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Background Hand hygiene (HH) is one of the core components of infection prevention and control and is critical for a high quality of care. Multimodal approaches are recommended to strengthen and drive HH systems in healthcare facilities (HCFs). We aimed to assess the extent of implementation of the WHO HH multimodal improvement strategy in HCFs in the Eastern Region of Ghana.Methods This study was a descriptive cross-sectional study involving 22 HCFs from 17 districts in the Eastern Region of Ghana. We collected data from 22 hospitals using the WHO Hand Hygiene Self-Assessment Framework (HHSAF). Data were analysed through descriptive statistics.Results The HHSAF median score denotes an intermediate HH implementation level (53.5%, IQR 48.8%–58.3%). Fourteen HCFs attained an intermediate level, five attained basic level, one attained advanced level and no facility exhibited inadequate HH implementation level. Evaluation and feedback had the highest score (64.3%, IQR 50%–71.4%), as ward-based audits for the availability of HH resources have become standard practice in many of the HCFs. Reminders in the workplace had the lowest score (33.3%, IQR 25.9%–37.0%), whereby less than half (46%) of the HCFs had posters explaining the indications for HH and the correct use of alcohol-based hand rubs. HH implementation level did not differ significantly among government (M=49.97, SD=12.30) and non-government (M=53.32, SD=18.73) facilities, (t (20)=−0.503, p=0.621).Conclusion Most HCFs had an intermediate HH implementation level. The provision of HH resources, including posters, HH rounds in patient care areas, introduction of HH corners, leadership, financial and organisational support are key elements for increased compliance with the WHO HH multimodal improvement strategy.

Infections by Extended-Spectrum Beta-Lactamase producing Escherichia coli (ESBL-Ec) are on the increase in Ghana, but the level of environmental contamination with this organism, which may contribute to growing Antimicrobial Resistance (AMR), is unknown. Using the WHO OneHealth Tricycle Protocol, we investigated the contamination of E. coli (Ec) and ESBL-Ec in two rivers in Ghana (Odaw in Accra and Okurudu in Kasoa) that receive effluents from human and animal wastewater hotspots over a 12-month period. Concentrations of Ec, ESBL-Ec and percent ESBL-Ec/Ec were determined per 100 mL sample. Of 96 samples, 94 (98%) were positive for ESBL-Ec. concentrations per 100 mL (MCs100) of ESBL-Ec and %ESBL-Ec from both rivers were 4.2 × 10 4 (IQR, 3.1 × 10 3 -2.3 × 10 5 ) and 2.79 (IQR, 0.96-6.03), respectively. MCs100 were significantly lower in upstream waters: 1.8 × 10 4 (IQR, 9.0 × 10 3 -3.9 × 10 4 ) as compared to downstream waters: 1.9 × 10 6 (IQR, 3.7 × 10 5 -5.4 × 10 6 ). Both human and animal wastewater effluents contributed to the increased contamination downstream. This study revealed high levels of ESBL-Ec in rivers flowing through two cities in Ghana. There is a need to manage the sources of contamination as they may contribute to the acquisition and spread of ESBL-Ec in humans and animals, thereby contributing to AMR.