Knowledge, practice on hand hygiene and some related factors among health workers at three district hospitals in thai binh province in 2019

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY DANG THI NGOC ANH KNOWLEDGE, PRACTICE ON HAND HYGIENE AND SOME RELATED FACTORS AMONG HEALTH WORKERS AT THREE DISTRICT HOSPITALS IN THAI BINH PROVINCE IN 2019 MASTER THESIS: PUBLIC HEALTH HANOI - 2019 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY DANG THI NGOC ANH KNOWLEDGE, PRACTICE ON HAND HYGIENE AND SOME RELATED FACTORS AMONG HEALTH WORKERS AT THREE DISTRICT HOSPITALS IN THAI BINH PROVINCE IN 2019 Major: Public Health Code: 8720701 MASTER THESIS Supervisors: Assoc Prof Nguyen Dang Vung, MD, PhD Assoc Prof Vu PhongTuc, MD, PhD HANOI - 2019 ACKNOWLEDGMENTS Foremost, this work would not have been possible without the support from the Hanoi Medical University (HMU), Institute for Preventive Medicine and Public Health, the Post Graduate Department, the Department of Population, and VOHUN scholarship I would like to express my sincere appreciation to my advisors: Assoc Prof Nguyen Dang Vung and Assoc Prof Vu Phong Tuc, for their excellent guidance, caring, patience, and providing me with the tremendous support for during this research Without your support, I could not complete this thesis I would like to express my sincere thanks to the Institutional Review Board of Hanoi Medical University for approving the research protocol In the preparation of this thesis, I have received tremendous support from the hospital authorities and health workers in three district hospitals, including Dong Hung General Hospital, Kien Xuong General Hospital, and Vu Thu General Hospital, for helping me with data collection I place on my record, my sincere gratitude to all members in my research group and my colleagues in Department of Environmental Health, Thai Binh University of Medicine and Pharmacy for sharing expertise, valuable support, and encouragement extended to me Last but not least, I owe you sincere thanks for my family, who were always willing to listen to me and support me to overcome many challenges in my life Thank you so much COMMITMENTS Respectfully addressed to: - The Boards of Training - Hanoi Medical University - The Boards of Post – Graduated Training - Institute for Preventive Medicine and Public Health - The Department of Population - The Boards of Dissertation Assessment I declare that the thesis ―Knowledge, practice on hand hygiene and some related factors among health workers at three district hospitals in Thai Binh province in 2019‖ is my own work under the guidance of Assoc Prof Nguyen Dang Vung - Vice Director of the Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam, and Assoc Prof Vu Phong Tuc - Head of Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam All data and results in this thesis were honest This thesis was compliant with ethical standards in research and has not been published in any journal or scientific work I contend that the work presented in this thesis is my own, except in instances where due references have been made to other referenced material This thesis was compliant with ethical standards in research The author of the thesis TABLE OF CONTENT LIST OF ABBREVIATIONS i LIST OF TABLES ii LIST OF FIGURES, GRAPHS iii INTRODUCTION CHAPTER LITERATURE REVIEW 1.1 The scientific evidence related to hand hygiene 1.2 Overview of hand hygiene 1.3 The researches of knowledge and practice on hand hygiene of health workers in the world and in Vietnam 13 1.4 Some factors related to knowledge and practices on hand hygiene of health workers in the world and in Vietnam 16 1.5 Conceptual framework 19 1.6 Description of research sites 20 CHAPTER METHODOLOGY 22 2.1 Research participants 22 2.2 Research sites and time 22 2.3 Research methods 23 2.4 Methods of evaluating the knowledge and practice on hand hygiene 28 2.5 Data analysis 30 2.6 Data quality control 31 2.7 Research ethics 32 CHAPTER RESULTS 33 3.1 Demographic characteristics of participants 33 3.2 Knowledge and practice of hand hygiene 34 3.3 Some factors related to the knowledge and practice on hand hygiene of health workers in three hospitals 42 CHAPTER DISCUSSION 64 4.1 Knowledge and practice on hand hygiene of health workers 64 4.2 Some factors related to the knowledge and practice on hand hygiene 71 4.3 Strength and limitation of the study 76 CONCLUSIONS 78 RECOMMENDATION 79 i LIST OF ABBREVIATIONS ABHR Alcohol-based hand rub CDC Centre for Disease Prevention and Control CFU Colony-forming units HAI Healthcare-Associated Infection HH Hand hygiene HWs Health workers ICU Intensive care unit MoH Ministry of Health NI Nosocomial infection WHO World Health Organization ii LIST OF TABLES Table 3.1 Demographic characteristics of respondents 33 Table 3.2 The general situation of three hospitals 34 Table 3.3 Correct knowledge on the healthcare-associated infection 34 Table 3.4 Correct knowledge on hand hygiene actions protecting patient and health workers 35 Table 3.5 Correct knowledge on hand hygiene 36 Table 3.6 Correct knowledge on hand hygiene methods required in certain situations 37 Table 3.7 Correct knowledge on the factors that contribute to hand colonization 38 Table 3.8 Hand hygiene compliance rate in each hospital 39 Table 3.9 Hand hygiene compliance rate according to occupation 40 Table 3.10 Hand hygiene compliance according to five moments 40 Table 3.11 Distribution of appropriateness of hand hygiene among different methods in three hospitals 41 Table 3.12 Hand hygiene compliance according to observation shift 41 Table 3.13 The relationship between demographic characteristics and knowledge on hand hygiene 43 Table 3.14 Multivariate analysis of associated factors 44 Table 3.15 Bivariate analysis of associated factors with HH compliance 44 Table 3.16 Multivariate analysis of associated factors 46 Table 3.17 Self-reported reasons for hand hygiene noncompliance 48 Table 3.18 Themes from qualitative analysis 50 iii LIST OF FIGURES, GRAPHS Figure 1.1 Five moments for hand hygiene 10 Figure 1.2 Washing hand protocol 11 Figure 3.1 Results of assessing the level of knowledge on hand hygiene 39 Figure 3.2 Hand hygiene compliance rate in different departments 40 Figure 3.3 Overall hand hygiene compliance rate in three hospitals 42 Figure 3.4 Factors improving hand hygiene compliance as suggested by health workers among three hospitals 46 INTRODUCTION Nowadays, thanks to the outstanding development of science and technology, many dangerous infectious diseases have almost been eradicated or prevented successfully, such as Polio, Smallpox, Measles, Pneumonia, and Diarrhea However, during the process of implementing medical examination and treatment activities in healthcare facilities, medical errors and other adverse events may occur which include nosocomial infection.In 2016, the European Centre for Disease Prevention and Control estimated that more than 2.6 million new cases of healthcare-associated infections (HAIs) occur every year in Europe [1] Many pieces of research showed that HAIs can lead to severe consequences for hospitalized patients and their familiesin highincome countries such as Germany, Greece, French, and the USA by giving rise to other diseases,prolonged hospital stays, reducing the functional ability, financial burden, and increased mortality[2],[3],[4],[5] The prevalence and the burden of HAIs in middle and low-income countries even were severe than in high-income countries[6],[7],[8],[9] Therefore, HAI has long been an issue that attracts great concern and poses an enormous challenge for the health sector not only in Vietnam but also in the world The hand of health workers (HWs) has been considered as the main route of transmission of HAIs among patient in healthcare settings Therefore,hand hygiene (HH) isthe single most important measure to avoid the transmission of pathogens and prevent HAIs[10] However, HWs often perform HH less than half as often as they should not only in high-income countries but also in middle and low-income countries [11],[12],[13] In Vietnam, hand hygiene education in healthcare facilities is not a new concept, however, it has not been understood and practiced fully and accurately yet The overall hand hygiene 93 Nguyen Van Ha (2012) Research on status and effectiveness of hand hygiene improvement preventing nosocomial infection prevention in some hospitals in Hung Yen province, 2009 - 2011, 2012, Ph.D., National Institute of Hygiene and Epidemiology 94 Ayşe Karaaslan, Eda Kepenekli Kadayifci, Serkan Atıcı et al (2014) Compliance of healthcare workers with hand hygiene practices in neonatal and pediatric intensive care units: overt observation Interdisciplinary perspectives on infectious diseases, 2014 95 Pamela A Lipsett and Sandra M Swoboda (2001) Handwashing compliance depends on professional status Surgical Infections, 2(3), 241-245 96 E L Larson and 1994 APIC Guidelines Committee (1995) APIC guidelines for handwashing and hand antisepsis in health care settings American journal of infection control,, 23(4), 251-269 97 E O Shobowale, B Adegunle and K Onyedibe (2016) An assessment of hand hygiene practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand hygiene Niger Med J, 57(3), 150-4 98 Nancy A Melville (2011) WHO Hand-Hygiene Initiative largely Ignored Mediscape Medical News 99 Farinaz Farhoudi, Anahita Sanaei Dashti, Minoo Hoshangi Davani et al (2016) Impact of WHO Hand Hygiene Improvement Program Implementation: A Quasi-Experimental Trial BioMed Research International, 100 B Allegranzi, A Gayet-Ageron, N Damani et al (2013) Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study Lancet Infect Dis, 13(10), 843-51 101 A R Marra, T Z Camargo, V J Cardoso et al (2013) Hand hygiene compliance in the critical care setting: a comparative study of different alcohol handrub formulations Am J Infect Control, 41(2), 136-9 102 J M Duggan, S Hensley, S Khuder et al (2008) Inverse correlation between level of professional education and rate of handwashing compliance in a teaching hospital Infect Control Hosp Epidemiol, 29(6), 534-8 103 D Pittet, S Hugonnet, S Harbarth et al (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene Infection Control Programme Lancet, 356(9238), 1307-12 104 K.Ushakrishnan, S.Ragunanthanan and G.Sumathi (2017) A qualitative study on perception of health care workers of intensive care unit on infection control in a tertiary care hospital Indian Journal of Basic and Applied Medical Research, 7(1), 45-50 105 A Kendall, T Landers, J Kirk et al (2012) Point-of-care hand hygiene: preventing infection behind the curtain Am J Infect Control, 40(4 Suppl 1), S3-10 106 Muhamad Alif Bin Ibrahim, Chengzi Chow, Bee Fong Poh et al (2018) Differences in psychosocial determinants of hand hygiene between health care professional groups: Insights from a mixed-methods analysis American journal of infection control, 46(3), 253-260 107 W Zingg, A Holmes, M Dettenkofer et al (2015) Hospital organisation, management, and structure for prevention of health-careassociated infection: a systematic review and expert consensus Lancet Infect Dis, 15(2), 212-24 APPENDICES APPENDIX SELF- COMPLETION QUESTIONNAIRE KNOWLEDGE OF HAND HYGIENE AMONG HEALTH WORKERS AT THREE DISTRICT HOSPITALS IN THAI BINH PROVINCE IN 2019 Hospital: ……………… Date:……./……/2019 The informed consent form Dear participants, We would like to invite you to participate in the study“Knowledge, practice of hand hygiene and some related factors among health workers at three district hospital in Thai Binh province” Your participation in this survey is voluntary We guarantee that the information you provide will only be served for research purposes Also, your personal information is strictly confidential We hope that through this activity, we can contribute to the recommendations of hand hygiene improvement strategies such as training courses, supervisions; build an institutional safety climate It will restrict the barriers to hand hygiene compliance among health workers at all departments in the hospital and enhance health worker's awareness and hand hygiene skills, which in turn preventing healthcare-associated infections The interview will last about 15-20 minutes; you could refuse to answer any questions you did not want to during the interview To ensure the accuracy and completeness of the information, please read carefully the contents of each question and fully answer the questionnaire Would you agree to participate in the interview? Yes No Sign: The questionnaire Please circle the number next to the answers, tick X in the box after each clause or fill the answers in the available blanks A GENERAL INFORMATION No A1 Gender A2 A3 A4 Age (years) Working experience (years) Professional status A5 Department A6 Did you receive formal training in hand hygiene in the last 12 months? If yes, how many times did you receive? Does your hospital have the monitoring hand hygiene programs in last year? Does your hospital have enough plain/liquid soap? Is AHBR always available at each point of care? Are soaps/AHBRs placed at convenient locations? Is your hospital/department overcrowded? How you assess the situation of hospital overcrowding current? A7 A8 A9 A10 A11 A12 A13 Questions Answers Male Female ………………… ………………… Doctor Nurse Nursing assistant Other (specific) ………………… Surgery wards Internal medicine wards Emergency and Intensive care Other (specific) ………………… Yes No (Move to A8) …………………… (times) Yes No 2 2 Yes No Yes No Yes No Yes No (Move to B1) Low Middle High B KNOWLEDGE OF HAND HYGIENE B1 What is the most common route of transmission of potentially harmful germs among patients in the hospital?(Circle one answer only) A Airborne transmission when the patient sneezes or coughs B Sharing non-invasive objects (i.e., stethoscopes, pressure cuffs, etc.) between patients C Transmission via contaminated hands of health care workers D Patients‘ exposure to colonized surfaces (i.e., beds, chairs, tables, floors) E Unknown/No answer B2 What is the most frequent source of germs responsible for healthcare-associated infections?(Circle one answer only) A The hospital‘s water system B The hospital air C Germs already present on or within the patient D The hospital environment (surfaces ) E Unknown/No answer B3 Which of the following hand hygiene actions prevents transmission of germs to the patient? (Tick X in the box after each clause) A Before rolling, moving or lifting the patient Yes No B Immediately before giving an injection Yes No C Immediately after contact with body fluid Yes No D After exposure to the immediate surroundings of a patient Yes No B4 Which of the following hand hygiene actions prevents transmission of germs to the health worker?(Tick X in the box after each clause) A After rolling, moving or lifting the patient Yes No B Immediately before giving an injection Yes No C Immediately after contact with body fluid Yes No D After exposure to the immediate surroundings of a patient Yes No B5 Which of the following statements are true?(Tick X in the box after each clause) A Proper hand hygiene compliance will reduce the risk of infection in patients and health workers B Handrubbing is faster for hand cleansing but causes skin dryness more than handwashing C Handwashing is more effective against germs than handrubbing D Handwashing and handrubbing performed sequence is the best way for hand cleansing in a E Wearing clean gloves during patient care is an alternative to handwashing F No need to perform hand hygiene after touching the patient‘s surrounding, without having touched the patient, such as adjusting perfusion speed, holding door handles, True False True False True False True False True False True False B6 How many steps in a routine of hand hygiene?(Circle one answer only) A B C D steps steps steps steps B7 What is the minimal time needed for alcohol-based handrub to kill most germs on your hands?(Circle one answer only) A B C D E 20 sec 35 sec 45 sec 60 sec Unknown/no answer B8 Which type of hand hygiene method is required in the following situations?(Tick X in the box after each clause) A After making a patient‘s bed Rubbing Washing None B Before palpation of the abdomen Rubbing Washing None C After using the toilet Rubbing Washing None D When hands are not visibly soiled Rubbing Washing None E After donning clean gloves Rubbing Washing None Rubbing Washing None Rubbing Washing None Rubbing Washing None F After hands are at risk of needlestick and sharps injuries G When moving from a contaminated body site to a clean body site in the same patient H After touching any object or furniture contaminated blood, body fluids or secretions of patients B9 Which of the following should be avoided, as a risk factor for the invasion of HWs hands with harmful germs? (Tick X in the box after each clause) A Wearing jewelry Yes No B Using moisturizing skincare products Yes No C Damaged skin Yes No D Artificial fingernails Yes No B10 In your opinion, what of the following subjective reasons affect hand hygiene compliance among HWs? (Multiple choices) A B C D E F Lack of knowledge on HH policies and guidelines Skin irritations and dryness from frequent hand hygiene Not believe in HH effectiveness on preventing HAIs The old habit of not hand hygiene/forgetfulness Wearing gloves during patient care procedures Other (specific) ………………… B11 In your opinion, what of the following objective reasons affect hand hygiene compliance among health workers? (Multiple choices) A The absence and inconvenient accessibility of HH supplies (ABHR, lavabo, towels, etc.) B Patient overcrowding, work overload, insufficient time to hand hygiene C Lack of role model from colleagues D Lack of guidance/requirement from superiors E Other (specific) ………………… B12 Do you think the organization the training courses; communications on proper hand hygiene procedure is necessary? (Circle one answer only) A Absolutely necessary B Necessary C Unnecessary B13 In your opinion, what of the following affect hand hygiene compliance among health workers? (Multiple choices) A B C D E F Place supplies at more convenient locations Provide more hand hygiene supplies Provide the poster guiding the procedure of hand hygiene at the lavabo Reinforce punishments and rewards Enhancing monitoring and reminders from colleagues and superiors Other (specific) ………………… Thank you very much for your time! APPENDIX Answers and scoring method for the questionnaire B Knowledge Correct answer Score B1 C B2 C B3.1 Yes B3.2 Yes B3.3 Yes B3.4 No B4.1 Yes B4.2 No B4.3 Yes B4.4 Yes B5.1 True B5.2 False B5.3 False B5.4 False B5.5 False B5.6 False B6 C B7 A B8.1 Rub B8.2 Rub B8.3 Wash B8.4 Rub B8.5 Rub B8.6 Wash B8.7 Wash B8.8 Wash B9.1 Yes B9.2 No B9.3 Yes B9.4 Yes Maximum scores 30 APPENDIX INFORMED CONSENT FORM Dear participants, We would like to invite you to participate in the research interview“Knowledge, practice of hand hygiene and some related factors among health workers at three district hospital in Thai Binh province” Your participation in this survey is voluntary However,we hope that you will spend some precious time to participate in our study Your enthusiasm cooperation will be a critical contribution to our study, which in turn supports the recommendations of hand hygiene improvement strategies such as training courses, supervisions, and building an institutional safety climate It will restrict the barriers to hand hygiene compliance among health workers at all departments in the hospital and enhance health workers awareness and hand hygiene skills, which in turn preventing healthcareassociated infections Wewill keeptheinformationcollectedin thissurveystrictlyconfidential.Also,wewill usetheinformation onlyforthe purposeofresearchandanalysis onthe conditionthatindividual respondent/institutionand his/her/its informationcannotbeidentified To ensure the accuracy and completeness of the information, please feel confident and comfortable when answering the questionnaire Thank you very much! Please mark X in the box if you confirmed to take part in the interview ☐ …………hospital, date… month…….2019 Participant’s signature APPENDIX INTERVIEW GUIDELINE (For representative of hospital leader, head of infection control department, head nurse of the hospital, and chief physician/head nurse of clinical departments) I GENERAL INFORMATION Age: Gender: Working experience: Major: Position: II CONTENT How you comment on the situation of healthcare-associated infections at the hospital at present? What are the causes of HAIs? Which department has the highest HAIs rate? Do you think that hand hygiene is important to prevent HAIs? Why/Why not? How you comment on implementing hand hygiene among health workers at departments/hospital at present? What are the barriers to hand hygiene compliance among health workers at the hospital? What is the most frequent barrier? Why? What would make it easier for you to comply with HH? List moments required hand hygiene compliance Which moment has the highest HH compliance? Why? How many are HH methods? Which method is the most frequently selected by HWs? Why? Does the HW often use gloves in unnecessary situations? If yes, give some examples Which types of hand hygiene facilities are available in your department? Do you access HH facilities easily as you would like? If no – What is difficult? Are HH facilities adequate? If no—what is missing? What did you to solve the missing? What did the hospital to make it easier for you to comply with HH more effectively/frequently? Are they worked? If no – Why not? 10 Have you ever been reminded by a patient or patient‘s family about performing HH before and after patient contact? 11 Can you propose measures to help the hospital increasing the hand hygiene compliance rate? 12 Which channels you often get information about hand hygiene policies and guidelines? What is the most effective channel? 13 Other opinions (specific) ………………… Thank you very much for your time! APPENDIX OBSERVATION FORM Hospital: Observer: Session No: Department: Date: _/ /2019 Start time: _: Prof.cat N° Prof.cat N° Opp Indication HH Action bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f  missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr Prof.cat N° Opp Indication HH Action bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr Opp Indication HH Action bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat bef-asept HR aft-b.f HW aft-pat missed aft.p.surr bef-pat HR bef-asept HW aft-b.f  missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat HR bef-asept HW aft-b.f missed aft-pat aft.p.surr bef-pat bef-asept HR aft-b.f HW aft-pat missed aft.p.surr ... Assessment I declare that the thesis Knowledge, practice on hand hygiene and some related factors among health workers at three district hospitals in Thai Binh province in 2019 is my own work... workers at three District Hospitals in Thai Binh province in 2019 To describe some related factors influencing knowledge and practice on hand hygiene of these health workers 3 CHAPTER LITERATURE...MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY DANG THI NGOC ANH KNOWLEDGE, PRACTICE ON HAND HYGIENE AND SOME RELATED FACTORS AMONG HEALTH WORKERS AT THREE DISTRICT