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Changes in Access to Alcohol-Based Hand Rub and Hand Hygiene Adherence among Healthcare Workers after a Hand Rub Production and Distribution Program in Rural Uganda before and during the COVID-19 Pandemic
Kanako Ishida
Kanako Ishida
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;
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Matthew Lozier
Matthew Lozier
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;
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Alexandra M. Medley
Alexandra M. Medley
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;
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Victoria Trinies
Victoria Trinies
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;
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Christiana Hug
Christiana Hug
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;
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Carrie Ripkey
Carrie Ripkey
CDC Foundation, Atlanta, GA;
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Maureen Kesande
Maureen Kesande
Infectious Disease Institute, Makerere University, Kampala, Uganda;
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Fred Tusabe
Fred Tusabe
Infectious Disease Institute, Makerere University, Kampala, Uganda;
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Sauda Yapswale
Sauda Yapswale
Infectious Disease Institute, Makerere University, Kampala, Uganda;
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Francis Ocitti
Francis Ocitti
Infectious Disease Institute, Makerere University, Kampala, Uganda;
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Herbert Isabirye
Herbert Isabirye
Infectious Disease Institute, Makerere University, Kampala, Uganda;
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Judith Nanyondo
Judith Nanyondo
Infectious Disease Institute, Makerere University, Kampala, Uganda;
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Martin Watsisi
Martin Watsisi
IRC International Water and Sanitation Centre, Kabarole District, Uganda
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Mohammed Lamorde
Mohammed Lamorde
Infectious Disease Institute, Makerere University, Kampala, Uganda;
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David Berendes
David Berendes
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;
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During the COVID-19 pandemic, the use of alcohol-based hand rubs (ABHRs) was critical for improving hand hygiene (HH) among healthcare workers (HCWs). Before and during the pandemic, we supported district-led production and district-wide distribution of ABHRs and one-time provision of portable handwashing stations to select healthcare facilities (HCFs) in five rural districts in Uganda. Comparison between baseline and follow-up assessments showed an overall increase in access to HH materials and HH adherence (HHA; handwashing with soap and water or use of ABHR) among HCWs. However, large differences in the changes in HH material coverage and HHA across districts may have been heavily influenced by the COVID-19 disease burden and its risk perception when the assessments were conducted. Using data collected at multiple time points before and during the pandemic across districts and estimating and controlling for pandemic effects in an exploratory multivariate analysis, the adjusted odds ratio of HHA in district HCFs was 4.6 (95% CI: 1.8–11.8) after (versus before) the ABHR intervention. This increase appeared to be primarily in larger HCFs, where the perceived need for ABHRs may have been greater. Additional strategies are needed to further increase HHA, especially in the smallest HCFs, among laboratory technicians and nurses and before patient contact. However, district-scale ABHR interventions seemed successful in ensuring the continued availability of HH materials.
Author Notes
Financial support: The implementation and evaluation of the study were funded by the Division of Food and Environmental Diseases and Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, the
Disclosure: 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: Kanako Ishida, Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), E-mail: kanakoi@g.ucla.edu. Matthew Lozier, Alexandra M. Medley, Victoria Trinies, Christiana Hug, Carrie Ripkey, and David Berendes, CDC, Atlanta, GA, E-mails: wfu2@cdc.gov, muv3@cdc.gov, omo3@cdc.gov, tjv6@cdc.gov, ogh0@cdc.gov, and uws8@cdc.gov. Maureen Kesande, Fred Tusabe, Sauda Yapswale, Francis Ocitti, Herbert Isabirye, Judith Nanyondo, and Mohammed Lamorde, Infectious Disease Institute, Makerere University, Kampala, Uganda, E-mails: mohalamorde@yahoo.co.uk, ftusabe@idi.co.ug, yapswale@gmail.com, focitti8@gmail.com, hisabirye@idi.co.ug, jnanyondo@idi.co.ug, and mlamorde@idi.co.ug. Martin Watsisi, IRC-WASH, Kampala, Uganda, E-mail: watsisi@ircwash.org.
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