Understanding hand hygiene behavior in a pediatric oncology unit in a low- to mid-income country

Knowledge, Attitude and Practice of Hand Hygiene among Healthcare Workers Caring for Children with Leukaemia in the Paediatric Oncology Ward of King Saud Medical City, Saudi Arabia

Background

Hands are the most common vehicle of pathogen transmission in a healthcare setting. Therefore, hand hygiene is the leading method of reducing healthcare-associated infections. This study aimed to determine the knowledge, attitude and practice (KAP) of hand hygiene and predictors for poor hand hygiene practice among healthcare workers who care for children with leukaemia in the paediatric oncology ward of King Saud Medical City (KSMC) in Saudi Arabia.

Methods

One hundred and ninety medical doctors and nurses, who were registered with the Saudi Commission for Health Specialities, were selected to participate in this cross-sectional study using a simple sampling technique. Their KAP of hand hygiene was assessed using a self-structured questionnaire and the collected data was analysed using IBM® SPSS® version 26.0.

Results

Of the 190 healthcare workers, 74.7% were nurses and 25.3% were medical doctors. Among the participants, 53.7% (102) had good knowledge of hand hygiene, 51.6% (98) had positive attitudes towards hand hygiene and 55.8% (106) practised satisfactory hand hygiene. Bachelor education level (adjusted OR = 2.736; 95% CI = 1.101, 6.799; P = 0.030), postgraduate education level (adjusted OR = 6.256; 95% CI = 2.171, 18.028; P = 0.001), poor knowledge (adjusted OR =2.575; 95% CI = 1.263, 5.246; P = 0.009) and negative attitude (adjusted OR = 4.702; 95% CI = 1.263, 5.246; P < 0.001) were the significant predictor variables of unsatisfactory hand hygiene practice among healthcare workers.

Conclusion

The performance of hand hygiene among healthcare workers is still far less than optimal, particularly in settings like oncology units. Effective programmes are needed to increase their awareness of hand hygiene KAP, while strict guidelines are needed to reduce nosocomial infections.

Standard Precautions are for everyone: The role of HIV stigma and implications for nursing education in India

Background and objective

Standard Precautions (SP) are infection control procedures universally applicable to every patient. Though SP reduces disease transmission, their implementation is dependent on the knowledge and skills of healthcare workers (HCWs). Poor knowledge regarding the appropriate use of SP can cause fear among HCWs, leading to stigma and discrimination while treating people living with HIV (PLWH). Stigma and discrimination are known barriers for PLWH to access HIV care services. The aim of the study was to assess nursing student knowledge of SP, SP self-efficacy and SP perceived efficacy of nursing students, and (2) to assess the association between SP knowledge, perceived efficacy, and intention to utilize unwarranted precautions, like using double gloves while treating PLWH.

Methods

This paper analyzes baseline (non-randomized) data of a cluster randomized controlled trial amongst 1868 Indian nursing students. Data was collected using computer-administered structured questionnaire. The associations between the measures were done using multiple, logistic and poisson regression models.

Results

Although 97% nursing students could identify SP, only 35.5% understood that they need to be used with all patients. Awareness of the importance of using SP with all patients was positively associated with self-efficacy. Students performing high-risk tasks frequently were significantly more likely to be confident in their ability to correctly use SP, but also had higher intention to use unwarranted precautions.

Conclusions

Existing teaching and training programs for HCWs need to provide clear guidelines and emphasize on the correct use of SP with all patients. This will increase both skills and confidence in their abilities (self-efficacy).

"The role as a champion is to not only monitor but to speak out and to educate": the contradictory roles of hand hygiene champions

BACKGROUND

Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term "HH champion" and how they define the role.

METHODS

An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes.

RESULTS

A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role.

CONCLUSIONS

Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance-and differentiate it from the role of a "compliance auditor." Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.