{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:02:44Z","timestamp":1785812564587,"version":"3.56.0"},"reference-count":40,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Proper hand hygiene (HH) is crucial to prevent healthcare-associated infections, including coronavirus disease 2019 (COVID-19), which disproportionately affects patients in low-and middle-income countries. As part of COVID-19 response, we evaluated key factors associated with HH practices in healthcare facilities (HCF) across five countries. From December 2020 to June 2021, we observed HH practices among healthcare personnel in 88 HCFs; observations occurred before and after patient contact. HH adherence (HHA) was defined as the use of alcohol-based hand rub (ABHR) or handwashing with soap and water. HH materials (soap and water, ABHR, or gloves) in patient care areas during observation were recorded in Belize, Uganda, and Kenya, and whether HHA occurred during invasive or noninvasive procedures. Descriptive methods and regression models were conducted. Overall, 3,940 HH observations were completed; average HHA was 32% (23\u201352% by country). Adjusted odds ratios (aORs) of HHA among nurses (aOR = 0.58; 95% CI = 0.44\u20130.77) and laboratory technicians (aOR = 0.41; 95% CI = 0.25\u20130.67) were lower than those among physicians, higher after versus before patient contact (aOR = 2.84; 95% CI = 2.44\u20133.28), higher with invasive procedures versus noninvasive (aOR = 1.45; 95% CI = 1.18\u20131.78), and higher when both ABHR and water and soap were available (aOR = 2.04, 95% CI = 1.73\u20133.53) or only ABHR was available (aOR = 1.86, 95% CI = 1.12\u20133.06) versus only water and soap were available. Our assessment highlights the need for behavioral and infrastructural interventions to improve HH practices in five resource-limited countries across two regions globally.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0066","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T11:30:05Z","timestamp":1748950205000},"page":"437-444","source":"Crossref","is-referenced-by-count":1,"title":["Characteristics of Hand Hygiene Adherence in Selected Healthcare Settings in Latin America and East Africa as Part of COVID-19 Response Efforts, 2020\u20132021"],"prefix":"10.4269","volume":"113","author":[{"given":"Denisse","family":"Vega Ocasio","sequence":"first","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Berendes","sequence":"additional","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Salah","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, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Garzaro","sequence":"additional","affiliation":[{"name":"Centro de Estudios en Salud, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke M.","family":"Ramay","sequence":"additional","affiliation":[{"name":"Centro de Estudios en Salud, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala;"},{"name":"Paul G. Allen School of Global Health, Washington State University, Pullman, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Fahsen","sequence":"additional","affiliation":[{"name":"Centro de Estudios en Salud, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Pieters Arroyo","sequence":"additional","affiliation":[{"name":"Centro de Estudios en Salud, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas Ruben","family":"Call","sequence":"additional","affiliation":[{"name":"Paul G. Allen School of Global Health, Washington State University, Pullman, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Cordon-Rosales","sequence":"additional","affiliation":[{"name":"Centro de Estudios en Salud, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala;"},{"name":"Paul G. Allen School of Global Health, Washington State University, Pullman, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramiro","family":"Quezada","sequence":"additional","affiliation":[{"name":"Centro de Estudios en Salud, Universidad del Valle de Guatemala, Ciudad de Guatemala, Guatemala;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Pratt","sequence":"additional","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy O.","family":"Murray","sequence":"additional","affiliation":[{"name":"Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Bivens","sequence":"additional","affiliation":[{"name":"Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anh N.","family":"Ly","sequence":"additional","affiliation":[{"name":"Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhaldine","family":"Morazan","sequence":"additional","affiliation":[{"name":"Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;"},{"name":"Belize Ministry of Health and Wellness, Belmopan, Belize;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Manzareno","sequence":"additional","affiliation":[{"name":"Belize Ministry of Health and Wellness, Belmopan, Belize;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Morey","sequence":"additional","affiliation":[{"name":"Belize Ministry of Health and Wellness, Belmopan, Belize;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Daniel","family":"Schnorr","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard University, Boston, Massachusetts;"},{"name":"Harvard Humanitarian Initiative, Cambridge, Massachusetts;"},{"name":"Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","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, 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":"Mohammed","family":"Lamorde","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Trinies","sequence":"additional","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Ngere","sequence":"additional","affiliation":[{"name":"Washington State University, Nairobi, 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Dominican Republic;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"de St. Aubin","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard University, Boston, Massachusetts;"},{"name":"Harvard Humanitarian Initiative, Cambridge, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devan","family":"Dumas","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard University, Boston, Massachusetts;"},{"name":"Harvard Humanitarian Initiative, Cambridge, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Duke","sequence":"additional","affiliation":[{"name":"Universidad Nacional Pedro Henr\u00edquez Ure\u00f1a, Santo Domingo, Dominican Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Skewes-Ramm","sequence":"additional","affiliation":[{"name":"Direcci\u00f3n General de 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