Article Category:
Research Article

Hand Hygiene Knowledge and Hand Dirtiness Assessment to Inform Alcohol-Based Hand Rub Appropriateness in Community Settings in Uganda and Kenya

Christiana Hug Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Evelyn Makena Mugambi Washington State University, Nairobi, Kenya;

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Maureen Kesande Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda;

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Caroline Pratt Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Lorna Maru Washington State University, Nairobi, Kenya;

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Raymond Odinoh Washington State University, Nairobi, Kenya;

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Fred Tusabe Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda;

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Matthew J. Lozier Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Victoria Trinies Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Graeme Prentice-Mott Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Alexandra Medley Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

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Alexandra Kossik Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Isaac Ngere Washington State University, Nairobi, Kenya;

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M. Kariuki Njenga Washington State University, Nairobi, Kenya;

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Mohammed Lamorde Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda;

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David Berendes Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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DOI:
https://doi.org/10.4269/ajtmh.24-0124
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Ahead of Print
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During the coronavirus disease 2019 pandemic, alcohol-based hand rub (ABHR) availability and use increased as a prevention measure. ABHR is a convenient, effective way to kill microbes on hands but is hampered by the presence of organic material, whereas handwashing with water and soap (HWWS) can physically remove microbes and dirt. Although ABHR is preferred in most health care settings, the suitability of ABHR use in community settings has not been measured. We compared characteristics between community members and health care personnel (HCP) to inform considerations for promoting ABHR in community settings. We included data from community locations and health care facilities in Kenya and Uganda collected between 2021 and 2022. Hand dirtiness swabs were measured using the Quantitative Personal Hygiene Assessment Tool (qPHAT), a visual scale where 0 is very visibly dirty and 10 is no visible dirt. Participants were also asked about the appropriate method to use when hands were visibly dirty. Hand swabs were collected from HCP and community members. Both groups had median qPHAT scores of five. Neither the adjusted odds of having a qPHAT score less than or equal to five (1.4, 95% CI: 0.8–2.2) nor the adjusted odds of responding correctly to the knowledge question (0.8, 95% CI: 0.4–1.4) differed significantly by setting. People in community settings may, therefore, have comparable hand dirtiness and knowledge of appropriate hand hygiene practices to use ABHR as a HWWS complement. Further investigation into guidance and use of supportive messaging should be considered as completed elsewhere.

Author Notes

Financial support: Portions of this project were supported via an Interagency Agreement with the U.S. Agency for International Development.

Disclosures: The data collection protocol was reviewed by institutional review boards at the Kenya Medical Research Institute (Protocol No. SERU 4323), the Uganda Infectious Diseases Institute and Uganda National Council for Science and Technology, and at the CDC with a determination to be nonresearch (CDC Project ID 0900f3eb81e62919). The authors declare no competing financial interests. The findings and conclusions of this paper are those of the authors and do not necessarily represent the official position of the CDC.

Current contact information: Christiana Hug, Caroline Pratt, Matthew J. Lozier, Victoria Trinies, Graeme Prentice-Mott, Alexandra Medley, Alexandra Kossik, and David Berendes, Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, E-mails: tjv6@cdc.gov, cqpratt@gmail.com, wfu2@cdc.gov, omo3@cdc.gov, qbt1@cdc.gov, muv3@cdc.gov, spj0@cdc.gov, and uws8@cdc.gov. Evelyn Makena Mugambi, Lorna Maru, Raymond Odinoh, Isaac Ngere, and M. Kariuki Njenga, Washington State University, Nairobi, Kenya, E-mails: evelyn.mugambi@wsu.edu, lorna.maru@wsu.edu, raymond.odinoh@wsu.edu, isaac.ngere@wsu.edu, and mkariuki.njenga@wsu.edu. Maureen Kesande, Fred Tusabe, and Mohammed Lamorde, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda, E-mails: mkesande@idi.co.ug, ftusabe@idi.co.ug, and mlamorde@idi.co.ug.

Address correspondence to Christiana Hug, Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329. E-mail: tjv6@cdc.gov
Copyright:
© American Society of Tropical Medicine and Hygiene 2024
Received:
20 Feb 2024
|
Accepted:
11 Sep 2024
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Published Online:
03 Dec 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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