Hand Hygiene Knowledge & Practices Among Healthcare Providers in a Tertiary Hospitals

Author:Timothy A EkwereIfeoma P Okafor

Presented By :Dr. Md. Masum BillahPG11-30-14-020

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

Taskmonth

1 2 3 4 5 6 7 8 9 10 11 12Approval 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

Budgetitem 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 55,80020% 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 BangladeshFormer Director Bangladesh Medical Research Council

and All Participants