Charité - Universitätsmedizin Berlin, Institute of Tropical Medicine and International Health, Berlin, Germany.
Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
Antimicrob Resist Infect Control. 2020 May 14;9(1):65. doi: 10.1186/s13756-020-00723-8.
Healthcare-associated infections are the most frequent adverse events in healthcare worldwide, with limited available evidence suggesting highest burden in resource-limited settings. Recent Ebola epidemics emphasize the disastrous impact that spread of infectious agents within healthcare facilities can have, accentuating the need for improvement of infection control practices. Hand hygiene (HH) measures are considered to be the most effective tool to prevent healthcare-associated infections. However, HH knowledge and compliance are low, especially in vulnerable settings such as Guinea. The aim of PASQUALE (Partnership to Improve Patient Safety and Quality of Care) was to assess knowledge and compliance with HH and improve HH by incorporating the WHO HH Strategy within the Faranah Regional Hospital (FRH), Guinea.
In a participatory approach, a team of FRH staff and leadership was invited to identify priorities of the hospital prior to the start of PASQUALE. The local hygiene committee was empowered to increase its activities and take ownership of the HH improvement strategy. A baseline assessment of knowledge, perception and compliance was performed months before the intervention. The main intervention consisted of local alcohol-based-hand-rub (ABHR) production, with final product efficacy testing, in conjunction with a training adapted to the needs identified in the baseline assessment. A follow-up assessment was conducted directly after the training. Effectiveness of the intervention was assessed via uncontrolled before-and-after comparison.
Baseline knowledge score (13.0/25) showed a significant increase to 19.0/25 in follow-up. Baseline-Compliance was 23.7% and increased significantly to 71.5% in follow-up. Compliance rose significantly across all professional groups except for midwifes and in all indications for HH, with the largest in the indication "Before aseptic tasks". The increase in compliance was associated with the intervention and remained significant after adjusting for confounders. The local pharmacy successfully supplies the entire hospital. The local supply resulted in a ten-fold increase of monthly hospital disinfectant consumption.
The WHO HH strategy is an adaptable and effective method to improve HH knowledge and compliance in a resource-limited setting. Local production is a feasible method for providing self-sufficient supply of ABHR to regional hospitals like the FRH. Participatory approaches like hygiene committee ownership builds confidence of sustainability.
在全球范围内，与医疗保健相关的感染是最常见的不良事件，有限的证据表明资源有限的环境中负担最重。最近的埃博拉疫情强调了传染性病原体在医疗机构内传播可能造成的灾难性影响，凸显了改进感染控制措施的必要性。手部卫生（HH）措施被认为是预防与医疗保健相关的感染的最有效工具。然而，HH 知识和依从性较低，尤其是在像几内亚这样的脆弱环境中。PASQUALE（改善患者安全和护理质量的伙伴关系）的目的是评估 HH 的知识和依从性，并通过将世卫组织 HH 战略纳入几内亚法拉纳地区医院（FRH）来改善 HH。
采用参与式方法，邀请 FRH 工作人员和领导层团队在 PASQUALE 开始之前确定医院的优先事项。当地卫生委员会被授权增加其活动并拥有 HH 改善战略的所有权。在干预措施之前的数月进行了知识、感知和依从性的基线评估。主要干预措施包括当地生产基于酒精的手消毒剂（ABHR），并结合在基线评估中确定的需求进行培训。培训后直接进行了后续评估。通过无对照的前后比较评估干预措施的效果。
基线知识得分（13.0/25）在随访时显著增加到 19.0/25。基线依从率为 23.7%，随访时显著增加到 71.5%。除了助产士外，所有专业群体的依从率都显著提高，所有 HH 指征的依从率都显著提高，其中“无菌操作前”指征的依从率提高最大。依从性的提高与干预措施有关，并在调整混杂因素后仍然显著。当地药房成功为整个医院供应。当地供应使每月医院消毒剂消耗增加了十倍。
世卫组织 HH 战略是一种适应性强且有效的方法，可在资源有限的环境中提高 HH 知识和依从性。像 FRH 这样的地区医院，当地生产是提供自给自足的 ABHR 的可行方法。像卫生委员会所有权这样的参与式方法建立了可持续性的信心。
