Measuring the observance of contact precautions when treating Buruli ulcer patient in a tertiary hospital in Benin

Main Article Content

AHOYO THEODORA ANGELE Perince Franel Djidjoho Fonton Evelyne Marie Claire LOZES Taofiki Wabi AMINOU


Background: Buruli ulcer, caused by Mycobacterium ulcerans, remains a public health issue in Benin. Treatments are based on antibiotics and surgery. Good hygiene is important for its management.

Objective: assess the observance of contact precautions practices by healthcare workers.

Methods: between 1st March and 30th October 2015 an investigation was carried out that involved the promotion of hands hygiene and basic infection prevention practices in health care. An effective education system was implemented to improve healthcare workers knowledge and compliance. The study period was divided in two. Period I corresponds to the promotion of standard precautions, based on training, direct observation and providing hygiene equipment and materials. Period II: hand hygiene audits were conducted using the World Health Organization ‘five moments for hand hygiene’ observational tool. Samples; taken from hands of medical personnel, and various hospital environment were screened for presence of pathogens bacteria. Susceptibilities to antimicrobial agents were tested by the disk diffusion method.

Results: before and after intervention there is no significant change for hand hygiene compliance globally, from 24.2%; (95% CI 21·1−36·9) to 33·3% after (31·8−41·3, but hand hygiene technique improved significantly. About 95% of personnel preferred hand washing with soap and water more than hand rubbing with alcohol based solutions. Pathogens bacteria were still present on hands (89%) and environment samples (42%) despite good knowledge of hand hygiene by 80% of medical personnel. Multi resistance bacteria represented 76% of strains

Conclusion: Inadequate compliance was noticed despite good knowledge of standard precautions. Antimicrobial resistance is particularly harmful to the Buruli ulcer secondary wound infection treatment. The lack of qualified personnel and financial resources allocated for this program is one of the causes of weak compliance.

Key words: Benin, hand hygiene, observance, Healthcare workers, Buruli ulcer, Multiresistance.

Article Details

How to Cite
THEODORA ANGELE, AHOYO et al. Measuring the observance of contact precautions when treating Buruli ulcer patient in a tertiary hospital in Benin. Medical Research Archives, [S.l.], v. 5, n. 6, june 2017. ISSN 2375-1924. Available at: <>. Date accessed: 09 dec. 2023.
Benin, hand hygiene, observance, Healthcare workers, Buruli ulcer, Multiresistance.
Research Articles


1 Williamson H. R, Benbow M E. Campbell LP. Johnson C R, Sopoh G, Barogui Y, Merritt R W, Small P L. C.: 2012 Detection of Mycobacterium ulcerans in the Environment Predicts Prevalence of Buruli Ulcer in Benin; January- Vol 6 Issue 1 | e1506.
2 Kpadonou T G, Germain M Houngbédji G M, Alagnidé E, Gouton E, Azanmasso H, Niama D, Sopoh G and Capo-Chichi J 2015: Health-Related Quality of Life of Adult Patients Healed from Buruli Ulcer in Benin BJMMR, 6(1): 88-98,; Article no.BJMMR.2015.186
3 Merritt RW, Walker ED, Small PLC, Wallace JR, Johnson PDR, et al 2010 Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review. PLoS Negl Trop Dis. 4(12): e911.
4 Nackers F, Johnson RC, Glynn JR, Zinsou C, Tonglet R, Portaels F. 2007 Environmental and health-related risk factors for Mycobacterium ulcerans disease (Buruli ulcer) in Benin. Am J Trop Med Hyg.; 77: 834–6.
5 World Health Organization. 2004. Provisional guidance on the role of specific antibiotics in the management of Mycobacterium ulcerans disease. World Health Organization, Geneva, Switzerland
6 Etuaful S, Carbonnelle B, Grosset J, Lucas S, Horsfield C, et al. 2005 Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of buruli ulcer inhumans. Antimicrob Agents Chemother.; 49: 3182-6
7 Johnson RC, Segla H, Dougnon TV, Boni G, Bankole HS, Houssou C, et al. 2014 Situation of water, hygiene and sanitation in a peri-urban area in Benin, West Africa: the case of Sèmè-Podji: J Environ Prot. 2014; 5: 1277–83. http://
8 Johnson R C , Boni G, Barogui Y, Sopoh G.E., Houndonougbo M, Anagonou E, Agossadou D, Diez G and Boko M 2015: Assessment of water, sanitation, and hygiene practices and associated factors in a Buruli ulcer endemic district in Benin (West Africa BMC Public Health 15:801 DOI 10.1186/s12889-015-2154-y
9 Geneva: WHO Press; 2014. World Health Organization. Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola
10 Briand S, Bertherat E, Cox P, Formenty P, Kieny MP, Myhre JK, et al. 2014; The international Ebola emergency. N Engl J Med. 371:1180–3.
11 Allegranzi B, Sax H, Bengaly L, Richet H, Minta DK, Chraiti MN. 2010 Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol; 31:133–41.
12 WHO guidelines on hand hygiene in health care: A summary, 2005. Available at: safety/events/05/HH_en.pdf. Accessed in Jan 2010.
13 National Committee for Clinical Laboratory Standards Performances standards for antimicrobial susceptibility testing. Twelfth informational supplement. NCCLS document (2002) M100-S12. National Committee for Clinical Laboratory Standards, Wayne, Pa.
14 Vuagnat, H; Comte, E 2009: L'Ulcère de Buruli, Un Exemple de Plaies Chroniques en Milieu Tropical JPC;14(69): 32-37
15 Barogui Y, Johnson RC, van der Werf TS, Sopoh G, Dossou A, et al 2009. Functional limitations after surgical or antibiotic treatment for buruli ulcer in Benin. Am J Trop Med Hyg.; 81:82-7.a
16 Trampuz A, Widmer AF. 2004 Hand hygiene: A frequently missed lifesaving opportunity during patient care. Mayo Clin Proc.;79: 109–16.
17 Pittet D, Mourouga P, Perneger TV. Compliance with hand washing in a teaching hospital: infection control program. Ann Intern Med. 1999; 130: 126–30. [PubMed]
18 Alsubaie S, bin Maither A, Alalmaei W et al. 2013 determinants of hand hygiene noncompliance in intensive care units. Am J infect control; 41: 131-135.
19 Randle J, Arthur A, Vaughan N. 2010 twenty four hour observational study of hospital hand hygiene compliance. J Hosp infect; 76; 252-255.
20 Fitzgérald G., Moore G., Wilson A.P.R. 2013 Hand hygiene after touching a patient’s surrounding: the opportunities most commonly missed, The Journal of Hospital Infection 84 27-31
21 Duerink DO, Farida H, Nagelkerke NJD, et al. 2006 Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital. J Hosp Infect; 64:36e 43
22 Fraise AP - Decontamination of the environment. J Hosp Infect 2007; 65 Suppl 2: 58-9.
23 Talon D. 1999 The role of hospital environment in the epidemiology of multiresistant bacteria; J Hosp Infect, 43:13-17.
24 Ahoyo T. A., Bankolé H., Adéoti F., Attolou A., Assavedo S., Amoussou-guenou M., Kindé-gazard D. and Pittet D. 2014 Prevalence of nosocomial infections and anti-infective therapy in Benin: results of the first nationwide survey in 2012 . Antimicrobial Resistance and Infection Control, 3:17
25 Baba-Moussa L, Ahoyo T.A, Le Brun. C, Makoutodé. M, Dramane K, Simeon Oloni Kotchoni S.O., and Prévost. G. 2013 Nosocomial Pneumonia Associated to PVL-Producing Staphylococcus aureus in Children in Benin Hindawi Publishing Corporation ISRN Infectious Diseases Volume, Article ID 420738, 7 pages