.89%) concluding that implementing the WHO hand hygiene program can significantly improve hand hygiene compliance among nurses.

    Article  Google Scholar 

  30. Baghaei R, Sharifian E, Kamran A. Can theoretical intervention improve hand hygiene behavior among nurses? Psychol Res Behav Manag. 2016;9:133–8. https://doi.org/10.2147/PRBM.S91433.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ataei B, Zahraei SM, Pezeshki Z, Babak A, Nokhodian Z, Mobasherizadeh S, et al. Baseline evaluation of hand hygiene compliance in three major hospitals, Isfahan. Iran J Hosp Infect. 2013;85(1):69–72. https://doi.org/10.1016/j.jhin.2013.07.001.

    Article  PubMed  CAS  Google Scholar 

  32. Fiaz A, Mujeeb S, Justina NM, Saji S. Effectiveness of multifaceted hand hygiene awareness campaign to reduce the hospital-acquired infections in Thumbay Hospital. Ajman. GMJ. 2016;5(S1):S154–8.

    Google Scholar 

  33. Nour-Eldein H, Eldahshan NA. The effectiveness of hand hygiene education intervention for medical students in primary care settings, Ismailia City, Egypt. Middle East J Family Med. 2017; 13(2). https://doi.org/10.5742/MEWFM.2015.92667.

  34. Rono BC. Hand washing compliance handicap in Kenya: a case of Moi Teaching and Referral Hospital, Kenya. 2013.

  35. Songa J, Van Roekel K, Mwangi J, Noel L. A study on hand washing practices among health care workers in Embu Referral Hospital, Embu County. Pinnacle Med Med Sci. 2015;2(6).

  36. Maosa EK. Factors influencing hospital infection prevention and control practices among medical staff in Kisii Level Five Hospital. Kisii Country: Kenya University of Nairobi; 2012.

    Google Scholar 

  37. Allegranzi B, Sax H, Bengaly L, Richet H, Minta DK, Chraiti MN, et al. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol. 2010;31(2):133–41. https://doi.org/10.1086/649796.

    Article  PubMed  Google Scholar 

  38. • Budd A, Lukas S, Hogan U, Priscille K, Fanny K, Hill P, et al. A case study and the lessons learned from in-house alcohol based hand sanitizer production in a district hospital in Rwanda. J Serv Sci Manag. 2016;9:150–9. https://doi.org/10.4236/jssm.2016.92019. This study showed how strategies including translation of the guidelines to local language, reminders in local language, and auditing via consumption measurement and direct observation, along with pharmacy distribution of hand sanitizer, increased hand hygiene compliance.

    Article  Google Scholar 

  39. • Holmen IC, Seneza C, Nyiranzayisaba B, Nyiringabo V, Bienfait M, Safdar N. Improving hand hygiene practices in a rural hospital in Sub-Saharan Africa. Infect Control Hosp Epidemiol. 2016;37(7):834–9. https://doi.org/10.1017/ice.2016.71. This study describes how the use of locally produced alcohol-based hand rub, pocket-sized hand rubs, education, and survey among healthcare workers to identify barriers in infrastructure and compliance enhanced knowledge significantly.

    Article  PubMed  Google Scholar 

  40. Umulisa S, Musabyimana A, Wong R, Adomako E, Budd A, Ntakirutimana T. Improvement of hand hygiene compliance among health professional staff of Neonatology Department in Nyamata Hospital. On the Horizon. 2016;24(4):349–56. https://doi.org/10.1108/OTH-07-2016-0038.

    Article  Google Scholar 

  41. Devine J, Koita SN. Senegal: A handwashing behavior change journey. 2010.

  42. Ahmed EE. Improving hand hygiene compliance among dental health workers in 3 dental clinics in Khartoum State 2011.

  43. Langoya COC, Fuller NJ. Assessment of knowledge of hand washing among health care providers in Juba Teaching Hospital. South Sudan South Sudan Med J. 2015;8(3).

  44. Muhumuza C, Gomersall JS, Fredrick ME, Atuyambe L, Okiira C, Mukose A, et al. Health care worker hand hygiene in the pediatric special care unit at Mulago National Referral Hospital in Uganda: a best practice implementation project. Int J Evid Based Healthc. 2015;13(1):19–27. https://doi.org/10.1097/XEB.0000000000000013.

    Article  PubMed  Google Scholar 

  45. Werne A, Dieckhaus K. Knowledge, attitudes, and barriers of infection control among healthcare workers in rural Ugunda. Ann Glob Health. 2015;81(1). https://doi.org/10.1016/j.aogh.2015.02.642.

  46. Samuel R, Almedom AM, Hagos G, Albin S, Mutungi A. Promotion of handwashing as a measure of quality of care and prevention of hospital-acquired infections in Eritrea: the Keren study. Afr Health Sci. 2005;5.

  47. •• Pfafflin F, Tufa TB, Getachew M, Nigussie T, Schonfeld A, Haussinger D, et al. Implementation of the WHO multimodal Hand Hygiene Improvement Strategy in a University Hospital in Central Ethiopia. Antimicrob Resist Infect Control. 2017;6:3. https://doi.org/10.1186/s13756-016-0165-9. This study showed how an intervention consisting of three different phases using a multimodal improvement strategy increased significantly compliance of hand hygiene. The improvement was independently associated with the intervention. However, absolute compliance remained low. It also concluded that a strong and long-term commitment by hospital management and healthcare workers might be needed for further improvement.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Federal Ministry of Health Ethiopia. Infection prevention guidelines for healthcare facilities in Ethiopia In: Department DPaC, editor. Addis Ababa, Ethiopia; 2004.

  49. Schmitz K, Kempker RR, Tenna A, Stenehjem E, Abebe E, Tadesse L, et al. Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control. 2014;3(1):8. https://doi.org/10.1186/2047-2994-3-8.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Jones M, Whitfield A, Thomas S, Gower S, Michael R. Educational innovation for infection control in Tanzania: bridging the policy to practice gap. J Infect Prev. 2013;15(3). https://doi.org/10.1177/1757177413516525.

  51. Ministry of Health and Social Welfare. National infection prevention and control standards for hospitals in Tanzania. 2012.

  52. Asian Hospital Management Award. Improving hand hygiene compliance. 2014. http://www.asianhospitalmanagementawards.com/improving-hand-hygiene-compliance.

  53. Lee SS, Park SJ, Chung MJ, Lee JH, Kang HJ, Lee JA, et al. Improved hand hygiene compliance is associated with the change of perception toward hand hygiene among medical personnel. Infect Chemother. 2014;46(3):165–71. https://doi.org/10.3947/ic.2014.46.3.165.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Paotong D, Trakarnchansiri J, Phongsanon K, Churncharoen P, Sitaphong S, Poldee T, et al. Compliance with handwashing in a university hospital in Thailand. AJIC. 2003; https://doi.org/10.1067/mic.2003.37.

  55. Picheansathian W, Pearson A, Suchaxaya P. The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. Int J Nurs Pract. 2008;14(4):315–21. https://doi.org/10.1111/j.1440-172X.2008.00699.x.

    Article  PubMed  Google Scholar 

  56. Apisarnthanarak A, Eiamsitrakoon T, Mundy LM. Behavior-based interventions to improve hand hygiene adherence among intensive care unit healthcare workers in Thailand. Infect Control Hosp Epidemiol. 2015;36(5):517–21. https://doi.org/10.1017/ice.2015.1.

    Article  PubMed  Google Scholar 

  57. Salmon S, Tran HL, Bui DP, Pittet D, McLaws ML. Beginning the journey of hand hygiene compliance monitoring at a 2100-bed tertiary hospital in Vietnam. Am J Infect Control. 2014;42(1):71–3. https://doi.org/10.1016/j.ajic.2013.07.011.

    Article  PubMed  Google Scholar 

  58. Nguyen KV, Nguyen PT, Jones SL. Effectiveness of an alcohol-based hand hygiene programme in reducing nosocomial infections in the Urology Ward of Binh Dan Hospital. Vietnam. Trop Med Int Health. 2008;13(10):1297–302. https://doi.org/10.1111/j.1365-3156.2008.02141.x.

    Article  PubMed  Google Scholar 

  59. •• Thi Anh Thu L, Thi Hong Thoa V, Thi Van Trang D, Phuc Tien N, Van Thuy D, Thi Kim Anh L, et al. Cost-effectiveness of a hand hygiene program on health care-associated infections in intensive care patients at a tertiary care hospital in Vietnam. Am J Infect Control. 2015;43(12):e93–9. https://doi.org/10.1016/j.ajic.2015.08.006. This study assessed the effectiveness of a hand hygiene program through evaluating the impact of this program on reducing HAI in ICUs and CCUs, increasing level of compliance with hand hygiene by health care workers(HCWs), and cost-effectiveness. The program mainly focused on improving the setting and increasing the education. Hand hygiene education was also provided to patients and their families admitted to the ICUs and CCUs.

    Article  PubMed  Google Scholar 

  60. Thi Anh Thu L, Dibley MJ, Vo VN, Archibald L, Jarvis WR, Sohn AH. Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam. Infect Control Hosp Epidemiol. 2007;28(5):583–8. https://doi.org/10.1086/516661.

    Article  Google Scholar 

  61. •• WHO. Pilot testing in the WHO South-East Asia Region (SEAR). http://www.who.int/infection-prevention/countries/hand-hygiene/bangladesh/en/. Accessed 27 Aug 2017. This pilot testing in the WHO South-East Asia Region showed that a project of system change and the introduction of the alcohol-based hand rub were critical to overcome obstacles to hand hygiene performance. It also showed that commitment by the director and significant support by the head of the newly formed infection control committee as well as medical and nurse leadership was another success factor of the project.

  62. Ho ML, Seto WH, Wong LC, Wong TY. Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial. Infect Control Hosp Epidemiol. 2012;33(8):761–7. https://doi.org/10.1086/666740.

    Article  PubMed  Google Scholar 

  63. Seto WH, Cowling BJ, Cheung CW, Wong CY, Ching PT, Pittet D, et al. Impact of the first hand sanitizing relay world record on compliance with hand hygiene in a hospital. Am J Infect Control. 2015;43(3):295–7. https://doi.org/10.1016/j.ajic.2014.12.004.

    Article  PubMed  Google Scholar 

  64. Ansari S, Gupta P, Jais M, Nangia S, Gogoi S, Satia S, Raza MW. Assessment of the knowledge, attitude and practices regarding hand hygiene amongst the healthcare workers in a tertiary health care centre. Int J Phar Res Health Sci 2015; 3(3):720–726.

  65. Harsha Kumar H, Devi D. An epidemiological study on hand washing practices among health care workers in hospitals of Mangalore City. Natl J Commun Med. 2013;4(2).

  66. Sharma R, Sharma M, Koushal V. Hand washing compliance among healthcare staff in intensive care unit (ICU) of a multispecialty hospital of North India. J Hosp Adm. 2012;1(2). https://doi.org/10.5430/jha.v1n2p27.

  67. Diwan V, Gustafsson C, Klintz SR, Joshi SC, Sharma M, Shah H, Pathak A, et al. Understanding healthcare workers self-reported practices, knowledge and attitude about hand hygiene in a medical setting in rural India. PLoS ONE. 2016;11(10). https://doi.org/10.1371/journal.pone.0163347.

  68. • Li Y, Wang Y, Yan D, Rao CY. Self-reported hand hygiene practices, and feasibility and acceptability of alcohol-based hand rubs among village healthcare workers in Inner Mongolia, China. J Hosp Infect. 2015;90(4):338–43. https://doi.org/10.1016/j.jhin.2015.04.006. This study assessed the feasibility and acceptability of using alcohol-based hand rubs to perform hand hygiene and showed that it actually improved hand hygiene practice among users; however, the main barriers were cost and inconvenience of alcohol-based hand rub in the setting.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  69. Popp W, Badarch U, Tsevegjav A, Natsagdorj L, Ross B, Tsend-Ochir O, Tsolmon M, et al. Hospital hygiene in Mongolia and the MeshHp project. Int J Infect Control. 2013;9(2). https://doi.org/10.3396/IJIC.v9i2.018.13.

  70. Chen P, Yuan T, Sun Q, Jiang L, Jiang H, Zhu Z, et al. Role of quality control circle in sustained improvement of hand hygiene compliance: an observational study in a stomatology hospital in Shandong. China. Antimicrob Resist Infect Control. 2016;5:54. https://doi.org/10.1186/s13756-016-0160-1.

    Article  PubMed  Google Scholar 

  71. Xiang LL, Xie DS, Li R, Fu XY, Wang HF, Hu Q, et al. The effect of hand hygiene promotion in a University Hospital in China. J Nurs Care. 2014;3:6. https://doi.org/10.4172/2167-1168.1000211.

    Article  Google Scholar 

  72. Mu X, Xu Y, Yang T, Zhang J, Wang C, Liu W, et al. Improving hand hygiene compliance among healthcare workers: an intervention study in a hospital in Guizhou Province, China. Braz J Infect Dis. 2016;20(5):413–8. https://doi.org/10.1016/j.bjid.2016.04.009.

    Article  PubMed  Google Scholar 

  73. Su D, Hu B, Rosenthal VD, Li R, Hao C, Pan W, et al. Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in five intensive care units in three cities of China. Public Health. 2015;129(7):979–88. https://doi.org/10.1016/j.puhe.2015.02.023.

    Article  PubMed  CAS  Google Scholar 

  74. Yuan CT, Dembry LM, Higa B, Fu M, Wang H, Bradley EH. Perceptions of hand hygiene practices in China. J Hosp Infect. 2009;71(2):157–62. https://doi.org/10.1016/j.jhin.2008.09.017.

    Article  PubMed  CAS  Google Scholar 

  75. Santosaningsih D, Erikawati D, Santoso S, Noorhamdani N, Ratridewi I, Candradikusuma D, et al. Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study. Antimicrob Resist Infect Control. 2017;6:23. https://doi.org/10.1186/s13756-017-0179-y.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Marjadi B, McLaws ML. Hand hygiene in rural Indonesian healthcare workers: barriers beyond sinks, hand rubs and in-service training. J Hosp Infect. 2010;76(3):256–60. https://doi.org/10.1016/j.jhin.2010.06.021.

    Article  PubMed  CAS  Google Scholar 

  77. Kong K, Kong S. A quality improvement project in a hospital in rural Nepal—improving infection control practice using the ‘Plan, Do, Study, Act’ (PDSA) cycle. Int Journal Infect Control. 2013;9(3). https://doi.org/10.3396/IJIC.v9i3.025.13.

  78. Oh E, Mohd Hamzah HB, Chain Yan C, Ang E. Enhancing hand hygiene in a polyclinic in Singapore. Int J Evid Based Healthc. 2012;10(3):204–10. https://doi.org/10.1111/j.1744-1609.2012.00277.x.

    Article  PubMed  Google Scholar 

  79. Ling ML, How KB. Impact of a hospital-wide hand hygiene promotion strategy on healthcare-associated infections. Antimicrob Resist Infect Control. 2012;1(1):13. https://doi.org/10.1186/2047-2994-1-13.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Chen JK, Wu KS, Lee SS, Lin HS, Tsai HC, Li CH, et al. Impact of implementation of the World Health Organization multimodal hand hygiene improvement strategy in a teaching hospital in Taiwan. Am J Infect Control. 2016;44(2):222–7. https://doi.org/10.1016/j.ajic.2015.10.004.

    Article  PubMed  Google Scholar 

  81. Chen YC, Sheng WH, Wang JT, Chang SC, Lin HC, Tien KL, et al. Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections. PLoS ONE. 2011;6(11):e27163. https://doi.org/10.1371/journal.pone.0027163.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  82. Pan SC, Chen E, Tien KL, Hung IC, Sheng WH, Chen YC et al. Assessing the thoroughness of hand hygiene: “seeing is believing”. Am J Infect Control 2014; 42(7):799–801. doi:https://doi.org/10.1016/j.ajic.2014.03.003.

  83. Liu WI, Liang SY, Wu SF, Chuang YH. Hand hygiene compliance among the nursing staff in freestanding nursing homes in Taiwan: a preliminary study. Int J Nurs Pract. 2014;20(1):46–52. https://doi.org/10.1111/ijn.12120.

    Article  PubMed  Google Scholar 

  84. WHO. WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. Geneva: WHO Guidelines Approved by the Guidelines Review Committee; 2009.

    Google Scholar 

  85. WHO. Guide to local production: WHO-recommended handrub formulations. 2010. http://www.who.int/gpsc/5may/Guide_to_Local_Production.p Accessed 23 Aug 2017.

  86. WHO. A guide to the implementation of the WHO multimodal Hand Hygiene Improvement Strategy. Geneva; 2009.

  87. Ahmed QA, Memish ZA, Allegranzi B, Pittet D, Challenge WHOGPS. Muslim health-care workers and alcohol-based handrubs. Lancet. 2006;367(9515):1025–7. https://doi.org/10.1016/S0140-6736(06)68431-6.

    Article  PubMed  Google Scholar 

  88. Infection Control Africa Network. Turn Africa orange. www.icanetwork.co.za/projects/turn-africa-orange/.

  89. Balkhy HH, Assiri AM, Mousa HA, Al-Abri SS, Al-Katheeri H, Alansari H, et al. The strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States. J Infect Public Health. 2016;9(4):375–85. https://doi.org/10.1016/j.jiph.2016.03.003.

    Article  PubMed  Google Scholar 

  90. Sax H, Allegranzi B, Uckay I, Larson E, Boyce J, Pittet D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect. 2007;67(1):9–21. https://doi.org/10.1016/j.jhin.2007.06.004.

    Article  PubMed  CAS  Google Scholar 

  91. Neves ZCP, Tipple AFV, Souza ACS, Pereira MS, Melo DS, Ferreira L. Hand hygiene: the impact of incentive strategies on adherence among healthcare workers from a newborn intensive care unit. Rev Latino-am Enfermagem. 2006;14(4):546–52.

    Article  Google Scholar 

  92. Hajbaghery MS, M. A model for empowerment of nursing in Iran. BMC Health Serv Res. 2005;5(1):24. https://doi.org/10.1186/1472-6963-5-24.

    Article  Google Scholar 

  93. • Ferguson SL, Al Rifai F, Maay’a M, Nguyen LB, Qureshi K, Tse AM, et al. The ICN Leadership For Change Programme—20 years of growing influence. Int Nurs Rev. 2016;63(1):15–25. https://doi.org/10.1111/inr.12248. This paper discusses the International Council of Nurses’ Leadership for Change programme launched in 1996 in order to strengthen leadership skills among nurses and broaden the positive impact of nursing on health systems. Being the backbone of our healthcare systems, empowering nurses would definitely be a major step in implementing different infection prevention strategies such as hand hygiene in developing countries.

    Article  PubMed  PubMed Central  Google Scholar 

  94. McGuckin M, Storr J, Longtin Y, Allegranzi B, Pittet D. Patient empowerment and multimodal hand hygiene promotion: a win-win strategy. Am J Med Qual. 2011;26(1):10–7. https://doi.org/10.1177/1062860610373138.

    Article  PubMed  Google Scholar 

  95. •• Zahreddine N, Tannous J, Kardas T, Ahmadieh R, Kanafani Z, Kanj SS. The impact of surveillance cameras in improving infection control practices and outcomes in an adult medical-surgical ICU in a Lebanese tertiary care center. Antimicrob Resist Infect Control. 2017;6(Suppl 3):P122. https://doi.org/10.1186/s13756-017-0201-4. This study proved that compliance with infection control practices improves when healthcare workers know that they are being observed. It also has shown that proper hand hygiene practices and decreased colonization pressure, both lead to a decline in rates of infections and colonization in intensive care units. It concludes that enhanced infection control measures can be sustained using surveillance cameras combined with a comprehensive plan to protect the safety of critically ill patients.

    Article  Google Scholar 

  96. Best practices for hand hygiene in all health care settings. 4th edition ed. April 2014.

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Correspondence to Madonna J. Matar MD, MPH.

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This article is part of the Topical Collection on Infection Prevention and Safety in Low and Middle Income Countries

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Matar, M.J., Moghnieh, R.A., Awad, L.S. et al. Effective Strategies for Improving Hand Hygiene in Developing Countries. Curr Treat Options Infect Dis 10, 310–329 (2018). https://doi.org/10.1007/s40506-018-0152-1

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