{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:34:14Z","timestamp":1791858854344,"version":"4.3.4"},"reference-count":35,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Alcohol-based hand rub (ABHR) is an effective hand hygiene measure to mitigate and prevent infectious disease transmission in healthcare facilities (HCFs); however, availability and affordability in low- and middle-income countries are limited. We sought to establish centralized local production of ABHR using a district-wide approach to increase provider access at all public HCFs in Kabarole and Kasese Districts in Western Uganda. Partner organizations worked with district governments to adapt and implement the WHO protocol for local ABHR production at the district scale. These groups identified and upgraded sites for ABHR production and storage to ensure recommended security, ventilation, and air conditioning. District governments selected technicians for training on ABHR production. Raw materials were sourced within Uganda. Alcohol-based hand rub underwent internal quality control by the production officer and external quality control (EQC) by a trained district health inspector before distribution to HCFs. We assessed ABHR production and demand from March 2019 to December 2020. All ABHR batches (<jats:italic>N<\/jats:italic> = 316) met protocol standards (alcohol concentration: 75.0\u201385.0%) with a mean of 79.9% (range: 78.5\u201380.5%). Internal quality control measurements (mean alcohol concentration: 80.0%, range: 79.5\u201381.0%) matched EQC measurements (mean: 79.8%, range: 78.0\u201380.0%). Production units supplied ABHR to 127 HCFs in Kasese District (100%) and 31 HCFs in Kabarole District (56%); 94% of HCFs were small (dispensary or next higher level). This district-wide production met quality standards and supplied ABHR to many HCFs where facility-level production would be unfeasible. Low- and middle-income countries may consider district models to expand ABHR production and supply to smaller HCFs.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0554","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T13:49:23Z","timestamp":1684158563000},"page":"191-200","source":"Crossref","is-referenced-by-count":20,"title":["Improving Access to WHO Formulations of Alcohol-Based Hand Rub in Healthcare Facilities: A District-Wide Approach"],"prefix":"10.4269","volume":"109","author":[{"given":"Fred","family":"Tusabe","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Nanyondo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Lozier","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Kesande","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olive","family":"Tumuhairwe","sequence":"additional","affiliation":[{"name":"Kabarole District Health Office, Kabarole District Local Government, Fort Portal, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Watsisi","sequence":"additional","affiliation":[{"name":"International Water & Sanitation Centre \u2013 WASH, Fort Portal, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Twinomugisha","sequence":"additional","affiliation":[{"name":"Makerere University School of Public Health, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Medley","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Mutoro","sequence":"additional","affiliation":[{"name":"Kasese District Health Office, Kasese, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Lamorde","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Berendes","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Int J Infect Dis","first-page":"3","article-title":"Hand hygiene: simple and complex","volume":"9","author":"Jumaa","year":"2005"},{"key":"b2","series-title":"WHO Guidelines on Hand Hygiene in Health Care","year":"2009"},{"key":"b3","series-title":"J Matern Fetal Neonatal Med","first-page":"23","article-title":"Prevention of nosocomial infections and surveillance of emerging resistances in NICU","volume":"24","author":"Cipolla","year":"2011"},{"key":"b4","series-title":"Infect Control Hosp Epidemiol","first-page":"891","article-title":"Clean care is safer care: the first global challenge of the WHO World 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