Probing Know Do Gaps for Inadequate Hand Washing before Vaccination by ANMs during

Routine Immunization inIndian Kosi Riverine Belt

Dr RISHABH KUMAR RANA ,MDMember IEA Member IAPSMMember IMA USAID /RMNCH+A Lohardagga, Jharkhand

Dr Manu Batra ,M.D.S Senior Lecturer Surendra dental college and Hospital Sri ganga Nagar ,Rajasthan

Dr C.Roy , D.T.M.H ,M.D Prof and Head Of the Department Department of Community Medicine Darbhanga Medical College ,Bihar

Background • The importance of hand hygiene was recognized as early as 1840s, by

Dr. Oliver Wendell Holmes to prevent childbed fever and in the late 1840's, by Dr. Ignaz Semmelweis to reduce maternal mortality in a Vienna hospital, however, adherence still remains low (40% or below) in most of the health care institutions.1,2

• Improper hand hygiene by healthcare workers (HCWs) is responsible for about 40% of nosocomial infections.3 Lack of knowledge and lack of recognition of hand hygiene opportunities during patient care are mainly responsible for poor hand hygiene among HCWs.3,6

• Clean Care is Safe Care !!!!!4

Immunization by ANMs • In Indian rural parts Immunization is an integral component to

address Infant ,Child and Maternal Health .• It is being provided by ANMs ( Auxiliary Nursing Midwives) along with

the help of other Health Activist (ASHA) and Anganwadi Workers .• The ANMs are the one , Immunizing beneficiaries .• Very Few Studies are done in Rural Indian Setting to know the status

of handwashing and its implementation by ANMs in field, while they vaccinate each and every beneficiary .5

The Objectives ,& The Methodology • This study Intended to probe in to the real time status of Handwashing

Implementation In the Rural Setting .• Methodology –A cross sectional, questionnaire and observation based

study was carried out across the Kosi riverine area in Four Different Districts of Bihar .

• A total sample of 60 ANMs were studied and observed .• A questionnaire was prepared based on WHO and CDC guidelines and

available studies on hand washing covering various aspects like knowledge about cross transmission of pathogens, recommended steps for hand washing, materials used, attitudes and hand hygiene practices and the availability of facilities in their community RI session sites.

Results1. Hand washing Before the Session starts and In service for more than 5 Years

 

In service for five years

TotalYes NoHand washing before start of the session

Yes 10 8 18

No 25 17 42

Total35 25 60

Pearson Chi-Square 0.082 p value >0.05

Results2. Handwashing before start of the session and Thinks should wash hands before starting the session.

   

Thinks should wash hands

before starting the session   Total

    Yes No  Hand washing

before start of the session

Yes 11 7 18

 No 22 20 42

Total 

33 27 60

Pearson Chi Square .388 p Value >0.05

Results 3.Hand washing before start of the session and Thinks should wash hands before immunizing every infant/child/mother

 

Thinks should wash hands before immunizing everychild

TotalYes NoHand washing before start of the session

1 17 18

1 41 42

Total2 58 60

Pearson Chi-Square 0.394 p value >0.05

Results 4. Handwashing before start of the session and Knows the steps of hand washing

 

Knows the steps of handwashing

TotalYes NoHand washing before start of the session

Yes 8 10 18

No 9 33 42

Total 17 43 60

Pearson Chi Square 3.92 P value <0.05

Results 5. Handwashing before start of the session and Has running water at the session site

 

Has running water at the session site

TotalYes NoHand washing before start of the session

Yes 7 11 18

No 11 31 42

Total18 42 60

Pearson Chi Square 0.967 p Value >0.05

Results 6. Handwashing before start of the session and Soap Available

 

Soap Available

TotalYes NoHand washing before start of the session

Yes 12 6 18

No 33 9 42

Total 45 15 60

Pearson Chi Square Test 0.0952 p value >0.05

Results 7. Handwashing before start of the session and If She Has been given the training to wash hands before starting the session??

 

Has been given the training to wash hands

before starting the session??

TotalYes NoHand washing before start of the session

Yes 5 13 18

No 15 27 42

Total20 40 60

Pearson Chi square 0.357 p value >0.05

Logistic Regression Model Analysis Variables in the Equation

  B S.E. Wald df Sig. Exp(B)Step 1a In service for five years -.495 .731 .460 1 .498 .609

Thinks should wash hands before starting the session -.951 .851 1.247 1 .264 .387

Knows the steps of hand washing 1.579 .772 4.186 1 .041 4.851

Has running water at the session site -.745 .671 1.233 1 .267 .475

Has been given the training to wash hands before starting the session .247 .683 .131 1 .717 1.280

Soap Available .676 .767 .776 1 .378 1.965Constant .204 1.058 .037 1 .847 1.226

a. Variable(s) entered on step 1: In service for five years, Thinks should wash hands before starting the session, Knows the steps of handwashing, Has running water at the session site, Has been given the training to wash hands before starting the session, Soap Available.

Results ..Where the Answer is No !!!

Hand washing before and after immunizing every infant/child/mother

  Yes 0No 60

Thinks should wash hands before immunizing every child

 Yes 2No 58Total 60

Ever monitored for hand washing before Immunization  Yes 0

No 60

Conclusion • ANMs are not aware about need of hand wash after every

immunization of the beneficiary .• In trainings handwashing is not stressed upon • No monitoring of this important activity is being done by any Agency • In the monitoring format used by GOI and All Partners no inclusion of

Handwashing .• More studies mandated to assess the potential losses being

incurred !!!

References 1.Katz J.D. Hand washing and hand disinfection: more than your mother taught you. Anaesthesiol Clin North America. 2004;22:457–471.

2.Trampuz A., Widmer A.F. Hand hygiene: a frequently missed life saving opportunity during patient care. Mayo Clin Proc. 2004;79:109–116. [PubMed]

3. Inweregbu K., Dave J., Pittard A. Nosocomial infections. Continuing education in Anaesthesia. Crit Care & Pain. Br J Anaesth. 2005;5(1):14–17.

4. www.who.int/patientsafety/information.../ICHE_Nov_05_CleanCare_1.p...by S CHALLENGE - 2005Worl health Organization 2005 .

5.Performance Needs Assessment Of Basic Health Care Workers in Immunization in India 2005 MOHFW (www.who.int/immunization/newsroom/170209_A_Johri.pd)

6. Suchitra J.B., Lakshmidevi N. Hand washing compliance – is it a reality? Online J Health Allied SCs. 2006;4:2.

7. Mathur P. Hand hygiene: back to basics of infection control. Indian J Med Res. 2011;134:611–620.