Hand hygiene knowledge & practices among healthcare providers in a tertiary hospital
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- Hand Hygiene Knowledge & Practices Among Healthcare Providers in a Tertiary Hospitals Author: Timothy A Ekwere Ifeoma P Okafor Presented By : Dr. Md. Masum Billah PG11-30-14-020
- Mr. X was admitted into hospital with severe abdominal pain and vomiting. He had to undergo emergency operation. The surgeon conclude that the operation was successful. Mr. X was counting days to go home. Unfortunately, on the 4th post operation days, he developed fever and need to stay longer in the hospital. He was suspected to get hospital acquired infection nosocomial infection, which is more difficult to treat even with the newest antibiotic.
- Research Questions How doctors/nurses perceived hand washing practice during their work? What are factors related to hand washing practice? What are the barriers of hand washing practice for HCPs in hospitals?
- Objectives To assess the knowledge , attitude and practice of this simple intervention hand washing . To explore doctors understanding about hand washing practice and hospital acquired infection To identify the hand-drying methods commonly used by the Health Care Providers. To identify factors that motivate and militate against hand washing practices amongst HCPs in hospitals.
- Background Proper Hand Hygiene is an important for prevention of Nosocomial Infections: Study giving a response rate 86% Had good knowledge : 83% Good Attitude 97.6% , good Hand washing practices 69.9% Hand washing After contact with patient 97.7% And Before 61.4%
- Background Reason for Improve hand hygiene among health workers (physicians, nurses, medical residents & medical students): Training on infection control on HCPs knowledge and practices. Most commonly used Running tap water with antiseptic rub (68.4%), Air dry (29.5%) , Personal handkerchief (28.8%), Common cloth towel (22.6%).
- Background Lagos University Teaching Hospital launched Infection Control Committee which is chaired by the Head of Microbiology Department: effort to reduce nosocomial infections. Organizes seminars , training on various aspects of infection control. Provide hand drying facilities : wash basin put in accessible location to encourage HCPs wash their hand, a poster was placed near basin as a reminder of ideal way of washing hand.
- Knowledge gap
- Conceptual Framework
- Conceptual Framework LOGISTIC Number of water point Access to water point Water availability Soap availability TIME number of patient working hours ENVIRON- MENTAL different stressor to hand washing practice between departments (ex: surgical VS medical) PSYCHOLO- GICAL ignorance doubting the necessity of practice
- Study Sites & Duration Study was conducted at the Lagos University Teaching Hospital (LUTH). Reason to select a foremost tertiary referral centre providing patient care to residents of Lagos & neighbouring states. The hospital has 761 Bed spaces ,25 in-patient wards including ICU, 654 Doctors & 734 Nurses at the time of study. Study time : August 2011
- Methodology Each wards provided Running Tap Water, Soap, Cloth Towel for hand drying. Stored water in plastic drums and buckets are provided as alternative source of water supply. Organizes Individual Departments seminars/training on infection control of their staff.
- Study Design and Population This was a Cross-Sectional Descriptive Study. Study Population were Health Care Providers working in LUTH : Only Doctors and Nurses who were working minimum one year with hospital. Other medical & non-medical personnel were excluded.
- Sampling Method Sample Size was calculated using the Formula for Descriptive Studies : Equal proportion of Doctors And Nurses were recruited . List of all doctors & nurses who were on duty in the wards in the month of study. By Simple Random Sampling , using computer generated random numbers,20HCPs (10+10) X 25 in-patient wards. Total Sample size (n)=500
- Data Collection Data Collection was done in August 2011 using Pretested. Structured. Self administered Questionnaire. Questionnaires delivered to the respondents and instructed to drop them at a designed collection point in the ward.
- Data Analysis Used SPSS software Version 11.5 and Microsoft Excel. Used Chi Square and Student t-test (level of significance at 5% ) Knowledge & Practice scored in Percentages and Grade . Score 0-33.3% Poor ; 33.3%-66.6% Fair ; 66.6% Good. Attitude was assess with Liker items ; rated scale Strongly agree =5 ,Agree=4, Neutral=3, Disagree=2, Strongly disagree=1.
- Ethical Issue Ethical approval obtained from the Ethics & Research Committee (ERC) of the hospital. Formal consent obtained from the respondents prior to research.
- Predetermined categories Predetermined categories / templete as shown in conceptual framework Templete TEXT Identify units Revise Categories Interpretively determine connections verify REPORT
- Timeline Task month 1 2 3 4 5 6 7 8 9 10 11 12 Approval for ERC Instrument development Recruitment and training Data collection Pretested Structured Administered Questionnaire Observation Data transcription Data coding & analysis summary report writing Draft manuscript Final report
- Budget item US$/month No. of staff month amount (US$) Personnel principle investigator 1,000 1 12 12,000 senior research officer 700 2 12 16,800 field research officer 500 3 12 18,000 Logistic* 5,000 Travelling 4,000 Total direct budget 55,800 20% overhead of direct budget 11,160 TOTAL BUDGET 66,960 *logistic: computer, software, recorder, portable HD, camera, mobile bill, stationaries
- References 1. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection control Programme. Lancet 2000; 356: 1307-1312. http://dx.doi.org/10.1016/S0140-6736(00)02814-2 2. Albert RK, Condie F. Hand washing pattern in medical intensive care units. N Engld Med 1981; 304: 1465-1466. http://dx.doi.org/10.1056/NEJM198106113042404 3.Pittet D, Mourouga P, Pemeger TV. Compliance with hand washing in a teaching hospital infection control programme. Ann Intern Med 1999; 130: 126-130. http://dx.doi. org/10.7326/0003-4819-130-2-199901190-00006 4. World Health Organization (WHO). Practical guidelines for infection control in health care facilities. Geneva, WHO 2004; Annex 1: 76-80.
- Acknowledgement Professor Dr. Harun-Ar-Rashid MD, MSc, MPH, PhD, FRCP Edin, MBA Professor of Public Health & Research Management and Director, Research & International Collaboration State University of Bangladesh Former Director Bangladesh Medical Research Council and All Participants