Hand hygiene compliance of patients' family members in India: importance of educating the unofficial 'fourth category' of healthcare personnel

COMPLIANCE OF PATIENT COMPANIONS AND VISITORS WITH HAND HYGIENE: AN OBSERVATIONAL STUDY

BACKGROUND

Hand hygiene is a simple and low-cost practice to prevent the spread of many microorganisms that cause healthcare-associated infections (HCAIs). Compliance with hand hygiene, especially by patient companions and visitors, is very important in order to prevent the transmission of pathogenic microorganisms between the health institutions and the community.

AIM

This is a descriptive study designed to investigate the compliance of patient companions and visitors with hand hygiene.

METHODS

The sample of the study included 209 individuals who were the companions and visitors of the patients who were hospitalized in a University Hospital in the west of Turkey. A questionnaire containing Demographics and Hand Hygiene and the Observation Form to assess Hand Hygiene Practice were used to acquire data. In order to conduct the research, permission was obtained from the ethics committee and the institution, and consent was obtained from the patient companions and visitors. To evaluate the data, the numbers, percentage calculations, mean and independent inter-observer agreement coefficient were used.

FINDINGS

96.2% of the patient companions and visitors stated that they did not receive training on the importance of hand washing during their stay in the hospital, and 74.6% stated that hand washing was very important in the prevention of diseases. The patient families reported that they most often washed their hands after touching bodily fluids (91.7%), and that they rarely washed their hands before touching a patient (34.0%). The rates were decreased in the observations, and the lowest rate for handwashing was before touching a patient (22.4%) and the highest rate for handwashing was after the risk for contamination with body fluids of patient (68.6%).

CONCLUSION

The results of this study indicate that patient companions and visitors did not receive any training on the importance of hand hygiene during the hospital stay, and the observed rate of compliance with hand hygiene was lower than stated. Recommendations include delivering planned handwashing training to patient companions and visitors using different teaching methods, and to conduct longer observational studies.

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit

BACKGROUND

Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units.

METHODS

We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive).

RESULTS

A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate.

CONCLUSION

Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia

BACKGROUND

Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behavioural change intervention in rural Cambodia, a formative mixed-methods observational study was conducted to investigate the context-specific behaviours and determinants of handwashing among healthcare workers, and maternal and non-maternal caregivers along the early newborn care continuum.

METHODS

Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and the associated communities were completed and hand hygiene compliance was assessed. Semi-structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional and environmental factors influencing the observed key hand hygiene behaviours.

RESULTS

Hand hygiene opportunities during newborn care were frequent in both settings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance with hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge.

CONCLUSIONS

Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

Barriers and facilitators to infection prevention and control in a neonatal unit in Zimbabwe - a theory-driven qualitative study to inform design of a behaviour change intervention

BACKGROUND

Hospital-acquired infection (HAI) is an increasing cause of neonatal morbidity/mortality in low-income settings. Hospital staff behaviours (e.g., hand hygiene) are key contributors to HAI. Understanding the drivers of these can inform interventions to improve infection prevention and control (IPC).

AIM

To explore barriers/facilitators to IPC in a neonatal unit in Harare, Zimbabwe.

METHODS

Interviews were conducted with 15 staff members of neonatal and maternity units alongside ethnographic observations. The interview guide and data analysis were informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model and explored individual, socio-cultural, and organizational barriers/facilitators to IPC. Potential interventions were identified using the Behaviour-Change Wheel.

FINDINGS

Enablers within Capability included awareness of IPC, and within Motivation beliefs that IPC was crucial to one's role, and concerns about consequences of poor IPC. Staff were optimistic that IPC could improve, contingent upon resource availability (Opportunity). Barriers included: limited knowledge of guidelines, no formal feedback on performance (Capability), lack of resources (Opportunity), often leading to improvization and poor habit formation. Further barriers included the unit's hierarchy, e.g., low engagement of cleaners and mothers in IPC, and staff witnessing implementation of poor practices by other team members (Opportunity). Potential interventions could include role-modelling, engaging mothers and staff across cadres, audit and feedback and flexible protocols (adaptable to water/handrub availability).

CONCLUSIONS

Most barriers to IPC fell within Opportunity, whilst most enablers fell under Capability and Motivation. Theory-based investigation provides the basis for systematically identifying and developing interventions to address barriers and enablers to IPC in low-income settings.

Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

BACKGROUND

Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility-based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care.

METHODS

This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge.

RESULTS

Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn.

CONCLUSIONS

In this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

Prevention and Control Strategies for Coronavirus Disease-2019 in a Tertiary Hospital in the Middle East of China

BACKGROUND

Coronavirus disease-2019 (COVID-19) is a new infectious disease. The COVID-19 outbreak has quickly spread globally and now is having remarkable effects on public health and national economies.

PURPOSE

Effective measures for prevention and control of nosocomial infection are urgently needed to control COVID-19 infection among medical staff.

METHODS

Herein, we described COVID-19 prevention and control strategies that have been implemented in a tertiary hospital in the middle east of China. Hospital layout was adjusted to prevent and control transmission. Other procedures were then implemented to prevent the spread of the virus, including specialized training and evaluation of medical staff, pre-testing and triage, measures to promote early identification of patients, environmental cleaning and disinfection, new medical waste processing procedures, new patient management procedures, timely disinfection of potential sources of nosocomial infection, and strict protective measures.

RESULTS

Since the new measures were implemented, to date there have only been three new confirmed cases of COVID-19 infection, no cases of medical staff infection, and no COVID-19-related deaths at the hospital.

CONCLUSION

The current report provides a protocol that could be implemented in medical departments in similar cities worldwide.

Healthcare facilities in low- and middle-income countries affected by COVID-19: Time to upgrade basic infection control and prevention practices

COVID-19 as a pandemic has spanned across all continents. With the increasing numbers in cases worldwide, even the countries with the best of healthcare facilities are reeling under the burden of the disease. Therefore, in countries with limited access to resources and poor healthcare infrastructure, the low and middle-income countries (LMICs), limiting spread becomes even more challenging. Low- and middle-income countries (LMICs) are severely hit by any outbreak and pandemics and face the lack of infrastructure and problem of overcrowding. Health facilities are compromised and almost exhausted at the time of emergency. There is disruption of normal supply chain, and consumables are not in sufficient quantity. In the current situation, rationalized use of available supplies is important. This paper presents the perspective on the basis of current literature on gaps in various infection prevention and control (IPC) strategies that are being followed currently in LMICs and suggestions for bridging these gaps.