World Health Organization Multimodal Improvement Strategy for Hand Hygiene

What is the long-term impact of the World Health Organization (WHO) multimodal improvement strategy (MMIS) for hand hygiene, combined with locally manufactured alcohol-based handrub (ABHR), in resource-limited settings? In this stepped-wedge cluster randomized trial with 27 895 hand hygiene opportunities observed across 8 health care facilities in eastern Uganda, hand hygiene adherence among health care workers increased by more than 50% during the intervention phase and remained high during the follow-up phase, compared with baseline. These findings support the scalability of the WHO MMIS approach for hand hygiene with locally manufactured ABHR at regional and national levels in resource-limited health care settings.

Corresponding Author: Hiroki Saito, MD, MPH, PhD, Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan (hiroki.saito@marianna-u.ac.jp).

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