Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a hospital-based longitudinal intervention study

Abstract

Background Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) which is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. Methods A hospital-based, longitudinal, interventional study was conducted, adhering to WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). 60 health workers across 4 hospitals in Sierra Leone were observed over a 30-days period on three separate visits (Day 1, 3–5, and 30) by trained observers. The outcomes of interest included skin tolerability, product acceptability, and HH practice evaluated using subjective and objective measures. Results Objective and subjective evaluations demonstrated strong skin tolerability and high satisfaction with the product. On all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluation on overall skin integrity showed 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). Primary acceptability criteria increased up to 95% (colour) and 88% (smell) in visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2&3 respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%) with more than half (n = 38, 63%) of them performing HH in almost every HH moment. The mean consumption of ABHR was notably high (76.1ml, SD ± 35), especially among nurses (mean = 80.1ml) and doctors (mean = 74.0ml). Conclusion The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours, while forgetfulness and time constraints were major barriers to HH performance. Further research is recommended to optimize product formulation for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.