title: Local production of WHO-recommended alcohol-based handrubs: feasibility, advantages, barriers and costs.
abstract: OBJECTIVE
  Reduction of health-care-associated infections in low- and middle-income countries is hampered by inadequate supplies of soap and water and the lack or high cost of alcohol-based handrubs (ABHs).
  
  
  METHODS
  In 2005, the World Health Organization (WHO) developed and tested two formulations for ABHs that were suitable for production in health-care facilities. In 2011, the feasibility, advantages and costs of the local production of the two formulations - and the barriers to such production - were evaluated in an online survey.
  
  
  METHODS
  The survey included 34 health-care facilities and 5 private companies in 29 countries.
  
  
  RESULTS
  Local production of one of the WHO formulations was feasible in every participating site. Twenty-one (54%) of the sites had replaced a previously used ABH with one of the WHO formulations. In 32 sites, the WHO formulation that had been produced was well tolerated and accepted by health-care workers. The WHO formulations were found to be less expensive than marketed ABHs. Barriers to local production included difficulty in identifying staff with adequate skills, the need for staff training, and constraints in ingredient and dispenser procurement.
  
  
  CONCLUSIONS
  The WHO formulations can be easily produced locally at low cost. They are well tolerated and accepted by health-care workers. Potential barriers to their local production - such as their smell and problems in the procurement of ingredients and dispensers and in performing quality control - require further investigation.
authors.affiliation: Institute of Tropical Medicine and International Health at Charité - Universitätsmedizin, Berlin, Germany .
authors.forename: Joanna
authors.initials: J
authors.lastname: Bauer-Savage
authors.affiliation: Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland .
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
authors.affiliation: Harvard School of Public Health, Boston, United States of America .
authors.forename: Eunmi
authors.initials: E
authors.lastname: Kim
authors.affiliation: Patient Safety, World Health Organization, Geneva, Switzerland .
authors.forename: Benedetta
authors.initials: B
authors.lastname: Allegranzi
mesh_terms: D019840:2-Propanol; D003428:Cross Infection / Q000517:prevention & control*; D003906:Developing Countries; D000431:Ethanol; D014943:Global Health; D006235:Hand Disinfection / Q000379:methods*; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods*; D066192:Manufacturing Industry / Q000458:organization & administration* / Q000706:statistics & numerical data; D014944:World Health Organization
chemical_list: D000431:Ethanol; D019840:2-Propanol