Surface Disinfection Practice in Public Hospitals in the Era of COVID-19: Assessment of Disinfectant Solution Preparation and Use in Addis Ababa, Ethiopia

Background

Surface disinfection of healthcare facilities with appropriate disinfectants is among the infection control strategies against the spread of coronavirus disease 2019 (COVID-19). As sodium hypochlorite solution (SHS) is a commonly used surface disinfectant, its preparation and proper use should be given a due attention. The current study aimed at assessing the practice of Addis Ababa public hospitals in the preparation and use of SHS.

Methods

A cross-sectional observational study was employed to assess the adequacy of disinfectant solution preparation and use. Checklists were used for data collection. Descriptive statistics were used for data analyses, and categorical variables were described by frequencies and percentages.

Results

Out of the twelve public hospitals included in the study; only three hospitals checked the potency of the working SHS. Majority of the hospitals (8 hospitals) stored the concentrated SHS products in cool, dry, and direct sunlight protected places. It was only in one hospital where appropriate personal protective equipment was used during the preparation and quality control activities. Surfaces were not cleaned in all hospitals before disinfection; and the rooms were ventilated only in 2 hospitals during the application of the disinfectant solution.

Conclusion

The study revealed that the preparations of SHS in the public hospitals did not comply with most of the requirements of good compounding practice. Moreover, standard practices were not maintained in majority hospitals during the use of SHS for surface disinfection. As a control strategy in the spread of COVID-19 and other infections, appropriate corrective actions shall be implemented in the studied hospitals to mitigate the limitations observed in the preparation and use of SHS.

Prescribing Pattern of Dermatological Compounding in Ethiopia: The Case of ALERT Hospital

BACKGROUND

Skin diseases are among the major contributors of disease burden in Ethiopia affecting individuals of all age. Extemporaneous compounding of topical medications serves as a necessary option to treat skin diseases when manufactured medications could not meet specific patient needs. Different classes of drugs are commonly used for the treatment of dermatologic diseases. Failure to periodically assess the prescribing pattern and patient needs may lead to inappropriate planning and implementation that ultimately compromise the service. Periodic prescription analysis for compounded medications helps to monitor the prescription pattern with respect to medication selection, disease condition, dosage form types and other relevant parameters. The current study was conducted to analyze the pattern of compounding prescriptions for dermatologicals in ALERT hospital.

METHODS

A cross-sectional design was conducted by retrospectively evaluating compounding prescription records of January and July, 2021. A total of 460 prescriptions in the hospital community pharmacy were systematically selected. Data related to disease pattern, product selection and dosage form type were extracted and analyzed. Data analysis was done using software for the statistical package for social science version 25.0.

RESULTS

A total of 441 prescriptions containing dermatological products for compounding were analyzed. Most patients were female (62.8%) and aged 30-64 years (44.0%). Psoriasis (36.2%), acne vulgaris (15.3%), and rosacea (13.4%) were the top 3 skin diseases for which the compounding preparations were prescribed. Salicylic acid (38.0%) was the most frequently prescribed drug followed by betamethasone (20.2%); while white petrolatum (47.2%) was the most common diluting agent used for compounding.

CONCLUSION

Psoriasis was the major dermatologic disease for compounding prescriptions and salicylic acid was the most frequent product used in compounding for treatment of the prescribed skin diseases.

Extemporaneous Compounding Practice for Dermatologic Preparations in Ethiopian Public Hospitals: Regulatory Requirements and Quality Concerns

Extemporaneous compounding is among the key hospital pharmacy services that promotes pharmaceutical care. It is a long-standing practice in dermatology for patients who need custom-made drug products. The practice of dermatologic compounding practice in Ethiopian public hospitals is found at the beginning and very few hospitals have started the practice so far. This research communication aimed at examining Ethiopian public hospitals' extemporaneous compounding practice for dermatologicals with emphasis on regulatory requirement and quality control activities. To benefit patients from these products, good compounding practice should be obeyed in line with the expansion of the service. Gaps have been observed in the facilities with regard to quality assurance system and compliance with the country's regulatory requirements. This implies a need to take appropriate and timely actions by the responsible stakeholders and expand the service in the country by fulfilling the regulatory requirement.

Adequacy of alcohol-based handrub solution production practice in response to COVID-19 in public hospitals found in Addis Ababa, Ethiopia: a multicentered cross-sectional study

Background

Proper hand hygiene using alcohol-based handrub (ABHR) is an effective preventive approach for the current Coronavirus Disease 2019 (COVID-19) pandemic and other infections. World Health Organization recommends local production of ABHR solution in healthcare settings which provides a feasible alternative to the use of relatively expensive commercially produced hand sanitizers. The aim of this study was to explore the adequacy of ABHR solution production practice in response to COVID-19 in public hospitals of Addis Ababa, Ethiopia.

Methods

A cross-sectional observational study was applied using assessment checklist for evaluation of the adequacy of ABHR production practice in compounding units of public hospitals. The evaluation was done with regard to the standard requirements as per the checklist. Statistical Package for Social Sciences (SPSS) version 23 was used for data entry and analysis. Descriptive statistics was employed for analyses of data and categorical variables were described by frequencies and percentages.

Results

Out of the 13 public hospitals observed in the study, 11 facilities had dedicated premises for compounding of ABHR solution. Seven facilities determined the concentration of ethanol in ABHR solution using alcoholmeters. Only one health facility had a titration kit and performed a strength test for the hydrogen peroxide raw material. Thermal and chemical disinfection processes were practiced for cleaning of recycled dispensing bottles only in 3 and 2 hospitals, respectively. Most of the hospitals (11 facilities) had standard operating procedures (SOPs) for production, but the majority lack SOPs for beyond-use-date assignment (11 facilities), premise and equipment cleaning (12 facilities), and disinfection of recycled bottles (12 facilities).

Conclusion

Most hospitals have fulfilled the majority requirements of premises required for compounding of ABHR solution in their facilities. Five hospitals did not verify the concentration of ethanol in the ABHR solution which might affect the effectiveness of the product. Generally, lower compliance of the majority studied hospitals to good compounding practice was observed during ABHR solution production especially for product preparation, quality control, and documentation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-021-00321-y.

Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study

BACKGROUND

Globally, the safety of patients and healthcare providers is at risk due to health care-associated infections (HCAIs). World Health Organization and the Centers for Disease Control and Prevention recommend using alcohol-based hand rub (ABHR) for hand hygiene in healthcare settings to prevent HCAIs. Irrational use of ABHR will have undesirable consequences including wastage of products, exposure of healthcare providers to infections and emergence of microbial resistance to the alcohol in hand sanitizers. This study aimed to explore the perspective and experiences of compounding pharmacists on production and utilization of ABHR solution for coronavirus disease in 2019 (COVID-19) prevention in public hospitals of Addis Ababa, Ethiopia.

METHODS

A descriptive qualitative study using in-depth interview of 13 key-informants serving as compounding pharmacists in public hospitals of Addis Ababa, Ethiopia, was conducted. The study participants were identified and selected by purposive sampling. All transcribed interviews were subjected to thematic analysis and transcripts were analyzed manually.

FINDINGS

The compounding pharmacists in this study had a mean age of 30.6 (±3.1) years and nine of the thirteen participants were men. Ten participants believed that the compounding practice in their respective sites followed the principles of good compounding practice. More than half of the participants did not believe that ABHR products were used rationally in health facilities. They argued that users did not have enough awareness when and how to use sanitizers. Most of the interviewees reported that compounding personnel had no formal training on ABHR solution production. Study participants suggested incentive mechanisms and reimbursements for experts involved in the compounding of ABHR solutions.

CONCLUSION

Three of the compounding pharmacists indicated that ABHR production in their setting lack compliance to good compounding practice due to inadequate compounding room, quality control tests, manpower and equipment. Despite this, most study participants preferred the in-house ABHR products than the commercially available ones. Thus, training, regular monitoring and follow-up of the hospital compounding services can further build staff confidence.

Alcohol-Based Handrub Utilization Practice for COVID-19 Prevention Among Pharmacy Professionals in Ethiopian Public Hospitals: A Cross-Sectional Study

Purpose

Rubbing the hands with alcohol-based handrub (ABHR) is globally recommended as the preferred approach to prevent healthcare-associated infections in most routine encounters with patients, except in cases handwashing with soap and water is advised. Inappropriate utilization of ABHR could have detrimental effects, most importantly during the coronavirus disease (COVID-19) pandemic, which include exposure of healthcare professionals to healthcare-associated infections and the development of resistant microorganisms. In a hospital setting, the utilization of ABHR among frontline healthcare workers including pharmacy professionals is low. Therefore, the purpose of this study was to explore the current practice of hand rubbing among pharmacy professionals in public hospitals of Addis Ababa during the pandemic of COVID-19.

Methods

The study was a cross-sectional study using a self-reported questionnaire conducted among pharmacy professionals in public hospitals found in Addis Ababa from 10th May to 9th June, 2020 to recognize ABHR utilization rate. Data were collected on a sample of 384 pharmacy professional by a self-administered questionnaire. Data analysis was done using software for the statistical package for social science version 25.0. To identify the significant predictors of ABHR utilization practice bivariable and multivariable logistic regressions were carried out. Crude odds ratio and adjusted odds ratio with 95% confidence interval were calculated to determine the predictors.

Results

Out of 384 participants, three hundred and four participants were included in the final analyses after the exclusion of incomplete responses. Female participants represented 41.4% of the study participants. More than half (58.9%) of the pharmacy professionals had sufficient knowledge on ABHR utilization for COVID-19 prevention. Similarly, 56.6% of pharmacy professionals had positive attitude towards ABHR for COVID-19 prevention. But only 35.9% of the study participants had good ABHR utilization practice.

Conclusion

Despite the modest level of knowledge and attitude towards ABHR, pharmacy professionals’ utilization practice of ABHR for COVID-19 prevention was found to be suboptimal. Provision of ABHR solutions through hospitals and increasing the awareness of pharmacy professionals on ABHR needs to be encouraged.

Increased Production of Alcohol-Based Hand Rub Solution in Response to COVID-19 and Fire Hazard Potential: Preparedness of Public Hospitals in Addis Ababa, Ethiopia

BACKGROUND

According to the World Health Organization (WHO), alcohol-based hand rubs (ABHRs) are regarded as the "gold standard" for hand disinfection in healthcare facilities. Local production of ABHRs in health facilities is recommended by WHO due to its availability and affordability reasons. However, fire hazard is a concern in health facilities during ABHRs production, storage, or use from dispensers.

OBJECTIVE

To evaluate the preparedness of public hospitals found in Addis Ababa, Ethiopia towards potential fire hazards during ABHR production and storage practices.

METHODS

A cross-sectional observational study was applied. An assessment checklist was used for evaluating public hospitals' measures taken for the potential fire hazards during ABHR production and storage practice. Statistical Package for Social Sciences (SPSS) version 23 was used for data entry and analysis.

RESULTS

Out of the 13 public hospitals observed in the study, fire extinguishers were not available in more than half of the hospitals' (7 hospitals) compounding premises. Also, 57.1% of the hospitals without fire extinguishers were manufacturing beyond the WHO 50 liters limit of ABHR solution at once under such unfavorable conditions. Moreover, ethanol and the oxidizing agent hydrogen peroxide were not stored separately in eight hospitals.

CONCLUSION

None of the hospitals were found to be well prepared for the potential risk of fire associated with ABHR solution production and storage practice. Generally, the practices taken by the studied hospitals for preventing the fire risk and minimizing the damage if fire hazards occurred during ABHR production and storage were not satisfactory. On the safety and precautions measures taken for the risk of fire, Tikur Anbessa Specialized Hospital (TASH), Amanuel Mental Specialized Hospital (AMSH), and Eka Kotebe General Hospital (EKGH) showed a relatively better preparedness compared to others. ABHR solutions should be manufactured and stored in a way that limits the risk of ignition and follows standard fire safety measures.