title: Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa.
abstract: OBJECTIVE
  To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country.
  
  
  METHODS
  A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention.
  
  
  METHODS
  University Hospital, Bamako, Mali. Participants. Two hundred twenty-four healthcare workers.
  
  
  METHODS
  The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up.
  
  
  RESULTS
  Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P < .001). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly (P < .05), and perception surveys showed a high appreciation of each strategy component by staff.
  
  
  CONCLUSIONS
  Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.
authors.affiliation: World Health Organization Patient Safety, Geneva, Switzerland.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Allegranzi
authors.forename: Hugo
authors.initials: H
authors.lastname: Sax
authors.forename: Loséni
authors.initials: L
authors.lastname: Bengaly
authors.forename: Hervé
authors.initials: H
authors.lastname: Richet
authors.forename: Daouda K
authors.initials: DK
authors.lastname: Minta
authors.forename: Marie-Noelle
authors.initials: MN
authors.lastname: Chraiti
authors.forename: Fatoumata Maiga
authors.initials: FM
authors.lastname: Sokona
authors.forename: Angèle
authors.initials: A
authors.lastname: Gayet-Ageron
authors.forename: Pascal
authors.initials: P
authors.lastname: Bonnabry
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods*; D006282:Health Personnel; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000379:methods / Q000458:organization & administration; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D008302:Mali; D015397:Program Evaluation; D012017:Referral and Consultation; D014944:World Health Organization