Effective hand hygiene saves lives by reducing the transmission of infection, a fact highlighted by the current COVID-19 pandemic. Our recent assessment of hand hygiene practices in the Chatinkha Neonatal Unit identified a lack of water, soap, and hand sanitisers as a key barrier for medical staff, patients, and guardians to perform these practices effectively.

The recent development of a locally produced hand sanitiser with the College of Medicine provides an ideal opportunity to trial a cost-effective alternative for hand hygiene practice. A behaviour-based study using trial of improved practices was conducted to determine and inform the level of acceptance, barriers, and opportunities for the long-term use of hand sanitiser for infection prevention and control as an alternative to traditional soap and water for health workers, patients, and guardians in an intensive neonatal care unit.

Previously hand sanitiser was being accessed only by health care workers in the unit and was not used because of its nature. Texture, smell, colour, method of dispensing, effective communication, and constant supply of hand sanitiser were found to be factors contributing to the low acceptability of hand sanitiser use.

If limitations in access to water and soap at critical times will persist

within the unit and the entire Queen Elizabeth Central Hospital for the foreseeable future then alternative solutions such as hand sanitiser use are needed to minimize the risk of infection transmission. The outcomes of the study will enable an effective roll-out plan to be established across QECH and other health care settings in Malawi.