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Table 2 Case Scenario 2 to simulate the completion of the WHO Hand Hygiene Self Assessment Framework (HHSAF)

From: Scenario-based simulation training for the WHO hand hygiene self-assessment framework

Case Scenario HHSAF Component Subtotal Score
St. Mary’s Teaching Hospital is a large tertiary care institution with 550 beds in rural Uganda. The hospital has 24 clinical wards, including radiology, laboratory, and pharmacy services.   
One-liter ABHR bottles are mounted on the walls of the wards for ease of access. Mobile bottles are also placed on the trolleys used for ward rounds, in the reception area and in the treatment room area. The ABHR used was locally produced from sugar cane. Local ABHR production and quality control have proven to be feasible and satisfactory. Hand hygiene supplies are scarce. Only one or no functional sinks/taps were available in each ward. Portable water bottles and basins are an alternative for handwashing. Gloves, even non-sterile ones, are rarely available. An action plan has recently been developed to improve the infrastructure in the hospital. System Change 10/100
HH education and training for health workers is sporadic and mainly occurs upon initial employment. The training is provided by the IPC nurse who has received training from the Infection Control Africa Network (ICAN) Training and Education 20/100
HH compliance rate is monitored by direct observations using the WHO hand hygiene monitoring tool, however there is no established HH promotion strategy; observations are conducted annually. The HH compliance rate was very low. In 2015, the overall reported compliance was 9.2%, but by 2017 it had increased to 21.8%. Evaluation and Feedback 10/100
The WHO ‘How to handwash’, ‘How to handrub’ and ‘My 5 Moments for Hand Hygiene’ posters were only available in some of the hospital wards. Reminders in the workplace 25/100
No IPC team, or experts in infection control is available in the country, although one part-time infection control nurse has been assigned infection control duties in the hospital. The director of nursing is committed to supporting hand hygiene improvement at St Mary’s hospital. Since 2017, the hospital is engaged in the WHO Save Lives Clean Your Hands annual campaign and is celebrating the 5th of May global HH day. Institutional Safety Climate 15/100
  Total Score 80/500
  1. Abbreviations: ABHR Alcohol-based handrub, HH Hand hygiene