The Hand Hygiene Project (HHP)

“Reducing Infection through Holistic and Sustainable Improvements in Hand Hygiene”

Project Management

The the Hand Hygiene Project (HHP) is a partnership initiative between: Knowledge for Change and the University of Salford in the UK; and Mountains of the Moon University (MMU), Kabarole Health District, Fort Portal Regional Referral Hospital and Virika Mission Hospital in Uganda. The project began in October 2015, initially funded by the UK Department for International Development (DfID) through the Tropical Health Education Trust (THET). The THET funded project ended in February 2017, however K4C has continued this important work supported by other income streams.

Project Objectives

  1. To improve the safety of healthcare workers in selected facilities in the Kabarole Region of Uganda and promote resilience to infectious disease outbreaks
  2. To improve the safety and well-being of patients in selected health care facilities in Kabarole Region
  3. To reduce the incidence of facility-acquired infections in selected health care facilities in Kabarole Region

Project Strategy

Needs Assessment

A thorough needs assessment was conducted at the beginning of the project using an adapted version of the WHO African Partnerships for Patient safety ‘Situational Analysis’ tool. The needs assessment highlighted serious problems in the local systems, ranging from lacking infrastructure, equipment and consumables (such as sinks with running water, soap and hand drying facilities) to poor knowledge and weak protocols regarding infection control and the importance of hand hygiene in reducing the incidence and rate of spread of infections in health facilities.

Infrastructural Intervention

Our project manager has been responsible for organising and conducting thorough audits of facilities for hand washing in 6 health facilities (Fort Portal Regional Referral Hospital, Virika Hospital, Bukuuku Health Centre 4, Kataraka Health Centre 4, Kibiito Health Centre 4 and Kagote Health Centre 3) using a recognized WHO-developed ‘Facilities Audit’ tool. Based on these audits, K4C has worked with One Brick At A Time (OBAAT), a local construction partner, to repair facilities to ensure the supply of clean running water and sinks for hand washing. We have fitted 6 new sinks in health facilities and repaired many others.

Training, Mentoring and Behaviour Change

The Clinical Team has delivered CME training for local health workers and MMU midwifery and nursing students on the importance of hand hygiene and infection prevention and control. This process has been aided by a number of UK students placed through the Ethical Elective Placement Project (pictured left) who have run sessions in Health Facilities and also local schools. K4C conducts regular and extensive monitoring of the effectiveness of these on-going training / mentoring programmes via the WHO-developed ‘Hand Hygiene Compliance Tool’. The findings will be reported at the end of the HHP.

Local Production and Distribution of Hand Soap, Reusable hand towels and Alcohol Hand Gel

The Production Team, working in partnership with the MMU Business and Enterprise Unit, has organised the local production and distribution of alcohol hand gel and reusable hand towel systems in the 6 health facilities mentioned above. 4 business students from Liverpool Hope University were placed in Fort Portal in June 2016. Working alongside 6 MMU business students, they designed, marketed and distributed the newly produced alcohol hand gel.

Impact Assessment and ‘Proof of Concept’

The Evaluation Team has been conducting an intensive evaluation of the impact of this intervention via on-going hand hygiene compliance, facilities audit and repeat situational analyses. We are assessing the possibility of conducting an audit of facility-acquired infections.

Project Developments

The evaluation of the HHP was expanded in the summer of 2016 to include an audit of infection causing bacteria found on the hands of local health workers. K4C set up a laboratory at our office in Fort Portal, and a team of microbiologists from the University of Salford travelled to Uganda in June 2016 to conduct hand swabbing activities. From these swabs, bacterial cultures were grown in the laboratory to assess the amount and type of bacteria on the health workers’ hands and the infection risk that this posed to patients. The hand bacterial audit will be repeated at the end of the HHP to assess whether any change has occurred as a result of the project. The University of Salford has funded a PhD scholarship to progress this work, also linking it to antimicrobial resistance which is a quickly growing and worrying phenomenon across Africa.

The Project Team

A project ‘Working Group’ will comprise the following members:

  1. Lead UK Partner and Project Director: Professor Louise Ackers representing Knowledge for Change and the University of Salford (
  2. Project Manager: Mr Allan Ndawula representing Knowledge for Change Uganda (
  3. Production Team Leader (Uganda): Mr Brian Senabulya representing UBEtech (
  4. Clinical Lead (Uganda): Sister Barbra Kamara representing Mountains of the Moon University (
  5. Microbiology Lead: Mr Gavin Ackers-Johnson representing the University of Salford (

For further information please contact the HHP Project Manager, Mr Allan Ndawula (

HHP Project Partner Organisations







HHP Funding Bodies