COMPLIANCE OF HEALTHCARE STAFF TOWARDS INFECTION CONTROL PRECAUTIONS IN HEMODIALYSIS UNITS â€“ GAZA GOVERNORATES
Objective: Health care associated infections are the most frequent adverse event in health care delivery, which lead to significant mortality and financial burden for health systems. This study aimed to assess the health care providersâ€™ compliance with infection control practices in the hemodialysis units.
Methods: A cross sectional, analytical design with census sample was used.Â The data were collected using interviewing questionnaire and observational checklist for the practice of health care providers. In total, 77 questionnaires were collected, 228 practice observational checklists and five physical environment observational checklists.
Results: The study findings revealed that hospital management does not practice its role efficiently in encouraging health care providers to be compliant with infection prevention and control protocol. Findings of the study revealed that the majority of the study participants had not adequate training (79.2%) about the infection prevention and control protocol. The findings of the standard precaution showed that the compliance with hand hygiene score was 56.2%; personnel protective equipment score was 87.5%; using waste management score was 39.6%; environmental infection control practices score was 54.3% and aseptic technique score was 62.8%. however, additional precaution score was 56.5%.Â Moreover, the study revealed that 45.8% of the health care providers were exposed to an injury from used needles or sharp medical instruments. The study also found that 93.5% of the health care providers working in the hemodialysis unit received the recommended three doses of hepatitis B vaccine. Finally, the study showed that there are a statistical deferenceâ€™s between hospitals and all standard precaution domains (P value= .000), while part of standard precaution domains (personnel protective equipment, waste management, environmental infection control practices) had a statistical difference with occupational type respectively (.000, .008, .031).
Conclusion: There is a need to develop a Palestinian infection prevention and control protocol special for hemodialysis unit. A continuous education and training programs for healthcare staff and physical environmental fitness concerning Infection Prevention and Control protocol should be implemented.
Key words: Â Hospital acquired, Hemodialysis units, Infection control, Compliance
1. Centers for Disease Control and Prevention (CDC). Infection control assessment tools. Retrieved January 01, 2018, from https://www.cdc.gov/dialysis/prevention-tools/assessment-tools.html, 2018.
2. World Health Organization (WHO). Prevention and control of hospital-associated infections: report of a regional workshop: report of a regional workshop, Pune, India, 24-26 September 2002.
3. Karkar A. Hand hygiene in hemodialysis units. Retrieved April 07, 2017, from http://file.scirp.org/pdf/OALibJ_2016082217000241.pdf, 2016.
4. World Health Organization (WHO). Health care without avoidable infections: the critical role of infection prevention and control, (2016).
5. Stein AD, Makarawo TP, Ahmad MF. A survey of doctors' and nurses' knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals. Journal of Hospital Infection.2003; 54 (1): 68-73.
6. Paudyal P, Simkhada P, Bruce J. Infection control knowledge, attitude, and practice among Nepalese health care workers. American journal of infection control,2008; 36(8): 595-2.â€
7. Yassin S, El Dib M, Roshd D. Nursesâ€™ performance, isolation policy and HCV seroconversion among hemodialysis patients in Egyptian hospitals. Life Sci J. 2012;9(1):740-9.
8. Abd Elaziz KM, Bakr IM. Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals in Cairo. The Egyptian J Communy Med. 2008;26(2):1-12.
9. Eljedi A, Dalo S. Compliance with the national Palestinian infection prevention and control protocol at governmental pediatric hospitals in Gaza governorates. Sultan Qaboos University medical journal.2014;14(3): e375.
10. Chalya P, Seni J, Mushi M, Mirambo M, Jaka H, Rambau P, Kalluvya S. Needle stick injuries and splash exposures among health care workers at a tertiary care hospital in north western Tanzania. Tanzania Journal of Health Research.2015:17(2).
11. Ismail N, Aboul Ftouh A, El-Shoubary W, Mahaba H. Safe injection practice among health-care workers in Gharbiya Governorate, Egypt. Eastern Mediterranean Health Journal.2007;13(4): 893-906.
12. Rice BD, Tomkins SE, Ncube FM. Sharp truth: health care workers remain at risk of blood borne infection. Occupational Medicine.2015; 65(3): 210-4.â€
13. Alkhan AA. Hepatitis b virus and hepatitis c virus infections among hemodialysis patients. Gen Med (Los Angel).2015;3:165. doi: 10.4172/2327-5146.1000165.
14. Al Saran K, Sabry A, Al Halawany Z, Ismail M. Factors affecting response to hepatitis B vaccine among hemodialysis patients in a large Saudi Hemodialysis Center. Saudi Journal of Kidney Diseases and Transplantation.2014;25(1): 185.
15. Centers for Disease Control and Prevention (CDC). Guideline for vaccinating kidney dialysis patients and patients with chronic kidney disease. Retrieved September 15, 2017, from https://www.cdc.gov/vaccines/pubs/downloads/dialysis-guide-2012.pdf. 2012.
16. Al-Ghamdi SMG. Nurses' knowledge and practice in hemodialysis units: comparison between nurses in units with high and low prevalence of hepatitis C virus infection. Saudi J Kidney Dis Transplant. 2004;15(1):34-40.
17. World Health Organization (WHO). AIDE-Memoire for infection prevention and control in a health care facility.2004.
18. NHS Professional. CG1 Standard Infection Prevention and Control Guidelines. Retrieved Jun 8, 2017, from
19. Siegel J, Rhinehart E, Jackson M, Chiarello L. Health care infection control practices advisory committee: Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. American journal of infection control.2007; 35(10): S65-S164.
20. Abou El-Enein NY, El Mahdy HM. Standard precautions: a KAP study among nurses in the dialysis unit in a University Hospital in Alexandria, Egypt. Journal of the Egyptian Public Health. 2011;86:3-10.
21. Saxena A, Panhotra BR, Sundaram DS, Naguib M, Venkateshappa CK, Uzzaman W, et al. Impact of dedicated space, dialysis equipment, and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the Middle East. AJIC. 2003;31(1):26-33.
22. Kebbesti IA, EI-Sayed NM, AI-Nawawy AN, Abou Selem MEIS, EI-Deek B, Hessen NM. Risk perception and precautions taken by health care workers for HIV infection in haemodialysis units in Egypt. East Med Health J. 2007;13(2):392-407.
23. Tabash MI, Hussein RA, Mahmoud AH, El-Borgy MD,Abu-Hamad BA. Impact of an educational program on knowledge and practice of health care staff toward pharmaceutical waste management in Gaza, Palestine. Journal of the Air & Waste Management Association. 2016;66(4): 429-38.â€
24. Biomedical waste solutions. Medical Waste Disposal â€“ The Definitive Guide. Retrieved October 8, 2017, from http://www.biomedicalwastesolutions.com/medical-waste-disposal/
25. An APIC Guide. Guide to the Elimination of Infections in Hemodialysis.(2010). Retrieved Jun 8, 2017, from http://www.esrdnetwork.org/sites/default/files/content/pdf/regulations/APIC_Hemodialysis_.pdf.
26. CataÃ±o J, Echeverri L, Szela C. Bacterial contamination of clothes and environmental items in a third-level hospital in Colombia. Interdisciplinary perspectives on infectious diseases.2012. http://dx.doi.org/10.1155/2012/507640.
27. Elamin S, Salih LOAM, Mohammed SI, Ali SEE, Mohammed NFE, Hassan EH, et al. Staff knowledge, adherence to infection control recommendations and seroconversion rates in hemodialysis centers in Khartoum. Arab J of Nephro and Transp. 2011;4(1):13-19.
28. Nagpal K, Dudeja N, Sharma N, Chaudhary N, Chaudhary S, Tewari S. Project report on a research on compliance with hand washing among health care workers during routine patient care a report. 2010;1-39.
29. Moore C, Besarab A, Ajluni M, Soi V, Peterson E, Johnson L, Yee J. Comparative effectiveness of two catheter locking solutions to reduce catheter-related bloodstream infection in hemodialysis patients. Clinical Journal of the American Society of Nephrology. 2014;9(7): 1232-39.
30. Zingg W, Cartier V, Inan C, Touveneau S, Theriault M, Gayet-Ageron A, Walder B. Hospital wide multidisciplinary, multimodal intervention program to reduce central venous catheter-associated bloodstream infection. PLOS One.2014; 9(4): //doi.org/10.1371/journal.pone.0093898.
31. Khanna U. The economics of dialysis in India. Indian journal of nephrology.2009; 19(1):1.