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Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control

  • Tartari, Ermira1, 2, 3
  • Fankhauser, Carolina1
  • Masson-Roy, Sarah1, 4
  • Márquez-Villarreal, Hilda5
  • Fernández Moreno, Inmaculada6
  • Rodriguez Navas, Ma Luisa7
  • Sarabia, Odet8
  • Bellisimo-Rodrigues, Fernando9
  • Hernández-de Mezerville, Marcela10
  • Lee, Yew Fong2, 11
  • Aelami, Mohammad Hassan12
  • Mehtar, Shaheen13
  • Agostinho, Américo1
  • Camilleri, Liberato3
  • Allegranzi, Benedetta14
  • Pires, Daniela1, 15
  • Pittet, Didier1
  • 1 University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, Geneva, 1211, Switzerland , Geneva (Switzerland)
  • 2 Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland , Geneva (Switzerland)
  • 3 University of Malta, Msida, Malta , Msida (Malta)
  • 4 Hotel-Dieu de Lévis, Lévis, Canada , Lévis (Canada)
  • 5 University of Guadalajara, Guadalajara, Jalisco, Mexico , Guadalajara (Mexico)
  • 6 Corporación Sanitaria Parc Taulí de Sabadell, Barcelona, Spain , Barcelona (Spain)
  • 7 Hospital Universitario Principe de Asturias, Madrid, Spain , Madrid (Spain)
  • 8 Universidad Anáhuac, Naucalpan de Juárez, Mexico , Naucalpan de Juárez (Mexico)
  • 9 University of São Paulo, Ribeirão Preto, Brazil , Ribeirão Preto (Brazil)
  • 10 Hospital Nacional de Niños, de Costa Rica Dr. Carlos Sáenz Herrera, San José, Costa Rica , San José (Costa Rica)
  • 11 Ministry of Health, Riyadh, Saudi Arabia , Riyadh (Saudi Arabia)
  • 12 Imam Reza Hospital ,Mashhad University of Medical Sciences, Mashhad, Iran , Mashhad (Iran)
  • 13 Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa , Cape Town (South Africa)
  • 14 World Health Organization, Geneva, Switzerland , Geneva (Switzerland)
  • 15 Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal , Lisbon (Portugal)
Published Article
Antimicrobial Resistance & Infection Control
BioMed Central
Publication Date
Dec 30, 2019
DOI: 10.1186/s13756-019-0666-4
Springer Nature


BackgroundHarmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a “Train-the-Trainers” (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries.MethodsWe developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training.ResultsBetween June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively.ConclusionsThe TTT in hand hygiene model proved to be effective in enhancing participant’s knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.

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