Academic journal article Bulletin of the World Health Organization

Local Production of WHO-Recommended Alcohol-Based Handrubs: Feasibility, Advantages, Barriers and costs/Production Locale De Produits Pour Friction Hydro-Alcooliques Recommandes Par l'OMS: Faisabilite, Avantages, Obstacles et couts/La Preparacion Local De Los Desinfectantes Para Manos a Base De Alcohol Recomendados Por la OMS: Viabilidad, Ventajas, Dificultades Y Costes

Academic journal article Bulletin of the World Health Organization

Local Production of WHO-Recommended Alcohol-Based Handrubs: Feasibility, Advantages, Barriers and costs/Production Locale De Produits Pour Friction Hydro-Alcooliques Recommandes Par l'OMS: Faisabilite, Avantages, Obstacles et couts/La Preparacion Local De Los Desinfectantes Para Manos a Base De Alcohol Recomendados Por la OMS: Viabilidad, Ventajas, Dificultades Y Costes

Article excerpt

Problem

Health-care-associated infections are the most frequent adverse events during the delivery of health-care worldwide. (1-3) Since the hands of health-care workers are the primary source of healthcare-associated pathogens, (4) good hand hygiene is an important factor in the reduction of such infections. In most health-care settings, alcohol-based handrubs (ABHs) are currently the preferred method for hand cleansing because they offer a broad antimicrobial spectrum, a rapid antimicrobial effect and good skin tolerance, and can be made available at the point of care. (5) However, problems in market availability, distribution and affordability severelylimit the use of such handrubs in low- and middle-income countries. (6,7)

In 2005--as part of its "Clean Care is Safer Care" programme --the World Health Organization (WHO)developed and tested two ABH formulations that complied with the relevant European norms for hand antisepsis and were suitable for local production in different settings. (5,8) One of these formulations had ethanol--at 80% v/v--as its active component while the other had isopropanol--at 75% v/v. In a randomized cross-over trial, both formulations demonstrated excellent skin tolerability and acceptability among healthcare workers. (9) In 2011, we evaluated the feasibility, advantages and costs of the local production of the two formulations--and the barriers to such production--in an online survey. The methods that we used and the results that we obtained are outlined in this paper.

Approach

The survey was based on a questionnaire--on the local production of the WHO formulations--that had already been tested in a pilot study. (5) The questionnaire consisted of 58 open and closed questions. Twenty of the questions were compulsory. The questionnaire was divided into two parts. Part I was designed to collect general information on the survey site and participants while Part II was designed to collect technical information on ABH preparation and storage, ingredient and dispenser procurement, quality control, tolerability, acceptability and promotion. The questionnaire was made available online--in English, Khmer, Mongolian and Spanish--using the Survey Monkey survey tool (Survey Monkey, Palo Alto, United States of America).

Through WHO regional focal points, country contacts and stakeholders, 125 potential local producers of either of the two WHO-recommended ABH formulations were identified and invited to complete the questionnaire. The survey was kept open for 9 months and up to four reminders were sent to the nonrespondents.

Results

Local setting

Of the 125 potential survey sites, 100 (80%) responded to our invitation to participate. Of the 100 respondents, 56 stated that they were not currently producing either of the WHO formulations, three did not wish to participate, one could not participate because the respondent could not understand any of the survey's languages, and one was excluded from the final analysis because the data provided were incomplete. Thirty-nine sites from 29 countries were therefore included in the final data analysis (Fig. 1). According to the World Bank classification, (10) seven (24%) of the 29 countries included in the final analysis were low-income, 16 (55%) were middle-income and the remaining six (21%) were high-income. The 39 survey sites were health-care facilities (n = 34) or private companies (n = 5). The five private companies were either selling one of the WHO ABH formulations on the local market (n = 3) or were contracted to produce one of the formulations by the national government (n = 2).

Human resources

The WHO formulations were produced only by pharmacists in 18 (46%) of the survey sites, jointly by pharmacists and technicians in six (15%) of the sites, only by technicians in four (10%) of the sites and by "other professionals" in the remaining 11 sites (28%). Sixteen (41%) of the survey sites had initial difficulty in identifying staff who had adequate skills for the local production of the WHO formulations, and the respondents representing 29 (74%) of the sites reported that staff had had to be trained in the production of such formulations (Table 1). …

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