Compliance with guidelines on hand hygiene (HH) is pivotal to prevent and control health-care associated infections and contributes to mitigating antimicrobial resistance. A baseline assessment in Dodoma region, Tanzania in March 2018 showed inadequate HH levels across health care facilities. We evaluated the impact of training in HH as part of a water, sanitation and hygiene (WASH) interventions of “Maji kwa Afya ya Jamii” (MKAJI) project. A comparative HH assessment was conducted in June 2019 involving health care facilities under MKAJI project (n = 87 from which 98 units were assessed) vs non-MKAJI facilities (n = 85 from which 99 units were assessed). Irrespective of MKAJI interventional status, baseline assessment in March 2018 were compared to re-assessment in June 2019 in all health care facility units (unpaired comparison: 261 vs 236 units, respectively), and in facilities assessed in both surveys (paired comparison: 191 versus 191 units, respectively). The ‘WHO HH Self-Assessment Framework Tool, 2010’ with five indicators each counting 100 points was used. The cumulative scores stratified each health facility’s unit into inadequate (0–125), basic (126–250), intermediate (251–375) or advanced (376–500) HH level (score). The HH compliance rates were also assessed and compared. The overall post-intervention median HH score [interquartile range (IQR)] was 187.5 (112.5–260). MKAJI health facilities had significantly higher median HH scores (IQR) [190 (120–262.5)] compared with non-MKAJI facilities [165 (95–230); p = 0.038]. Similarly, the HH compliance rate of ≥51% was significantly higher in MKAJI than non-MKAJI facilities [56.1% versus 30.3%; chi2 = 13.39, p < 0.001]. However, the recommended WHO compliance rate of ≥81% was only reached by 6.1 and 3.0% units of MKAJI and non-MKAJI facilities, respectively. Both paired and unpaired comparisons during baseline and re-assessment surveys showed increase in HH level from inadequate to basic level. The overall HH level after the combined WASH and training intervention was at basic level. Higher median HH scores (IQR) and HH compliance rates were evident in health facilities of the MKAJI project, underscoring the impact of the intervention and the potential value of a national roll-out.

中文翻译：

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手卫生干预的影响：使用世界卫生组织方法在坦桑尼亚多多玛地区的卫生保健机构进行的比较研究。

遵守手部卫生（HH）准则对于预防和控制与卫生保健相关的感染至关重要，并有助于减轻抗菌素耐药性。2018年3月在坦桑尼亚Dodoma地区进行的基线评估显示，各医疗机构的HH水平不足。作为“ Maji kwa Afya ya Jamii”（MKAJI）项目的水，环境卫生（WASH）干预措施的一部分，我们评估了HH培训的影响。2019年6月，对MKAJI项目下的医疗保健设施（n = 87个，评估了98个单位）进行了比较HH评估，其中非MKAJI项目（n = 85，评估了99个单位）。不论MKAJI的干预状态如何，将2018年3月的基线评估与2019年6月所有医疗机构的重新评估进行了比较（未配对比较：261 vs 236，）和两次调查中评估的设施（配对比较：分别为191个和191个单位）。使用了“ 2010年世卫组织HH自我评估框架工具”，其中包含五个指标，每个指标均计100分。累积分数将每个医疗机构的单位分为不适当的（0–125），基本（126–250），中级（251–375）或高级（376–500）HH水平（得分）。还对HH符合率进行了评估和比较。干预后总体HH中位数[四分位间距（IQR）]为187.5（112.5-260）。与非MKAJI机构[165（95-230）]相比，MKAJI卫生机构的中位HH分数（IQR）[190（120–262.5）]高得多。p ＝ 0.038]。同样，MKAJI的HH达标率≥51％显着高于非MKAJI的设施[56.1％对30.3％；chi2 ＝ 13.39，p ＜0.001]。然而，MKAJI和非MKAJI设施分别仅达到6.1和3.0％的推荐WHO达标率≥81％。基线和重新评估调查期间的配对和非配对比较均显示，HH水平从不足水平增加到基本水平。WASH和培训干预相结合后的总体HH水平处于基本水平。在MKAJI项目的医疗机构中，HH中位数（IQR）和HH达标率明显较高，这突出说明了干预措施的影响和全国推广的潜在价值。WASH和培训干预相结合后的总体HH水平处于基本水平。在MKAJI项目的医疗机构中，HH中位数（IQR）和HH达标率明显较高，这突出说明了干预措施的影响和全国推广的潜在价值。WASH和培训干预相结合后的总体HH水平处于基本水平。在MKAJI项目的医疗机构中，HH中位数（IQR）和HH达标率明显较高，这突出说明了干预措施的影响和全国推广的潜在价值。