BACKGROUND Healthcare-associated infections are the most frequent adverse events in healthcare worldwide, with limited available evidence suggesting highest burden in resource-limited settings. Recent Ebola epidemics emphasize the disastrous impact that spread of infectious agents within healthcare facilities can have, accentuating the need for improvement of infection control practices. Hand hygiene (HH) measures are considered to be the most effective tool to prevent healthcare-associated infections. However, HH knowledge and compliance are low, especially in vulnerable settings such as Guinea. The aim of PASQUALE (Partnership to Improve Patient Safety and Quality of Care) was to assess knowledge and compliance with HH and improve HH by incorporating the WHO HH Strategy within the Faranah Regional Hospital (FRH), Guinea. METHODS In a participatory approach, a team of FRH staff and leadership was invited to identify priorities of the hospital prior to the start of PASQUALE. The local hygiene committee was empowered to increase its activities and take ownership of the HH improvement strategy. A baseline assessment of knowledge, perception and compliance was performed months before the intervention. The main intervention consisted of local alcohol-based-hand-rub (ABHR) production, with final product efficacy testing, in conjunction with a training adapted to the needs identified in the baseline assessment. A follow-up assessment was conducted directly after the training. Effectiveness of the intervention was assessed via uncontrolled before-and-after comparison. RESULTS Baseline knowledge score (13.0/25) showed a significant increase to 19.0/25 in follow-up. Baseline-Compliance was 23.7% and increased significantly to 71.5% in follow-up. Compliance rose significantly across all professional groups except for midwifes and in all indications for HH, with the largest in the indication "Before aseptic tasks". The increase in compliance was associated with the intervention and remained significant after adjusting for confounders. The local pharmacy successfully supplies the entire hospital. The local supply resulted in a ten-fold increase of monthly hospital disinfectant consumption. CONCLUSION The WHO HH strategy is an adaptable and effective method to improve HH knowledge and compliance in a resource-limited setting. Local production is a feasible method for providing self-sufficient supply of ABHR to regional hospitals like the FRH. Participatory approaches like hygiene committee ownership builds confidence of sustainability.

中文翻译：

---

在几内亚法拉纳地区医院实施世卫组织手部卫生战略。

背景技术与医疗保健相关的感染是全世界医疗保健中最常见的不良事件，有限的可用证据表明资源有限的环境中负担最高。最近的埃博拉疫情凸显了医疗机构内传染源传播可能造成的灾难性影响，凸显了改进感染控制措施的必要性。手卫生 (HH) 措施被认为是预防医疗保健相关感染的最有效工具。然而，家庭户的知识和合规性较低，尤其是在几内亚等脆弱地区。PASQUALE（提高患者安全和护理质量的伙伴关系）的目的是评估对 HH 的了解和遵守情况，并通过在几内亚法拉纳地区医院 (FRH) 纳入世卫组织 HH 战略来改善 HH。方法 采用参与式方法，邀请 FRH 工作人员和领导团队在 PASQUALE 启动之前确定医院的优先事项。当地卫生委员会被授权增加其活动并负责 HH 改进策略。在干预前几个月进行了知识、感知和依从性的基线评估。主要干预措施包括当地酒精类洗手液 (ABHR) 的生产、最终产品功效测试以及根据基线评估中确定的需求进行的培训。培训结束后立即进行跟踪评估。通过不受控制的前后比较来评估干预的有效性。结果 基线知识评分 (13.0/25) 在随访中显着提高至 19.0/25。基线依从率为 23.7%，并在随访中显着增加至 71.5%。除助产士外，所有专业群体以及 HH 的所有适应症的依从性均显着提高，其中最大的是“无菌任务之前”的适应症。依从性的增加与干预有关，并且在调整混杂因素后仍然显着。当地药房成功地为整个医院供货。当地供应导致医院每月的消毒剂消耗量增加了十倍。结论 世界卫生组织 HH 战略是一种适应性强且有效的方法，可在资源有限的环境中提高 HH 知识和依从性。本地生产是向 FRH 等地区医院提供自给自足的 ABHR 供应的可行方法。卫生委员会所有权等参与性方法可以建立对可持续发展的信心。