Hand washing practice among health care workers in Ethiopia: systemic review and meta-analysis, 2020

Objective

Hand washing with soap and water is the single most weapon against infectious agents. Proper hand washing is not only reduces nosocomial infection, but also prevents the spread of current global concern Novel Corona viruses (COVID-19) and other viral illnesses like cold and flu. Therefore, the aim of this study is to assess hand washing practice among health care workers in Ethiopia.

Methods

In the current meta-analysis, the target variables search from different databases, like Google Scholar, African Journals OnLine, PubMed, and Scopus. All necessary data extracted by using a standardized data extraction format. Heterogeneity across the studies was evaluated using the I² index and Cochran's Q test. A random effect model computes to estimate the pooled proportion of hand washing practice among health care workers.

Results

In this meta-analysis, we included fifteen observational studies summarize the proportional of hand washing practice among health care workers. In the current study, the pooled hand washing practices among Ethiopian was 57.87% (95% CI: 44.14–71.61). Subgroup analysis conduct to identifying the sources of heterogeneity.

Conclusion

The overall pooled proportion of hand washing practice among health care workers was low. Hand washing with water and soap is recommended at least for 20 s to prevent contagious disease like Corona viruses.

Contamination of hospital tap water: the survival and persistence of Pseudomonas aeruginosa on conventional and 'antimicrobial' outlet fittings

BACKGROUND

Pseudomonas aeruginosa infections have been linked to contaminated hospital taps, highlighting the potential for tap outlet fittings (OF) to harbour biofilm. P. aeruginosa may be transferred to OFs via contaminated cleaning cloths. Suggested interventions include flushing regimens and alternative OF designs.

AIM

To investigate the transfer of P. aeruginosa from a contaminated cleaning cloth to conventional and 'antimicrobial/antibiofilm' OFs and to determine whether this contamination persists and/or leads to contamination of tap water.

METHODS

Microfibre cloths contaminated with P. aeruginosa (10⁸ cfu/mL) were used to wipe four different types of OF [one of conventional design (OF-A) and three marketed as 'antimicrobial' and/or 'antibiofilm' (OF- B, -C and -D)]. OFs were inserted into an experimental water distribution system for up to 24 h. Survival was assessed by culture. Single and multiple water samples were collected and cultured for P. aeruginosa.

FINDINGS

The median number of P. aeruginosa transferred from cloth to OF was 5.7 × 10⁵ cfu (OF-A), 1.9 × 10⁶ cfu (OF-B), 1.4 × 10⁵ cfu (OF-C) and 2.9 × 10⁶ cfu (OF-D). Numbers declined on all OFs during the 24 h period with log reductions ranging from 3.5 (OF-C) to 5.2 (OF-B; P > 0.05). All water samples delivered immediately after OF contamination contained P. aeruginosa at ≥10 cfu per 100 mL. Contamination of water delivered from OF-A persisted despite continued flushing. Water delivered from OF-B did not contain P. aeruginosa beyond the first flush.

CONCLUSION

Contaminated cleaning cloths may transfer P. aeruginosa to OFs, leading to contamination of tap water. Although not removing the potential for contamination, 'antimicrobial/antibiofilm' OFs may prevent P. aeruginosa from continually contaminating water delivered from the outlet.

A multifactorial action plan improves hand hygiene adherence and significantly reduces central line-associated bloodstream infections

BACKGROUND

Although hand hygiene (HH) is key to reducing health care-associated infections, it is well documented that health care worker (HCW) adherence to appropriate HH protocols is relatively low.

METHODS

This was a collaborative quality improvement project with multiple interventions conducted in a 570-bed academic hospital in Columbia, MO between April 2006 and September 2012. A multimodal action plan to improve HH adherence among all HCWs was developed, addressing 4 key areas: staff education, staff accountability, hand sanitizer product selection and accessibility, and organizational culture. HH adherence and central line-associated bloodstream infection (CLABSI) rates were monitored as outcome measures.

RESULTS

The overall HH adherence rate increased from 58% in April 2006 to 98% in September 2012. The adherence rates increased among all hospital units and among all HCW categories; in September 2012, HH adherence was 96% for physicians, 99% for nursing staff, and 99% for food services staff. CLABSI rates decreased over the same period, from 4.08 per 1000 device-days to 0.42 per 1000 device-days.

CONCLUSIONS

This multifactorial quality improvement project resulted in an institution-wide increase in HH adherence and a significant decrease in CLABSIs.

Compliance with the national palestinian infection prevention and control protocol at governmental paediatric hospitals in gaza governorates

OBJECTIVES

Nosocomial infections are a significant burden for both patients and the healthcare system. For this reason, infection prevention and control (IPC) practices are extremely important. The Palestinian Ministry of Health adopted the national IPC Protocol in 2004. This study aimed to assess the compliance of healthcare providers (HCPs) with the Protocol in three governmental paediatric hospitals in Gaza governorates.

METHODS

This descriptive cross-sectional study was conducted from February to November 2010. Data were collected from a sample of doctors, nurses and physiotherapists (N = 334) using a self-administered questionnaire and observation checklists to record HCP practices and assess the hospital environment.

RESULTS

The response rate was 92%. The most important reasons for non-compliance with the IPC Protocol were the absence of an education programme (61.5%), lack of knowledge (52.4%) and the scarcity of required supplies (46.9%). Only 2.3% of respondents had a copy of the IPC Protocol, while 65.8% did not know of its existence. Only 16.9% had participated in training sessions regarding general IPC practices. The observation checklist regarding HCP practices revealed low levels of compliance in hand washing (45.9%), wearing gloves (40.7%) and using antiseptics/disinfectants (49.16%). The health facilities checklist indicated that there was a lack of certain essential equipment and materials, such as covered waste containers and heavy-duty gloves.

CONCLUSION

Due to the lack of HPC knowledge, the authors recommend that the IPC Protocol be made available in all hospitals. In addition, a qualified team should implement intensive IPC education and training programmes and facilities should provide the required equipment and materials.

Contamination of medical charts: an important source of potential infection in hospitals

Objective

This prospective study aims to identify and compare the incidence of bacterial contamination of hospital charts and the distribution of species responsible for chart contamination in different units of a tertiary hospital.

Methods

All beds in medical, surgical, pediatric, and obstetric-gynecologic general wards (556) and those in corresponding special units (125) including medical, surgical, pediatric intensive care units (ICUs), the obstetric tocolytic unit and delivery room were surveyed for possible chart contamination. The outer surfaces of included charts were sampled by one experienced investigator with sterile cotton swabs rinsed with normal saline.

Results

For general wards and special units, the overall sampling rates were 81.8% (455/556) and 85.6% (107/125) (p = 0.316); the incidence of chart contamination was 63.5% and 83.2%, respectively (p<0.001). Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards. Coagulase-negative staphylococci was the most common contaminant in general wards (40.0%) and special units (34.6%) (p>0.05). Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%). Logistic regression analysis revealed the incidence of chart contamination was 2- to 4-fold higher in special units than in general wards [odds ratios: 1.97–4.00].

Conclusions

Noting that most hospital charts are contaminated, our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions.

Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections

BACKGROUND

Hand hygiene is the single most important intervention to combat infections in any health care setting. However, adherence to hand hygiene practice remains low among health care workers.

OBJECTIVES

Our objective was to assess compliance with hand hygiene over time utilizing a multifaceted approach to hand hygiene. In addition, we assessed the rate of device-associated infections.

METHODS

This is a descriptive time series study with a multitude of interventions from October 2006 to December 2011 set in a 350-bed community hospital in Saudi Arabia. We utilized a multimodal program to promote hand hygiene activities. We also calculated device-associated infection rates as outcome measures.

RESULTS

Over the study, the overall hand hygiene compliance rate increased from a baseline of 38% in second quarter 2006 to 65% in 2010 and then to 85% in 2011 (P < .001). The compliance rates increased among all professions and different hospital units. The compliance rates were 87% for physicians, 89% for nursing staff, and 93% for nutritionist. The rate of health care-associated methicillin-resistant Staphylococcus aureus per 1,000 patient-days decreased from 0.42 in 2006 to 0.08 in 2011. Ventilator-associated infection rates decreased from 6.12 to 0.78, central line-associated bloodstream infections rates decreased from 8.23 to 4.8, and catheter-associated urinary tract infection rates decreased from 7.08 to 3.5.

CONCLUSION

This intervention used a multitude of interventions and resulted in an institution-wide increase and sustained improvement in compliance rates.

Compliance of nursing students with infection prevention precautions: effectiveness of a teaching program

BACKGROUND

In Jordan's nursing schools, infection prevention precautions are not taught in special courses. Instead, most nursing schools include the topic as a 1-hour lecture within the clinical courses, which is believed to be insufficient. This study aimed to test the effectiveness of a nursing infection prevention educational program presented to nursing students before graduation, to promote their knowledge of infection prevention precautions.

METHODS

A true experimental design was used to examine the effects of the infection prevention educational program on students' educational knowledge. This study involved a random assignment of subjects to experimental and control groups, and administration of the pretest and the posttest to all subjects in both groups separately.

RESULTS

Participants in the experimental group demonstrated significantly better knowledge (t = 19.15; df = 95; P = .000) and attitude scores (t = 2.29; df = 46; P = .04) than participants in the control group after particpating in the infection prevention educational program. However, compliance scores were not significantly differernt between the 2 groups (t = 1.92; df = 95; P = .067); indeed, compliance was found to be significant within the experimental group (t = 10.65; df = 46; P = .000).

CONCLUSIONS

It is important that nursing students be competent in infection prevention precautions; however, there may be deficits in their education in this area. The nursing curriculum should include additional emphasis on practice as a means to help translate theory into clinical behavior.

Types of interventions used to improve hand hygiene compliance and prevent healthcare associated infection

Hand hygiene is regarded as the most effective means of preventing healthcare associated infection. However, systematic reviews provide limited evidence of effectiveness, a finding that is attributed to the poor quality of research designs, dubious outcome measures and flawed approaches to audit. The ability of interventions to improve hand hygiene compliance has not previously been questioned. This review categorises the types of interventions used to promote hand hygiene and discusses their plausibility, taking selected examples from previous systematic searches. Opinion leaders have emphasised the need for interventions to be underpinned by theory. This is an ambitious endeavour for infection control personnel based in National Health Service trusts. However, it is possible to offer pragmatic suggestions to promote compliance. Initiatives are most likely to be successful if needs analysis is undertaken at the outset to address local barriers and identify enablers to compliance, and if interventions are clearly justified by existing evidence, customised according to occupational group, consider health workers’ needs and preferences for training and updating, and avoid punishment.

Long-term persistence of seroprotection by hepatitis B vaccination in healthcare workers of southern Italy

BACKGROUND

The impact of hepatitis B virus (HBV) vaccination campaigns on HBV epidemiology needs to be evaluated, in order to assess the long-term immunity offered by vaccines against HBV.

OBJECTIVES

To evaluate the current status of anti-HBV vaccine coverage among healthcare workers (HCWs) in Southern Italy, and to determine the long-term persistence of antibodies to hepatitis B surface antigens (anti-HBs) in such a cohort of subjects.

PATIENTS AND METHODS

A longitudinal, retrospective seroepidemiological survey was conducted among 451 HCWs, who were working at or visiting, the Occupational Health Department of a city hospital, in Catania, Italy, between January 1976 and December 2010.

RESULTS

At the 30-year follow-up (mean follow-up 10.15 ± 5.96 years, range 0.74-30), 261 HCWs had detectable anti-HBs titers indicating a persistence of seroprotection of 89.4% (out of 292 anti-HBs positive results, three months after vaccination). An inadequate vaccination schedule was the strongest predictor of antibody loss during follow-up (OR = 8.37 95% CI: 5.41-12.95, P < 0.001). A Kaplan-Maier survival curve revealed that the persistence of anti-HBs 30 years after vaccination, was 92.2% for high responders, while it was only 27.3% for low responders (P = 0.001).

CONCLUSIONS

A good level of seroprotection persisted in 57.9% of the subjects after 30 years. Factors related to this immunization status confirmed the importance of vaccinating HCWs early in their careers and ensuring an adequate vaccination schedule. However, with particular reference to the low rate of hepatitis B vaccine coverage among HCWs in Southern Italy, the implementation of a new educational intervention as part of an active vaccination program is needed.

Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program

PURPOSE

Healthcare-associated infections (HCAIs) impact 10% of hospitalized patients. Some of these infections result from bacterial cross contamination and poor compliance with guidelines (Pittet D: Compliance with hand disinfection and its impact on hospital-acquired infections. J HospInfect 48 Suppl A:S40-S46, 2001); (Watanakunakorn C, Wang C, Hazy J: An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 19:858-860, 1998). Contamination of provider hands may be a modifiable risk factor. We instituted a novel multimodal system designed to improve hand hygiene by ICU providers.

MATERIALS AND METHODS

A before and after study design was used to evaluate the impact on the incidence of CRBSI and VAP of a multi-modal program incorporating education, performance feedback, and a body worn hand hygiene device. Compliance was communicated quarterly. Primary outcomes were CRBSIs and VAPs per 1,000 line days or per 1,000 ventilator days and compliance rates. Secondary outcomes were hospital length of stay and mortality.

RESULTS

A total of 1, 262 and 1,331 patients were evaluated during consecutive 12 month periods. VAP per 1000 vent days were significantly reduced after introduction of the program [3.7 vs. 6.9] P < .01. The reduction in CRBSI per 1000 line days was not significant [1.5 vs. 2.6], P = .09. Observed hand hygiene increased during the study period. There was no significant difference in mortality.

CONCLUSIONS

A novel multi-modal hand hygiene system resulted in a reduction in VAP. Provider hand contamination during patient care in the ICU is a modifiable risk factor for reducing ventilator associated pneumonias.

The role of education in the prevention and control of infection: a review of the literature

This paper discusses a literature review which was undertaken prior to a research study about student nurses' and midwives' experiences of learning infection control in clinical practice. Its aim is to identify the role of education in the prevention and control of infection, with a specific focus on compliance with infection control precautions and reduction in infection rates. It also identifies the methods used for teaching infection control. The review concludes that there is no rigorous and convincing evidence that education improves compliance with infection control precautions or reduces rates of infection, particularly in the long-term. Areas for future research are identified.

Interventions to improve hand hygiene compliance in patient care

BACKGROUND

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure.

OBJECTIVES

To update the review done in 2007, to assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection.

SEARCH STRATEGY

We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. Originally searched to July 2006, for the update databases were searched from August 2006 until November 2009.

SELECTION CRITERIA

Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group were eligible for inclusion. Studies reporting indicators of hand hygiene compliance and proxy indicators such as product use were considered. Self-reported data were not considered a valid measure of compliance. Studies to promote hand hygiene compliance as part of a care bundle approach were included, providing data relating specifically to hand hygiene were presented separately. Studies were excluded if hand hygiene was assessed in simulations, non-clinical settings or the operating theatre setting.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed data quality.

MAIN RESULTS

Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the same paper: simple substitutions of product and two multifaceted campaigns, one of which included involving practitioners in making decisions about choice of hand hygiene products and the components of the hand hygiene program. The other study also presented two separate multifaceted campaigns, one of which involved application of social marketing theory. In these two studies follow-up data collection continued beyond twelve months, and a proxy measure of hand hygiene compliance (product use) was recorded. Microbiological data were recorded in one study. Hand hygiene compliance increased for one of the studies where it was measured by direct observation, but the results from the other study were not conclusive. Product use increased in the two studies in which it was reported, with inconsistent results reported for one initiative. MRSA incidence decreased in the one study reporting microbiological data.

AUTHORS' CONCLUSIONS

The quality of intervention studies intended to increase hand hygiene compliance remains disappointing. Although multifaceted campaigns with social marketing or staff involvement appear to have an effect, there is insufficient evidence to draw a firm conclusion. There remains an urgent need to undertake methodologically robust research to explore the effectiveness of soundly designed and implemented interventions to increase hand hygiene compliance.

Improving hand hygiene compliance: a multidisciplinary approach

This article focuses on improving hand hygiene compliance using a multidisciplinary approach. Historically, hand hygiene compliance among health care workers and physicians has been far below an acceptable level. The facility discussed in this article uses an ongoing "Hand Hygiene" campaign, which is multidisciplinary and addresses numerous barriers to compliance.

An investigation of the division between espoused and actual practice in infection control and of the knowledge sources that may underpin this division

Aims: This paper aims to provide a better understanding of divisions between the espoused and actual infection control practice of staff working within a renal unit and to investigate the sources of knowledge used to underpin practice.

Background: Healthcare associated infection continues to be a major problem for health services. It has been claimed that healthcare associated infections may be reduced by around a third through the use of effective infection control measures. The effectiveness of these measures will rely upon the learning and skills of those implementing them.

Methods: The study employed a primarily qualitative approach using participant observation and semi structured interviews over a six month period on a renal unit within a district general hospital.

Results: Results gained provided some indication of a gap between espoused and actual compliance with infection control policy in practice while also indicating that tacit knowledge and learning in practice may offer an effective means of gaining and implementing infection control knowledge.

Conclusions: This study highlights divisions between espoused and actual infection control practice, it also emphasises the role of tacit learning and how tacit knowledge may be gained and employed in practice.

Measuring handwashing performance in health service audits and research studies

Handwashing is regarded as the most effective way of controlling healthcare-associated infection. A search of the literature identified 42 intervention studies seeking to increase compliance in which the data were collected by directly observing practice. The methods used to undertake observation were so poorly described in most studies that it is difficult to accept the findings as reliable or as valid indicators of health worker behaviour. Most studies were limited in scope, assessing the frequency of handwashing in critical care units. The ethical implications of watching health workers during close patient contact were not considered, especially when observation was covert or health workers were misinformed about the purpose of the study. Future studies should take place in a range of clinical settings to increase the generalizability of findings. Observation should be timed to capture a complete picture of 24h activity and should include all health workers in contact with patients because all have the potential to contribute to cross-infection. Reported details of observation should include: vantage of data collectors; inter-rater reliability when more than one individual is involved; and attempts to overcome the impact of observation on usual health worker behaviour. Ideally an additional data collection method should be used to corroborate or refute the findings of observation, but no well-validated method is presently available.

Interventions to improve hand hygiene compliance in patient care

BACKGROUND

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure.

OBJECTIVES

To assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection.

SEARCH STRATEGY

We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. All databases were searched to July 2006; MEDLINE was searched from 1980, CINAHL from its inception, and the remainder from 1990 until July 2006.

SELECTION CRITERIA

Randomised controlled trials; controlled clinical trials; controlled before and after studies; and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group. Studies reporting proxy indicators of hand hygiene compliance were considered. Studies to promote compliance with universal precautions were included providing data relating specifically to hand hygiene were presented separately.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed data quality.

MAIN RESULTS

Two studies met the criteria for review. One was a randomised controlled trial. The other was a controlled before and after study. Both were poorly controlled. Statistically significant post-intervention increase in hand washing was reported in one study up to four months after the intervention. In the other there was no post-intervention increase in hand hygiene compliance.

AUTHORS' CONCLUSIONS

There is little robust evidence to inform the choice of interventions to improve hand hygiene. It appears that single interventions based on short, 'one off' teaching sessions are unlikely to be successful, even short-term. There is a need to undertake methodologically robust research to explore the effectiveness of soundly designed interventions to increase hand hygiene compliance.

The CleanYourHandsCampaign: critiquing policy and evidence base

Handwashing is considered to be the most effective way of reducing cross-infection. Rates of healthcare-associated infection and the incidence of meticillin-resistant Staphylococcus aureus are higher in the UK than in many other European countries. The government has responded by introducing the 'CleanYourHandsCampaign' throughout England and Wales, based on the success of the approach employed in Geneva. Alcohol hand rub is placed at every bedside in acute hospitals, ward housekeepers should replenish supplies and feedback on compliance is provided to health workers. Posters and other promotional materials are used to remind health workers and visitors to use the hand rub. Patients are encouraged to ask health workers if they have cleaned their hands before contact. In this paper we argue that the evidence base underpinning the CleanYourHandsCampaign is incomplete. Alcohol hand rub is acknowledged as a useful adjunct to hand hygiene but it is not effective in all circumstances. There is some evidence to support the use of feedback on performance to encourage compliance but no evidence that promotional materials such as posters or patient reminders are effective. The ethics of encouraging hospital patients to take responsibility for their own safety is questioned. Much of the success in Geneva must be attributed to the attention given to contextual factors within the organization that encouraged hand rub use, especially hospital-wide 'ownership' of the initiative by managers and senior health professionals. A customized intervention from another country that fails to consider local organizational factors likely to influence the implementation of the campaign is unlikely to be effective. It is concluded that although hand hygiene is of undoubted importance, undue emphasis should not be placed on it as a 'quick fix' to solve the unacceptably high rates of healthcare-associated infection in National Health Service hospitals.

Contamination of patients' files in intensive care units: an indication of strict handwashing after entering case notes

BACKGROUND

The extent to which bedside patients' files become contaminated and the range of bacterial flora attributable to contamination in high-risk areas of the hospital are not known with certainty. The aim of the present study was to determine the degree of contamination of the patient's files and also to analyze and compare the spectrum of contaminant bacterial flora between the intensive care unit (ICU) and surgical wards, the 2 most high-risk areas for nosocomial transmission of infection.

METHODS

Microbiologic samples were collected from the exposed outer surface of the patients' files kept bedside in the ICU and surgical wards with sterile swabs moistened with sterile normal saline. Swabs were cultured within an hour of collection on blood agar and MacConkey's agar plates, which were incubated at 37 degrees C for 48 hours. Gram-negative bacilli were identified by Gram's stain, catalase, oxidase tests, and API 20E and API 20NE. Staphylococcus species were identified by Gram's stain, catalase test, and tube coagulase test. Antibiotic susceptibility of the isolated bacteria was determined by the disk diffusion technique according to the criteria of National Committee for Clinical Laboratory Standards (NCCLS).

RESULTS

In ICU, 85.2% (87/102) and, in surgical wards, 24.7% (22/89) of patient's files were found to be contaminated with pathogenic and potentially pathogenic bacteria (OR, 17.664; 95% CI: 8.050-39.423; P < .0001). Pseudomonas aeruginosa was the most commonly isolated bacteria (32.3%, 33/102) in ICUs, whereas Staphylococcus aureus was the peak contaminant (11.2%, 10/89) of the files in surgical wards. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 6.8% (7/102) of ICU patient's files, whereas only 1.1% (1/89) of patient's files in surgical wards were contaminated with MRSA (OR, 6.484; 95% CI: 3.215-13.463; P < .0001). The multidrug-resistant P aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Serretia marcesens isolated from the patient's files had the same antibiotic resistance pattern as of these bacteria isolated from the patients.

CONCLUSION

The majority of the patient's files in ICUs were contaminated often with multidrug-resistant bacteria and even MRSA. Contaminated files could be a source of transmission of infection. To prevent this, handwashing practice should be strictly followed after attending the patient and before entering the case notes in the patient's file. The maintenance of good hand hygiene by the health care workers (HCWs) after handling contaminated files should perhaps be the most prudent approach to prevent patient-patient transmission of infection in high-risk areas including ICU and surgical wards.

Compliance to hepatitis B vaccination and subsequent development of seroprotection among health care workers of a tertiary care center of Saudi Arabia

BACKGROUND

There is lack of reliable data on compliance to hepatitis B virus (HBV) vaccine and development of seroprotective levels of antibodies among health care workers (HCWs) from the countries with high HBV endemicity such as Saudi Arabia. This study aimed to assess the compliance with HBV vaccine and subsequent levels of seroprotection among HCWs of a large tertiary care center of the Eastern Province of Saudi Arabia.

METHODS

All the HCWs (n = 1302) involved in direct patient care, including 374 (28.7%) physicians, 619 (47.6%) nurses, and 309 (23.7%) technicians, were enrolled for the study. Those having antibody to hepatitis B surface antigens (anti-HBs) levels less than 10 mIU/mL were advised to take 3 doses of yeast-derived recombinant HBV vaccine at 0, 1, and 6 months of 1 mL (20 microg/mL) in the deltoid muscle. Blood samples were checked for anti-HBs antibody levels by enzyme immunoassay during the initial screening of HCWs and 3 months after the third dose of HBV vaccine. The group of physicians included 34.5% (129/374) of consultants, 16.8% (63/374) of specialists, and 48.6% (182/374) of residents.

RESULTS

An overall HBV vaccine compliance rate of 71.6% (932/1302) was observed among HCWs including that of 79.5% (492/619) among nurses, 78.3% (242/309) among technicians, and 52.9% (198/374) among physicians. Thus, physicians recorded the lowest compliance (OR, 3.211; 95% CI, 2.259-4.567; P < .0001) to HBV vaccine. Among physicians, the lowest compliance of 42.3% (77/182) was observed in residents (OR, 3.690; 95% CI, 1.067-3.703; P < .0001). The overall seroprotection after vaccination was achieved in 92.2% of the compliant HCWs, and 7.8% of them failed to mount adequate response to HBV vaccine. Nonresponders included mainly the physicians (OR, 2.229; P = .05)-consultants in particular (OR, 3.476; P < .0001). The mean age of nonresponders was higher than those who mounted an adequate anti-HBs response (46.7 +/- 6.3 vs. 32.2 +/- 3.3 years OR, 1.845; 95% CI, 0.999-3.414; P < .05).

CONCLUSIONS

Poor compliance to HBV vaccine among physicians--residents in particular-is an issue of immense concern, which demands close examination and identification of the specific action that needs to be taken to enhance the uptake of the vaccine by this target population.