{"id":31472,"date":"2026-10-31T04:55:00","date_gmt":"2026-10-30T20:55:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=31472"},"modified":"2026-10-31T05:54:15","modified_gmt":"2026-10-30T21:54:15","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%b8%96%e7%95%8c%e5%8d%ab%e7%94%9f%e7%bb%84%e7%bb%87%e6%89%8b%e5%8d%ab%e7%94%9f%e7%9a%84%e5%a4%9a%e6%a8%a1%e6%80%81%e6%94%b9%e8%bf%9b","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=31472","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u4e16\u754c\u536b\u751f\u7ec4\u7ec7\u624b\u536b\u751f\u7684\u591a\u6a21\u6001\u6539\u8fdb\u7b56\u7565"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Infectious Diseases<\/p>\n\n\n\n

World Health Organization Multimodal Improvement Strategy for Hand Hygiene: A Stepped-Wedge Cluster Randomized Trial<\/h1>\n\n\n\n

Emma Nyawere, Hiroki Saito, Robinah Ajok, et al<\/h3>\n\n\n\n

JAMA Netw Open 2026;9;(7):e2625250. doi:10.1001\/jamanetworkopen.2026.25250<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  What is the long-term impact of the World Health Organization (WHO) multimodal improvement strategy (MMIS) for hand hygiene, combined with locally manufactured alcohol-based handrub (ABHR), in resource-limited settings?<\/p>\n\n\n\n

Findings<\/strong>  In this stepped-wedge cluster randomized trial with 27\u202f895 hand hygiene opportunities observed across 8 health care facilities in eastern Uganda, hand hygiene adherence among health care workers increased by more than 50% during the intervention phase and remained high during the follow-up phase, compared with baseline.<\/p>\n\n\n\n

Meaning<\/strong>  These findings support the scalability of the WHO MMIS approach for hand hygiene with locally manufactured ABHR at regional and national levels in resource-limited health care settings.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Evidence on hand hygiene promotion in resource-limited settings remains sparse, and its generalizability and long-term sustainability are poorly understood. Previous studies have predominantly relied on single-center, short-duration, before-and-after interventional designs.<\/p>\n\n\n\n

Objective<\/strong>  To assess the long-term impact of the World Health Organization (WHO) multimodal improvement strategy (MMIS) supported by locally manufactured alcohol-based handrub (ABHR) on hand hygiene performance across multiple health care facilities in Uganda.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This stepped-wedge cluster randomized trial was conducted at 8 health care facilities across 4 districts in eastern Uganda from November 1, 2020, to July 31, 2024 (45 months). Participants included all health care workers at the participating sites.<\/p>\n\n\n\n

Intervention<\/strong>  Following a baseline phase of 12 to 21 months, the WHO MMIS combined with locally manufactured ABHR was sequentially introduced in each district at 3-month intervals and implemented for 12 to 21 months (ie, the intervention phase), followed by a 12-month follow-up period without additional intervention.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was hand hygiene adherence among health care workers. Secondary outcomes included scores on the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and the Infection Prevention and Control Assessment Framework (IPCAF).<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A total of 27\u202f895 hand hygiene opportunities were observed. Hand hygiene adherence increased from 22.1% (95% CI, 11.4%-32.8%) at baseline to 79.2% (95% CI, 67.2%-91.2%;\u00a0P<\/em>\u2009<\u2009.001) during the intervention phase and remained high at 72.7% (95% CI, 57.8%-87.6%;\u00a0P<\/em>\u2009<\u2009.001) during follow-up. Median HHSAF scores improved significantly from 145.00 (IQR, 52.50-202.50) at baseline to 383.75 (IQR, 367.50-417.50 [P<\/em>\u2009=\u2009.008]) during the intervention phase and 366.25 (IQR, 316.25-380.00 [P<\/em>\u2009=\u2009.008]) during follow-up. Median IPCAF scores followed a similar pattern, from 335.00 (IQR, 235.00-520.25) at baseline to 657.50 (IQR, 648.75-705.00) (P<\/em>\u2009=\u2009.008) during the intervention phase and 676.25 (IQR, 656.25-705.00) (P<\/em>\u2009=\u2009.008) during follow-up. ABHR accounted for more than 99% of observed hand hygiene actions during the intervention and follow-up phases.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this study of hand hygiene promotion in eastern Uganda, the WHO MMIS supported by locally produced ABHR led to substantial and sustained improvements in hand hygiene adherence. This stepped-wedge cluster randomized trial provides robust evidence supporting the scalability of this approach at regional and national levels in resource-limited settings.<\/p>\n\n\n\n

Trial Registration<\/strong>  University Hospital Medical Information Network Clinical Trials Identifier: UMIN000039483<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Infectious Diseases World […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31472"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31472"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31472\/revisions"}],"predecessor-version":[{"id":31855,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31472\/revisions\/31855"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31472"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31472"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31472"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}