{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T03:46:14Z","timestamp":1785210374294,"version":"3.55.0"},"reference-count":19,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Local alcohol-based hand rub (ABHR) production systems in low-resource settings, such as in health care facilities (HCFs) in low- and middle-income countries, frequently reuse containers for storing and dispensing ABHR. Cleaning\/disinfection (C\/D) of ABHR containers is necessary to safely reuse them and is an integral part of the WHO\u2019s guidelines on local ABHR production. However, HCFs may not be aware of the need for C\/D; combined with suboptimal implementation, this poses a risk of contamination of ABHR. As part of district-led ABHR production in HCFs in five rural districts in Uganda, we developed a standard operating procedure (SOP) for C\/D of reused ABHR containers and provided on-site training for infection prevention and control personnel. Using in-person surveys, we assessed the availability of C\/D supplies and equipment and the self-reported C\/D practices before and after the training. At baseline, almost all (<jats:italic>n<\/jats:italic> = 90\/91) HCFs reported reusing ABHR containers; 8% and 12% of HCFs routinely had all of the key C\/D materials needed for adequately cleaning and disinfecting containers using chlorine and thermal disinfection methods, respectively. HCFs that reported adequately cleaning containers per the SOP increased from 3% (<jats:italic>n<\/jats:italic> = 2) at baseline to 18% (<jats:italic>n<\/jats:italic> = 16) after the training, whereas adequate disinfection increased from 0% (<jats:italic>n<\/jats:italic> = 0) to 5% (<jats:italic>n<\/jats:italic> = 5). All HCFs that performed disinfection reported using chlorine, and none reported using thermal disinfection. Improving access to C\/D supplies, providing routine mentorship, and monitoring ABHR container C\/D are needed to further improve C\/D practices.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0189","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T13:26:56Z","timestamp":1739885216000},"page":"1146-1151","source":"Crossref","is-referenced-by-count":1,"title":["Cleaning and Disinfection Practices of Reused Alcohol-Based Hand Rub Containers in Health Care Settings: Evidence from Five Rural Districts in Uganda"],"prefix":"10.4269","volume":"112","author":[{"given":"Fred","family":"Tusabe","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanako","family":"Ishida","sequence":"additional","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Ocitti","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sauda","family":"Yapswale","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"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":"Herbert","family":"Isabirye","sequence":"additional","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":"Victoria","family":"Trinies","sequence":"additional","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Medley","sequence":"additional","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia"}],"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":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"WHO Guidelines on Hand Hygiene in Health Care","year":"2009"},{"key":"b2","series-title":"Arch Intern Med","first-page":"1037","article-title":"Alcohol-based handrub improves compliance with hand hygiene in intensive care units","volume":"162","author":"Hugonnet","year":"2002"},{"key":"b3","series-title":"PLOS Water","first-page":"e0000027","article-title":"Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19","volume":"1","author":"Berendes","year":"2022"},{"key":"b4","series-title":"Am J Trop Med Hyg","first-page":"881","article-title":"Access to and use of hand hygiene resources during the COVID-19 pandemic in two districts in Uganda, January\u2013April 2021","volume":"109","author":"Pratt","year":"2023"},{"key":"b5","series-title":"Emerg Infect Dis","first-page":"1592","article-title":"Inactivation of severe acute respiratory syndrome coronavirus 2 by WHO-recommended hand rub formulations and alcohols","volume":"26","author":"Kratzel","year":"2020"},{"key":"b6","series-title":"J Hosp Infect","first-page":"430","article-title":"Handrubbing with sprayed alcohol-based hand rub: An alternative method for effective hand hygiene","volume":"104","author":"Tan","year":"2020"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0008412","article-title":"Global resource shortages during COVID-19: Bad news for low-income countries","volume":"14","author":"McMahon","year":"2020"},{"key":"b8","series-title":"J Water Sanit Hyg Dev","first-page":"847","article-title":"Establishment of district-led production of WHO-recommended alcohol-based hand rub (ABHR) during the COVID-19 pandemic: A model for improving access to ABHR during health emergencies","volume":"13","author":"Tusabe","year":"2023"},{"key":"b9","series-title":"Guide to Local Production: WHO-Recommended Handrub Formulations","year":"2010"},{"key":"b10","series-title":"Lancet Infect Dis","first-page":"843","article-title":"Global implementation of WHO\u2019s multimodal strategy for improvement of hand hygiene: A quasi-experimental study","volume":"13","author":"Allegranzi","year":"2013"},{"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":"Bull World Health Organ","first-page":"963","article-title":"Local production of WHO-recommended alcohol-based handrubs: Feasibility, advantages, barriers and costs","volume":"91","author":"Bauer-Savage","year":"2013"},{"key":"b13","series-title":"Antimicrob Resist Infect Control","first-page":"2","article-title":"Evaluation of a program to improve hand hygiene in Kenyan hospitals through production and promotion of alcohol-based Handrub\u20142012\u20132014","volume":"8","author":"Ndegwa","year":"2019"},{"key":"b14","series-title":"Antimicrob Resist Infect Control","first-page":"129","article-title":"Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda (\u201cWardGel\u201d study)","volume":"6","author":"Saito","year":"2017"},{"key":"b15","year":"2013"},{"key":"b16","year":"2024"},{"key":"b17","year":"2023"},{"key":"b18","series-title":"Int J Hyg Environ Health","first-page":"409","article-title":"Environmental conditions in health care facilities in low-and middle-income countries: Coverage and inequalities","volume":"221","author":"Cronk","year":"2018"},{"key":"b19","series-title":"Am J Trop Med Hyg","first-page":"1033","article-title":"Water, sanitation, and hygiene in rural health-care facilities: A cross-sectional study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia","volume":"97","author":"Guo","year":"2017"}],"container-title":["The American Journal of Tropical Medicine and 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