Abstract
Poor hand-hygiene adherence endangers the safety of both healthcare workers and patients. A cross-sectional Knowledge Attitudes Practicing (KAP) survey (n= 268) and an observation of hand-hygiene compliance (n= 36) were conducted among staff in a general hospital in Syria. The aim of this study was to investigate the degree of compliance with hand hygiene protocols by general health care workers including their knowledge, attitude and practice. The mean overall observed hand-hygiene compliance rate was 45.7% (95% CI 37.1 – 54.3). Nurses were observed to have better compliance than physicians. Staff were observed to be more concerned in performing hand-hygiene after than before patient contact (before mean= 32.0%, after mean= 51.2%, p< 0.05). The questionnaire showed that there was a significant correlation between knowledge, attitude, and facilities on the one hand and poor self-reported adherence on the other. Multivariate analysis showed that poor adherence was statistically significantly associated with males (63.5%), untrained staff (58.5%) and unavailability of washing basins (60.4%). Poor adherence was high in ICU, among younger and unaware participants.
Â
Keywords: compliance, hand hygiene, hospital acquired infection, healthcare workers, Knowledge-Attituded-Practice (KAP), patient safety
Abstrak
Â
Kepatuhan pada kebersihan tangan yang buruk membahayakan keselamatan tenaga kesehatan dan pasien. Survei potong lintang Pengetahuan Sikap Praktek (n= 268) dan observasi kepatuhan kebersihan tangan (n= 36) dilakukan di antara staf di rumah sakit umum di Suriah. Tujuan dari penelitian ini adalah untuk mengidentifikasi tingkat kepatuhan dengan protokol kebersihan tangan oleh tenaga kesehatan termasuk pengetahuan, sikap dan praktik mereka. Rerata tingkat kepatuhan kebersihan tangan yang diamati secara keseluruhan adalah 45,7% (95% CI 37,1-54,3). Perawat diamati memiliki kepatuhan yang lebih baik daripada dokter. Staf yang diamati tampak lebih peduli melakukan kebersihan tangan setelah kontak dengan pasien dibanding sebelum kontak (rerata sebelum= 32,0%, rerata setelah= 51,2%, p< 0,05). Hasil kuesioner menunjukkan bahwa ada korelasi yang signifikan antara pengetahuan, sikap, dan fasilitas, namun disisi lain kepatuhan dilaporkan buruk. Analisis multivariat menunjukkan bahwa kepatuhan yang buruk secara statistik terkait secara signifikan dengan jenis kelamin laki-laki (63,5%), staf tidak terlatih (58,5%) dan tidak tersedianya tempat cuci tangan (60,4%). Tingkat kepatuhan yang rendah angkanya ditemukan cukup tinggi di ICU, di antara responden yang lebih muda dan tidak sadar.
Â
Kata Kunci: kebersihan tangan, kepatuhan, hospital acquired infection, tenaga kesehatan, keselamatan pasien, Pengetahuan-Sikap-Praktik
References
- References
- Allegranzi, B., et al. (2013). Global implementa-tion of WHO’s multimodal strategy for improvement of hand hygiene: A quasi-experimental study. The Lancet Infectious Diseases, 13 (10), 843–851.
- Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the health-care infection control practices advisory committee and the HICPAC/ SHEA/APIC/IDSA hand hygiene task force. Morbidity and Mortality Weekly Report, 51(RR–16).
- Chandra, P.N., & Milind, K. (2001). Lapses in measures recommended for preventing hospital acquired infection. Journal of Hospital Infection, 47, 218–22.
- Chen, P., et al. (2016). Role of quality control circle in sustained improvement of hand hygiene compliance: An observational stu-dy in a stomatology hospital in Shandong, China. Antimicrobial Resistance & Infection Control, 5, 54.
- Deyneko, A., Cordeiro, F., Berlin, L., Ben-David, D., Perna, S., & Longtin, Y. (2016). Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: A cross-sectional study. BMC Infectious Diseases, 16, 203.
- Eckmanns, T., Bessert, J., Behnke, M., Gastmeier, P. & Ruden H. (2006). Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infection Control & Hospital Epidemiology, 27 (9), 931–934.
- Fuller, C. et al. (2012). The Feedback Intervention Trial (FIT) – Improving hand-hygiene compliance in UK healthcare workers: a stepped wedge cluster randomised controlled tiral. PLoS ONE, 7 (10).
- IHI. (2006). How-to guide: Improving hand hygiene, a guide for improving practices among health care workers. Cambridge: Institute for Healthcare Improvement.
- Lankford, M.G., Zembower, T.R., Trick, W.E., Hacek D.M, Noskin, D.A. & Peterson, L.R. (2003). Influence of role models and hospital design on hand hygiene of health care workers. Emerging Infectious Diseases Journal, 9 (2), 217–223.
- Loveday, H.P., Lynam, S., Singleton, J. & Wilson, J. (2014). Clinical glove use: Healthcare workers’ actions and perceptions. Journal of Hospital Infection, 86 (2), 110–116.
- Luangasanatip, N., et al. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: A systematic review. British Medical Journal, 351, h3728.
- Mauritio, N., et al. (2014) Do peer effects improve hand hygiene adherence among healthcare workers? Infection Control and Hospital Epidemiology, 35 (10), 1277–1285.
- Makay Ö., Içöz G., Yilmaz A. & Kolcu, F. (2008). Yoğun bakım çalışanlarının el yıkama alışkanlıkları. Ulus Travma Acil Cerrahi Derg., 14 (2), 149–153.
- Novoa, A.M. Pi-Sunyer, T. Sala, M., Molins, E., & Castells, X. (2007). Evaluation of hand hygiene adherence in a tertiary hospital. American Journal of Infection Control, 35, 676–683.
- Pittet, D. Mourouga, P., & Perneger, T.V. (1999). Compliance with handwashing in a teaching hospital. Annals of Internal Medicine, 130,126–130.
- Pittet, D., Simon, A., Hugonnet, S., Pessoa Silva, C.L, Sauvan V. & Perneger T.V. (2004). Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions. Annals of Internal Medicine, 141 (1), 1–8.
- Rosenthal, V.D. Guzman, S. & Safdar, N. (2005). Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. American Journal of Infection Control, 33, 392–97.
- Sacar, S., Turgut, H., Kaleli, I., Cevahir, N., Asan, A., Sacar, M. & Tekin, K. (2006). Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets. American Journal of Infection Control, 34 (9), 606–609.
- Santosaningsih, D., et al. (2017). Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: A randomized controlled trial study. Antimicrobial Resistance and Infection Control, 6 (1), 23.
- Srigley, J.A., et al. (2015). Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. Journal of Hospital Infection, 9 (3), 202–210.
- Stewardson, A.J., et al. (2016). Enhanced performance feedback and patient partici-pation to improve hand hygiene compli-ance of health-care workers in the setting of established multimodal promotion: a single centre, cluster-randomised control-led trial. The Lancet Infectious Diseases, 16 (12), 1345–1355.
- The Joint Commission (2009). Measuring hand hygiene adherence: Overcoming the challenges. Illinois: The Joint Commission.
- Trick, W.E,. Vernon, M.O., Welbel, S.F., Demarais, P, Hayden, M.K., Weinstein, R.A. & Chicago Antimicrobial Resistance Project. (2007). Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicro-bial resistance. Infection Control & Hospital Epidemiology, 28 (1), 42–49.
- Wendt, C., Knautz, D., & Von Baum, H. (2004) Differences in hand hygiene behavior related to the contamination risk of health care activities in different groups of health care workers. Infection Control & Hospital Epidemiology, 25 (3), 203–206.
- WHO. (2009a). Save live, clean your hands: guide to implementation: A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Geneva: World Health Organization.
- WHO (2009b). WHO Guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care. Geneva: World Health Organization.
- WHO. (2011). Report on the burden of endemic health care-associated infection world-wide. Clean Care is Safer Care. Geneva: World Health Organization.