{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:47:30Z","timestamp":1793256450855,"version":"4.5.0"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2023,12,14]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Hand hygiene (HH) is one of the core components of infection prevention and control and is critical for a high quality of care. Multimodal approaches are recommended to strengthen and drive HH systems in healthcare facilities (HCFs). We aimed to assess the extent of implementation of the WHO HH multimodal improvement strategy in HCFs in the Eastern Region of Ghana.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study was a descriptive cross-sectional study involving 22 HCFs from 17 districts in the Eastern Region of Ghana. We collected data from 22 hospitals using the WHO Hand Hygiene Self-Assessment Framework (HHSAF). Data were analysed through descriptive statistics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The HHSAF median score denotes an intermediate HH implementation level (53.5%, IQR 48.8%\u201358.3%). Fourteen HCFs attained an intermediate level, five attained basic level, one attained advanced level and no facility exhibited inadequate HH implementation level. Evaluation and feedback had the highest score (64.3%, IQR 50%\u201371.4%), as ward-based audits for the availability of HH resources have become standard practice in many of the HCFs. Reminders in the workplace had the lowest score (33.3%, IQR 25.9%\u201337.0%), whereby less than half (46%) of the HCFs had posters explaining the indications for HH and the correct use of alcohol-based hand rubs. HH implementation level did not differ significantly among government (M=49.97, SD=12.30) and non-government (M=53.32, SD=18.73) facilities, (t (20)=\u22120.503, p=0.621).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Most HCFs had an intermediate HH implementation level. The provision of HH resources, including posters, HH rounds in patient care areas, introduction of HH corners, leadership, financial and organisational support are key elements for increased compliance with the WHO HH multimodal improvement strategy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2023-000606","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T12:25:55Z","timestamp":1707135955000},"page":"e000606","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Multimodal strategies to hand hygiene in Ghanaian hospitals: a cross-sectional study in the Eastern Region of Ghana"],"prefix":"10.1136","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9833-2676","authenticated-orcid":false,"given":"Stephen Dajaan","family":"Dubik","sequence":"first","affiliation":[{"name":"School of Allied Health Sciences, University for Development Studies, Tamale, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kingsly E","family":"Amegah","sequence":"additional","affiliation":[{"name":"Department of Data Science and Economic Policy, University of Cape Coast, Cape Coast, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ama Akyampomaa","family":"Owusu-Asare","sequence":"additional","affiliation":[{"name":"World Health Organization Country Office, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akosua Takyiwa","family":"Kwakye","sequence":"additional","affiliation":[{"name":"World Health Organization Country Office, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiana","family":"Akufo","sequence":"additional","affiliation":[{"name":"Department of Quality Assurance, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Amponsah","sequence":"additional","affiliation":[{"name":"Department of Quality Assurance, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hectoria","family":"Awekeya","sequence":"additional","affiliation":[{"name":"Eastern Regional Health Directorate, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Vander Puije","sequence":"additional","affiliation":[{"name":"Eastern Regional Health Directorate, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Asibey","sequence":"additional","affiliation":[{"name":"Eastern Regional Health Directorate, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Twum","sequence":"additional","affiliation":[{"name":"Eastern Regional Health Directorate, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis Mensa","family":"Akwetey","sequence":"additional","affiliation":[{"name":"Eastern Regional Health Directorate, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Portia","family":"Sam","sequence":"additional","affiliation":[{"name":"Eastern Regional Health Directorate, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfred","family":"Ofosu","sequence":"additional","affiliation":[{"name":"Eastern Regional Health Directorate, Ghana Health Service, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Ackon","sequence":"additional","affiliation":[{"name":"World Health Organization Country Office Ghana, Accra, 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National policy and guidelines for infection prevention and control in health care settings; 2015."},{"key":"2025083109454785000_2.1.e000606.26","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.ajic.2010.09.016","article-title":"Observation-based evaluation of hand hygiene practices and the effects of an intervention at a public hospital cafeteria","volume":"39","author":"Filion","year":"2011","journal-title":"Am J Infect Control"},{"key":"2025083109454785000_2.1.e000606.27","doi-asserted-by":"crossref","first-page":"398","DOI":"10.2166\/washdev.2021.254","article-title":"Evaluation of water, sanitation and hygiene status of COVID-19 healthcare facilities in Ghana using the WASH FIT approach","volume":"11","author":"Ashinyo","year":"2021","journal-title":"J Water Sanit Hyg Dev"},{"key":"2025083109454785000_2.1.e000606.28","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.2147\/RMHP.S269315","article-title":"Strategies to prevent healthcare-associated infections: a narrative overview","volume":"13","author":"Haque","year":"2020","journal-title":"Risk Manag Healthc Policy"},{"key":"2025083109454785000_2.1.e000606.29","doi-asserted-by":"crossref","first-page":"4263","DOI":"10.2147\/IDR.S273851","article-title":"Infection prevention and control preparedness level and associated determinants in 56 acute healthcare facilities in Ghana","volume":"13","author":"Oppong","year":"2020","journal-title":"Infect Drug Resist"},{"key":"2025083109454785000_2.1.e000606.30","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19095275","article-title":"Infection prevention and control in three tertiary healthcare facilities in freetown, Sierra Leone during the COVID-19 Pandemic: more needs to Be Done!","volume":"19","author":"Kamara","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025083109454785000_2.1.e000606.31","doi-asserted-by":"crossref","first-page":"129","DOI":"10.2166\/h2oj.2021.095","article-title":"Water, sanitation, and hygiene (WASH) in healthcare facilities of 14 low- and middle-income countries: to what extent is WASH implemented and what are the \u2018drivers\u2019 of improvement in their service levels?","volume":"4","author":"Kmentt","year":"2021","journal-title":"H2Open Journal"},{"key":"2025083109454785000_2.1.e000606.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-018-3029-5","article-title":"An educational intervention to improve hand hygiene compliance in Vietnam","volume":"18","author":"Phan","year":"2018","journal-title":"BMC Infect Dis"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2023-000606","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T16:46:01Z","timestamp":1756658761000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2023-000606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,2,5]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bmjph-2023-000606"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2023-000606","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}