World Health Organization Hand Hygiene Compliance Self-Assessment and Microbiological Hand Contamination Among Healthcare Workers in Mwanza Region. Tanzania
Rayson Devis [Male]
World Health Organization Hand Hygiene Compliance Self-Assessment and Microbiological Hand Contamination Among Healthcare Workers in Mwanza Region. Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2020 - xiii; 98 Pages Includes References and Appendices
Abstract:
Background: Hand hygiene (HH) practices recommended by the World Health Organization (WHO) are pivotal cost-effective measures to prevent health care associated infections (HCAI), but compliance remained to be a major challenge. We compared the self-reported HH compliance among health care workers (HCWs) using a WHO tool across healthcare facilities (HCF), and microbiological assessment of hand contamination so as to guide specific infection prevention and control (IPC) measures.
Methodology: A cross-sectional analytical study was conducted between July and September 2019 involving 18 HCF in Mwanza region. HH was assessed using the WHO Hand Hygiene Self-Assessment Framework (2010) in the six priority units. A total of 212 HCWs’ hands were sampled for microbiological analysis to identify Gram negative faecal coliforms and Methicillin resistant Staphylococcus aureus. Self-reported HH compliance was compared with the microbiological hand contamination, and associated factors determined.
Results: The median HH score (IQR) was 212.5 (190-245) i.e. basic level. The scores were progressively increasing from health centers 190(175-215) (basic level), district hospital 215(205-240) (basic level), regional referral hospital 275(275-287.5) (intermediate level), and tertiary hospital 320(315-325) (intermediate level) A total of 203 (95.8%) self-reported to have washed their hands. Self-reported HH compliance using cut-off value of ≥51.0% and the WHO recommended cut-off value of ≥81.0% were 39.2% (29/74) and 10.8% (8/74), respectively. Of the 212 HCW, 56 (26.4%) had bacteria contamination; 17.9% (n=38) by Gram negative fecal coliforms, 8.0% (n=17) by MRSA and 0.5% (n=1) by both. Hand contamination was significantly higher in district hospitals (pvalue=0.0437) compared to other HCF; and among HCW residing in the rural areas (27.5%), pvalue=0.017.
Conclusion: The median HH score amongst HCF in Mwanza region was at basic level, and was increasing from lower to higher rank of HCF. A quarter of HCW’s hands were contaminated and this was not matching with the self-reported HH assessment tools. A need to incorporate HH microbiological parameters to the WHO HH assessment tool is needed. Future IPC interventional measures should be tailored to the HCF tiers and rural areas.
= OPERATIONAL DEFINITIONS Hand contamination: a situation where by sampled hands of a health care worker is found to have bacteria upon laboratory analysis. In this study, two indicator bacteria which were used to ascertain the presence of microbial hand contamination were Gram negative fecal coliforms and Methicillin resistant Staphylococcus aureus (the most common pathogen involved in the health care associated infections). OPERATIONAL DEFINITIONS Hand hygiene level (score): a quantitative interpretation obtained by adding individual scores of the four components of WHO Hand Hygiene Self-Assessment Framework Tool (2010). Each component has a total score of 100, giving an overall maximum hand hygiene score of 500. Interpretation of hand hygiene levels is inadequate (0-125), basic (126 – 250), intermediate (251 – 375) or advanced (376 -500). = ABBREVIATIONS AND ACRONYMS CFU Colony – Forming Units CLSI Clinical and Laboratory Standard Institute CUHAS Catholic University of Health and Allied Sciences EF Evaluation and Feedback ESBL Extended Spectrum Beta – Lactamases ET Education and Training HCAI Health Care Associated Infection HCWs Health Care Workers HH Hand Hygiene ICU Intensive Care Unit ISC Institution Safety Climate IPC Infection Prevention and Control MRSA Methicillin - Resistant Staphylococcus Aureus OPD Out Patient Department RW Reminder in the workplace SC System Change SDG Standard Development Goals SSI Surgical Site Infection WHO World Health Organization
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz: www.bugando.ac.tz
--Public Health
World Health Organization Hand Hygiene Compliance Self-Assessment and Microbiological Hand Contamination Among Healthcare Workers in Mwanza Region. Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2020 - xiii; 98 Pages Includes References and Appendices
Abstract:
Background: Hand hygiene (HH) practices recommended by the World Health Organization (WHO) are pivotal cost-effective measures to prevent health care associated infections (HCAI), but compliance remained to be a major challenge. We compared the self-reported HH compliance among health care workers (HCWs) using a WHO tool across healthcare facilities (HCF), and microbiological assessment of hand contamination so as to guide specific infection prevention and control (IPC) measures.
Methodology: A cross-sectional analytical study was conducted between July and September 2019 involving 18 HCF in Mwanza region. HH was assessed using the WHO Hand Hygiene Self-Assessment Framework (2010) in the six priority units. A total of 212 HCWs’ hands were sampled for microbiological analysis to identify Gram negative faecal coliforms and Methicillin resistant Staphylococcus aureus. Self-reported HH compliance was compared with the microbiological hand contamination, and associated factors determined.
Results: The median HH score (IQR) was 212.5 (190-245) i.e. basic level. The scores were progressively increasing from health centers 190(175-215) (basic level), district hospital 215(205-240) (basic level), regional referral hospital 275(275-287.5) (intermediate level), and tertiary hospital 320(315-325) (intermediate level) A total of 203 (95.8%) self-reported to have washed their hands. Self-reported HH compliance using cut-off value of ≥51.0% and the WHO recommended cut-off value of ≥81.0% were 39.2% (29/74) and 10.8% (8/74), respectively. Of the 212 HCW, 56 (26.4%) had bacteria contamination; 17.9% (n=38) by Gram negative fecal coliforms, 8.0% (n=17) by MRSA and 0.5% (n=1) by both. Hand contamination was significantly higher in district hospitals (pvalue=0.0437) compared to other HCF; and among HCW residing in the rural areas (27.5%), pvalue=0.017.
Conclusion: The median HH score amongst HCF in Mwanza region was at basic level, and was increasing from lower to higher rank of HCF. A quarter of HCW’s hands were contaminated and this was not matching with the self-reported HH assessment tools. A need to incorporate HH microbiological parameters to the WHO HH assessment tool is needed. Future IPC interventional measures should be tailored to the HCF tiers and rural areas.
= OPERATIONAL DEFINITIONS Hand contamination: a situation where by sampled hands of a health care worker is found to have bacteria upon laboratory analysis. In this study, two indicator bacteria which were used to ascertain the presence of microbial hand contamination were Gram negative fecal coliforms and Methicillin resistant Staphylococcus aureus (the most common pathogen involved in the health care associated infections). OPERATIONAL DEFINITIONS Hand hygiene level (score): a quantitative interpretation obtained by adding individual scores of the four components of WHO Hand Hygiene Self-Assessment Framework Tool (2010). Each component has a total score of 100, giving an overall maximum hand hygiene score of 500. Interpretation of hand hygiene levels is inadequate (0-125), basic (126 – 250), intermediate (251 – 375) or advanced (376 -500). = ABBREVIATIONS AND ACRONYMS CFU Colony – Forming Units CLSI Clinical and Laboratory Standard Institute CUHAS Catholic University of Health and Allied Sciences EF Evaluation and Feedback ESBL Extended Spectrum Beta – Lactamases ET Education and Training HCAI Health Care Associated Infection HCWs Health Care Workers HH Hand Hygiene ICU Intensive Care Unit ISC Institution Safety Climate IPC Infection Prevention and Control MRSA Methicillin - Resistant Staphylococcus Aureus OPD Out Patient Department RW Reminder in the workplace SC System Change SDG Standard Development Goals SSI Surgical Site Infection WHO World Health Organization
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz: www.bugando.ac.tz
--Public Health