{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:35:05Z","timestamp":1790922905779,"version":"4.1.0"},"reference-count":33,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"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":[[2024,12,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>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\u201311.8) 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.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0040","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T13:32:01Z","timestamp":1726666321000},"page":"1343-1352","source":"Crossref","is-referenced-by-count":8,"title":["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"],"prefix":"10.4269","volume":"111","author":[{"given":"Kanako","family":"Ishida","sequence":"first","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Lozier","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra M.","family":"Medley","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Trinies","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiana","family":"Hug","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Ripkey","sequence":"additional","affiliation":[{"name":"CDC Foundation, Atlanta, GA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Kesande","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Tusabe","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sauda","family":"Yapswale","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Ocitti","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Isabirye","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Nanyondo","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Watsisi","sequence":"additional","affiliation":[{"name":"IRC International Water and Sanitation Centre, Kabarole District, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Lamorde","sequence":"additional","affiliation":[{"name":"Infectious Disease 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, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Cutis","first-page":"233","article-title":"Hand hygiene in preventing COVID-19 transmission","volume":"105","author":"Gupta","year":"2020"},{"key":"b2","series-title":"J Popul Ther Clin Pharmacol","first-page":"e37","article-title":"Handwashing in averting infectious diseases: Relevance to COVID-19","volume":"27","author":"Haque","year":"2020"},{"key":"b3","series-title":"J Hosp Infect","first-page":"776","article-title":"Hand hygiene and the novel coronavirus pandemic: The role of healthcare workers","volume":"105","author":"Lotfinejad","year":"2020"},{"key":"b4","series-title":"J Infect","first-page":"318","article-title":"The economics of infection prevention: Why it is crucial to invest in hand hygiene and nurses during the novel coronavirus pandemic","volume":"81","author":"Peters","year":"2020"},{"key":"b5","series-title":"J Prim Care Community Health","first-page":"2150132720943331","article-title":"Rigorous hand hygiene practices among health care workers reduce hospital-associated infections during the COVID-19 pandemic","volume":"11","author":"Roshan","year":"2020"},{"key":"b6","series-title":"The Least Developed Countries Report 2022","year":"2022"},{"key":"b7","series-title":"National Micro Planning Handbook for Water, Sanitation and Hygiene (WASH) in Healthcare Facilities (HCFs) in Uganda","year":"2022"},{"key":"b8","series-title":"Progress on WASH in Healthcare Facilities: Special Focus on WASH in Infection Prevention and Control","year":"2022"},{"key":"b9","series-title":"Am J Infect Control","first-page":"473","article-title":"Effect of using portable alcohol-based handrub on nurses\u2019 hand hygiene compliance and nasal carriage of Staphylococcus aureus in a low-income health setting","volume":"48","author":"Nyamadzawo","year":"2020"},{"key":"b10","series-title":"WHO Guidelines on Hand Hygiene in Health Care","year":"2009"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"191","article-title":"Improving access to WHO formulations of alcohol-based hand rub in healthcare facilities: A district-wide approach","volume":"109","author":"Tusabe","year":"2023"},{"key":"b12","series-title":"Guide to Local Production: WHO-Recommended Handrub Formulations","year":"2010"},{"key":"b13","series-title":"Am J Infect 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