An audit and observational study on Interns’ awareness, attitudes and

compliance to hand hygiene in Gondar University Hospital

RN-0008

Martha Belete (King’s College London elective medical student)

Addisu Alemu (Audit Clerk)

Contents }  Introduction }  Aims }  Method }  Inclusion and exclusion criteria }  Sample size & location }  WHO standard }  Results }  Discussion & Recommendations

Introduction

‘HCAI is a major problem for patient safety and its surveillance and prevention must be a first priority for settings and institutions committed to making health care safer.’ WHO

In general there are more healthcare-associated infections in developing countries Est. 1.4 million patients affected at any one time worldwide Burden is greater in high risk populations

Aim }  The aim was to establish the following from the interns:

}  Interns self reported practice of hand hygiene }  Awareness of good hand hygiene practice }  Attitudes towards hand hygiene }  Perceptions of the risk of cross infection }  Subjective norms of hand hygiene }  Perceived difficulties in adhering to good hand hygiene practice }  Motivation to change hand hygiene practice }  Test their use of alcohol gel

Method 1.  In which of the following situations do you normally wash your hands? 2.  Do current guidelines suggest that it is necessary to clean your hands with soap &

water or alcohol gel ?

3.  When should you use soap & water instead of alcohol gel?

4.  In which of the following situations do you think cleaning your hands with soap & water or alcohol gel will reduce the risk of cross infection to patients?

5.  Do you think your behavior towards hand hygiene is taken as an example by your colleagues ?

6.  Are you influenced by your seniors’ practice of hand washing?

7.  How easily accessible is it for you to clean your hands in the following situations?

8.  What makes cleaning your hands difficult?

9.  If alcohol gel was more readily available would you improve your compliance with hand hygiene?

10.  Have you ever had specific training sessions on hand hygiene?

11.  Do you think that having posters on hand hygiene technique will be useful to you and your colleagues?

12.  Show me how you clean your hands once I have given you some alcohol gel How long should it take? …………………………..

Inclusion & Exclusion Criteria

}  INCLUSION: }  Any interns working in any department in the hospital between

3rd – 7th September

}  EXCLUSION: }  Any other healthcare professionals in the hospital }  Interns questioned before the 3rd or after the 7th of September

Sample Size & Location }  Overall 47 interns filled in the questionnaire

}  Interns from surgical, internal medicine, pediatric and obstetrics & gynecology departments filled in questionnaires

WHO standards }  Standards used were:

}  WHO 5 moments for hand hygiene

}  WHO how to handrub poster

Results

In which of the following situations do you normally wash your hands?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Don't wash hands

Wash hands

74% of interns report

not washing their hands

before touching a patient…

In which of the following situations do you think cleaning your hands with soap & water or alcohol gel will reduce the risk of cross infection to patients?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No

Yes

…however 98% believe that it reduces the risk of cross infection to

patients

Do current guidelines suggest that it is necessary to clean your hands with soap & water or alcohol gel in the following situations?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No

Yes

The majority of interns are

aware of when they should clean their

hands

How easily accessible is it for you to clean your hands?

Very easy Easy Neither easy or difficult

Difficult Very difficult

11%

29% 30%

27%

3%

What makes it difficult to clean your hands?

}  68% of interns said lack of resources and problems with access make cleaning hands difficult

}  25% of interns said being busy makes it difficult to clean their hands

}  4% of interns said they were negligent about cleaning their hands

SINK AUDIT – 17 clinical areas

}  2 sinks had no running water }  3 sinks had hand hygiene posters

Sink in ward/clinical room

Sink elsewhere

No sink

24% 24%

52%

SINK AUDIT – 17 clinical areas

}  3 clinical areas had towels available

Bar of soap

Bottle of soap

Powder soap

No soap

No alcohol handrub is available

24% 53%

6%

18%

If alcohol gel was more readily available would you improve your compliance with hand hygiene?

Yes Possibly No 0

5

10

15

20

25

30

35

40 81% of all interns said they would

improve compliance if

alcohol gel was more available.

Yes

Possibly

No

70% of interns said yes

26% said possibly

4% said no

Would hand hygiene posters be helpful?

Handrub technique

Handrub technique (37 interns observed)

0

2

4

6

8

10

12

14

16

1 action 2 actions

3 actions

4 actions

5 actions

6 actions

7 actions

8 actions

5%

35% 38%

22%

Discussion & Recommendations

Recommendations

1.  Alcohol gel must be a priority

2.  Sinks must be stocked with }  Soap – if a bar of soap is used there should be a soap rack }  Personal towels

3.  WHO hand hygiene posters

4.  Train new interns in hand hygiene

5.  Observational hand washing audits

Many thanks to…

}  All the interns who completed the questionnaires

}  Addisu Alemu

}  UOG hospital