Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda


  • Jean Paul Mvukiyehe Department of Anesthesia, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
  • Eugene Tuyishime Department of Anesthesia, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
  • Anne Ndindwanimana Department of General Medicine, University of Rwanda, Kigali, Rwanda
  • Jennifer Rickard Department of Surgery, University of Minnesota, Minnesota, USA; and Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
  • Olivier Manzi Department of Internal Medicine, Kigali University Teaching Hospital, Kigali, Rwanda
  • Gregory R. Madden Department of Internal Medicine, Division of Infectious Diseases, University of Virginia, Charlottesville, USA
  • Marcel E. Durieux Department of Anesthesiology, University of Virginia, Charlottesville, USA
  • Paulin R. Banguti Department of Anesthesia, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda



hand hygiene, hospitals, intensive care units, less-developed countries, Rwanda


Background: Proper hand hygiene (HH) practices have been shown to reduce healthcare-acquired infections. Several potential challenges in low-income countries might limit the feasibility of effective HH, including preexisting knowledge gaps and staffing.

Aim: We sought to evaluate the feasibility of the implementation of effective HH practice at a teaching hospital in Rwanda.

Methods: We conducted a prospective quality improvement project in the intensive care unit (ICU) at the Kigali University Teaching Hospital. We collected data before and after an intervention focused on HH adherence as defined by the World Health Organization ‘5 Moments for Hand Hygiene’ and assuring availability of HH supplies. Pre-intervention data were collected throughout July 2019, and HH measures were implemented in August 2019. Post-implementation data were collected following a 3-month wash-in.

Results: In total, 902 HH observations were performed to assess pre-intervention adherence and 903 observations post-intervention adherence. Overall, HH adherence increased from 25% (222 of 902 moments) before intervention to 75% (677 of 903 moments) after intervention (P < 0.001). Improvement was seen among all health professionals (nurses: 19–74%, residents: 23–74%, consultants: 29–76%).

Conclusions: Effective HH measures are feasible in an ICU in a low-income country. Ensuring availability of supplies and training appears key to effective HH practices.


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How to Cite

Mvukiyehe, J. P., Tuyishime, E., Ndindwanimana, A., Rickard, J., Manzi, O., Madden, G. R., Durieux, M. E., & Banguti, P. R. (2021). Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda. International Journal of Infection Control, 17(1).



Original Articles