Making hand hygiene the standard for all healthcare facilities: Made in Africa alcohol hand sanitizers and human resource training to combat healthcare-associated infections

In the 2000s, WHO recognized healthcare-associated infections as a major problem and promoted various measures to address the issue internationally. Nevertheless, their negative impact remains significant today, with reports that 41% of new cases during the first wave of the COVID-19 pandemic in 2020 were healthcare-associated infections.

It is estimated that these healthcare-associated infections can be reduced by 70% through the promotion of hand hygiene and subsequent cost-effective infection prevention and control measures. However, in developing countries where physical and human resources are scarce and infection prevention and control measures are inadequate, the risk of infection is said to be 2 to 20 times higher than in developed countries, and thus commitment, human resource development, and monitoring systems at the national level are required.

Source: WHO : Global report on infection prevention and control

In 2013 Saraya established a local subsidiary in Uganda in response to the WHO's "Clean Care is Safer Care" global campaign against healthcare-associated infectious diseases. The results of the demonstration project were that hand hygiene with alcohol sanitizers can be fully accepted by providing appropriate education and awareness-raising to medical institutions in Uganda and also that hand hygiene with alcohol sanitizers can improve the compliance rate of hand hygiene and contribute to the promotion of the campaign in Uganda. The positive correlation between increased adherence to hand hygiene with alcohol sanitizer and the reduce of healthcare-associated infections was also explained at Uganda's first international conference on infectious diseases.

In 2014, we began local production of alcohol hand sanitizers using ethanol derived from sugarcane, and began full-scale activities to promote effective hand hygiene based on WHO guidelines.

In 2015, we invited Ugandan medical professionals to Japan for a 3-day infection prevention and control training, and the following year we held a 2-day infection prevention and control training in Uganda with the participants as lecturers, as part of our human resource development efforts.

Practical training in sorting medical waste during training in Japan

Infectious sewage disposal practice in Uganda training

Infection Control Training participants from across Uganda

In 2017, we also established a sales company in Kenya to promote Made in Africa hand sanitizers and the WHO's campaign against healthcare-associated infections in the two East African countries.

SARAYA「100％Hospital Hand Hygiene project」site：https://hospital.tearai.jp/

These early efforts paid off and contributed to some degree during the 2018-19 Ebola outbreak in the Democratic Republic of Congo and the 2020-21 COVID-19 pandemic by operating our factory in Uganda 24 hours a day.

In our activities to date, we have worked closely with the Infection Control Team at the University of Geneva. As a pioneer in the field of infection prevention and control of hand hygiene, they are one of the WHO collaborating facilities that have contributed to the promotion of hand hygiene by the WHO. Their work has led to the standard use of alcohol hand sanitizers in healthcare facilities and the inclusion of the five hand hygiene timelines in the WHO guidelines. The team has also been involved for many years in "train the trainer" (TTT) training programs around the world to develop leaders who can take leadership positions in their respective countries as part of activities to put hand hygiene improvements into practice.

Saraya is currently preparing with the Ugandan Ministry of Health and JICA to host the second TTT on the African continent by the end of 2023, after South Africa. Healthcare-associated infections are a very important complication that occurs during patient care, and more than half of them are preventable through proper practice of hand hygiene. It has also been reported that the combination of proper use of antimicrobial agents can reduce the incidence of drug-resistant bacteria by two-thirds, making thorough infection prevention management, including hand hygiene, an important factor from the perspective of drug resistance. Therefore, Saraya believes that this program, sponsored by the Ugandan Ministry of Health, will make a significant contribution to the establishment of a global standard for hand hygiene and a sustainable organization for infection prevention and control at medical facilities in Uganda.

Saraya has educated a total of approximately 5,000 healthcare workers in Uganda and Kenya on infection prevention and control. Although awareness of hand hygiene has spread after the COVID-19 pandemic, it is still not easy to provide stable and appropriate information to more than the100,000 healthcare workers in both countries. Therefore, we aim to contribute to the promotion of autonomous organizational response through the TTT that is currently under preparation. In addition to hand hygiene, as a business we are also working to expand the provision of various consumables in order to promote comprehensive responses, such as equipment hygiene and environmental hygiene.

While alcohol hand sanitizers and other hygiene agents are regarded as commodity necessities, they are characterized by the fact that they do not produce the necessary effect unless used correctly at the appropriate time, which is also the reason why healthcare-associated infections are not easily eliminated. In addition, many drugs need to be treated as dangerous goods for international transportation, making it difficult to deal with them in a simple, cost-effective trade.

Therefore, it is essential to combine local production with education and awareness-raising efforts. However, especially in developing countries with small markets, the hurdles are high as a business, and few other companies are taking similar approaches. On the other hand, the risk of healthcare-associated infection is higher in developing countries than in developed countries, and the reality is that many lives continue to be lost while waiting for the normal business environment to be established. Therefore, our motivation is to save lives that would otherwise be lost by taking an active role early on to accelerate the start-up of sanitation businesses and advance the fight against healthcare-associated infections.