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Kamara MN, Lakoh S, Kallon C, Kanu JS, Kamara RZ, Kamara IF, Moiwo MM, Kpagoi SSTK, Adekanmbi O, Manzi M, Fofanah BD, Shewade HD. Hand Hygiene Practices and Promotion in Public Hospitals in Western Sierra Leone: Changes Following Operational Research in 2021. Trop Med Infect Dis 2023; 8:486. [PMID: 37999605 PMCID: PMC10674222 DOI: 10.3390/tropicalmed8110486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Hand hygiene is the most important intervention for preventing healthcare-associated infections and can reduce preventable morbidity and mortality. We described the changes in hand hygiene practices and promotion in 13 public hospitals (six secondary and seven tertiary) in the Western Area of Sierra Leone following the implementation of recommendations from an operational research study. This was a "before and after" observational study involving two routine cross-sectional assessments using the WHO hand hygiene self-assessment framework (HHSAF) tool. The overall mean HHSAF score changed from 273 in May 2021 to 278 in April 2023; it decreased from 278 to 250 for secondary hospitals but increased from 263 to 303 for tertiary hospitals. The overall mean HHSAF score and that of the tertiary hospitals remained at the "intermediate" level, while secondary hospitals declined from "intermediate" to "basic" level. The mean score increased for the "system change" and "institutional safety climate" domains, decreased for "training and education" and "reminders in the workplace" domains, and remained the same for the "evaluation and feedback" domain. Limited resources for hand hygiene promotion, lack of budgetary support, and formalized patient engagement programs are the persistent gaps that should be addressed to improve hand hygiene practices and promotion.
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Affiliation(s)
- Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention, Freetown 00232, Sierra Leone
| | | | - Matilda Mattu Moiwo
- Republic of Sierra Leone Armed Forces, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Satta S T K Kpagoi
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan 200005, Nigeria
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | | | | | - Hemant Deepak Shewade
- Division of Health Systems Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India
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Kamara D, Bah D, Sesay M, Maruta A, Sesay BP, Fofanah BD, Kamara IF, Kanu JS, Lakoh S, Molleh B, Guth J, Sagili KD, Tavernor S, Wilkinson E. Evaluation of Drinking Water Quality and Bacterial Antibiotic Sensitivity in Wells and Standpipes at Household Water Points in Freetown, Sierra Leone. Int J Environ Res Public Health 2022; 19:ijerph19116650. [PMID: 35682235 PMCID: PMC9180853 DOI: 10.3390/ijerph19116650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
Water quality surveillance can help to reduce waterborne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources. In this cross-sectional study, we collected water samples from 15 standpipes and 5 wells and measured the physicochemical and bacteriological water quality, and the antimicrobial sensitivity of Escherichia coli (E. coli) in two communities in Freetown, Sierra Leone in the dry and wet seasons in 2021. All water sources were contaminated with E. coli, and all five wells and 25% of standpipes had at least an intermediate risk level of E. coli. There was no antimicrobial resistance detected in the E. coli tested. The nitrate level exceeded the WHO’s recommended standard (>10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (>10 Nephelometric Turbidity Units) was much higher in the rainy season (73% vs. 7%). The level of water contamination is concerning. We suggest options to reduce E. coli contamination. Further research is required to identify where contamination of the water in standpipes is occurring.
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Affiliation(s)
- Dauda Kamara
- Water Sanitation and Hygiene (WASH) Program, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
- Correspondence: ; Tel.: +232-78-893-760
| | - Doris Bah
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
| | - Momodu Sesay
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
| | - Anna Maruta
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Bockarie Pompey Sesay
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Bobson Derrick Fofanah
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Joseph Sam Kanu
- National Disease Surveillance Program, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Freetown 00232, Sierra Leone;
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
- Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Sustainable Health Systems Sierra Leone, 34 Military Research Center, Freetown 00232, Sierra Leone;
| | - Bailah Molleh
- Sustainable Health Systems Sierra Leone, 34 Military Research Center, Freetown 00232, Sierra Leone;
| | - Jamie Guth
- Global Health Connections, Center Barnstead, Barnstead, NH 03225, USA;
| | - Karuna D. Sagili
- International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi 110016, India;
| | - Simon Tavernor
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK;
| | - Ewan Wilkinson
- Institute of Medicine, University of Chester, Chester CH2 1BR, UK;
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