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. 2021 Feb 25;21(1):211.
doi: 10.1186/s12879-021-05895-1.

A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation

Salim Mezaache  1   2 , Laélia Briand-Madrid  3   4 , Linda Rahni  3   4 , Julien Poireau  5 , Fiona Branchu  6 , Khafil Moudachirou  6   7 , Yourine Wendzinski  8 , Patrizia Carrieri  3   4 , Perrine Roux  3   4
Affiliations

A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation

Salim Mezaache et al. BMC Infect Dis. .

Abstract

Background: Inconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID.

Methods: A mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study.

Results: Among the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention.

Conclusions: ABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention's educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention's efficacy through increased hand hygiene frequency and a reduced risk of infection.

Keywords: Alcohol-based hand rubs; Hand hygiene; Hand sanitizers; Harm reduction; Intervention; People who inject drugs; Skin and soft tissue infections.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Design of the study
Fig. 2
Fig. 2
The simplified 3-step hand hygiene technique using MONO-RUB. (1) Pouring the product from one hand into the palm of the other hand; (2) Using fingertips of each hand to rub product into the palm of the other hand; (3) Rubbing both hands together for at least 15s
Fig. 3
Fig. 3
Predictive margins of mixed linear models with interaction between age (a) and follow-up, and housing (b) and W6 follow-up visit
See this image and copyright information in PMC

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