Availability of hand hygiene infrastructure and point-of-care resources in Sierra Leone’s public hospitals: a nationwide multicentre cross-sectional study

Category	Detail
Condition	Hand hygiene infrastructure and point-of-care resource availability in public hospitals
Key Mechanisms	Hand hygiene involves cleansing hands with soap and clean water or alcohol-based handrub to decrease harmful microorganisms. The WHO multimodal improvement strategy highlights point-of-care practice and a functional built environment.
Target Population	Operational inpatient and clinical wards in 19 eligible secondary and tertiary public hospitals in Sierra Leone.
Care Setting	Hospital wards, including acute care, general medical and surgical wards, high-dependency and intensive care units, and emergency areas.

Nationwide multicentre cross-sectional survey conducted in February and March 2025.
Assessors used a validated WHO instrument derived from the WHO multimodal hand hygiene improvement strategy.
Nineteen of Sierra Leone’s 27 public hospitals were eligible because they had a functional infection prevention and control programme and a trained focal person.
Ward assessments combined interviews with direct inspection and counting of hand hygiene infrastructure and supplies at the point of care.

The study assessed hand hygiene infrastructure and resources; it did not evaluate disease diagnosis.

The WHO multimodal improvement strategy highlights hand hygiene practice at the point of care and a functional built environment.

Assessors evaluated wards through interviews and direct inspection, including checks of sinks, alcohol-based handrub, soap, and towels.

The introduction reports that healthcare-associated infections and antimicrobial resistance compromise treatment outcomes, extend hospitalisation, and increase healthcare expenditure. It cites an estimate of 15.5 healthcare-associated infections per 100 patients in low- and middle-income countries, approximately three times the rate in high-income countries, and a 12.9% rate in Sub-Saharan Africa.

No patient-level treatment or prescribing data were reported; the study assessed hospital wards and hand hygiene resources.

No treatment regimens or prescribing outcomes were evaluated.

Hand hygiene is performed with soap and clean water or alcohol-based handrub to decrease harmful microorganisms.
The WHO multimodal strategy emphasizes hand hygiene practice at the point of care and a functional built environment.
The survey assessed availability and functionality of hand hygiene infrastructure and supplies through direct inspection.

Clinical Scorecard: Availability of Hand Hygiene Infrastructure and Point-of-Care Resources in Sierra Leone’s Public Hospitals