Strategies to improve hand hygiene practices in two university hospitals.

OBJECTIVE: To evaluate the strategies to improve hand hygiene practices among participants in two university hospitals. MATERIAL AND METHOD: A quasi-experimental study was performed from January 1, 2001 to December 31, 2004 at Siriraj Hospital and from January 1, 2004 to July 31, 2004 at the neonatal intensive care unit (NICU), Maharaj Nakorn Chiang Mai Hospital. The study was divided into three phases; 1) pre-intervention phase to identify factors associated with non-adherence in hand hygiene practices among participants, 2) intervention phase, 3) post-intervention phase to include observations to evaluate the effectiveness of interventions on hand hygiene practices among participants. Interventions at Siriraj Hospital included distribution of posters, leaflets, rewarding healthcare workers (HCWs) who suggest the most attractive name for alcohol gel and a handwashing slogan, and a parade to boost hand hygiene practice. Interventions at Maharaj Nakorn Chiang Mai Hospital included training, a reminder poster display, provision of alcohol-based handrubs and performance feedback. RESULTS: Six hundred and forty-six HCWs were observed before and after the non-invasive procedures and 404 HCWs were observed before and after an invasive procedure at Siriraj Hospital. At Maharaj Nakorn Chiang Mai Hospital, participants included 26 nursing personnel in the NICU. After intervention, significant improvement on handwashing was observed in both the invasive procedure (p<0.001) and non-invasive procedures (p<0.001) at Siriraj Hosptial. Significant improvement on handhygiene practice was also observed among participants at Maharaj Nakorn Chiang Mai Hosptial (p=0.001). CONCLUSION: Different strategies worked well in different institutions. The present study suggested the role of multi-faceted approaches to help improve handhygiene practices among HCWs.

Program on nosocomial infection in the curricula of medicine, dentistry, nursing and medical technology in Thailand.

OBJECTIVES: To identify defects in the program on NI in curricula of medical, dental, medical technology and nursing schools. Impacts of the results of the study on the changes of the program were also evaluated MATERIAL AND METHOD: Questionnaires study of all 12, 8, 9 medical, dental, medical technology and 20 of 62 nursing schools. Data were collected and analyzed. Defects in the program of NI were identified and recommendation for improving was drafted in a workshop participated by curriculum directors and researchers. Results of the study were fedback to the schools enrolled. Changes of the program were later followed.. RESULTS: Program on NI was present in the curricula of 11 of 12 medical, some dental and medical technology but in none of the nursing schools. Education program varied in methods of teaching, hours and years of students. A few schools modified the program in their curricula by the results of the study and recommendation of a workshop participated in by researchers and program directors. CONCLUSION: Program on NI in the curricula of medical, dental, medical technology and nursing schools in Thailand varied in education methods, teaching hours and in student years. The present study results had little impact on changing the program. An evidence-based program on NI in medical, dentistry, medical technology and nursing is urgently needed.

Catheter-associated urinary tract infection.

OBJECTIVES: To study the incidence, risk factors, clinical outcomes and antibiotic costs of catheter-associated urinary tract infections (CAUTI) in patients with indwelling urinary catheter for one week and longer MATERIAL AND METHOD: Patients in neurology and neurosurgery wards in a teaching hospital were studied. Patients with UTI before catheterization and in whom the catheter was removed before one week were excluded. Urine cultures were done immediately after catheterization and 3 times a week there after. Patients were followed for symptoms of UTI for 1 week after catheter removal, for 4 weeks without evidence of UTI or until discharge. RESULTS: One hundred and one patients met the inclusion criteria. The incidence of CA UTI was 73.3%. High incidence of CAUTI was found in the first 2 weeks after catheterization. About one-half of the patients with CAUTI had a single episode and were symptomatic. None of the 132 episodes of CAUTI were associated with secondary bacteremia. Risk factors for CAUTI identified were prolonged catheterization and change of the catheter Nosocomial pathogens were found in urine and yeast was the commonest. Eleven patients (14.9%) with CAUTI died and only in 2, CAUTI was considered a contributory factor for mortality. The cost of antimicrobials for treating one episode of CAUTI was 8,180 baht and this rose to 49,983 baht for CAUTI associated with concurrent infections at other sites. CONCLUSION: Catheter-associated urinary tract infection was common. Uropathogens were nosocomial micro-organisms with high incidence of resistance to antimicrobials. Impacts on morbidity, mortality and costs were substantial. Better management of urinary catheter is to be explored and implemented.

A study on powdering of reusable surgical gloves.

OBJECTIVES: To study the need of powdering surgical gloves and to produce a powdering machine. MATERIAL AND METHOD: The need of powdering surgical gloves was done by questionnaires to directors or chiefs of purchase departments in 29 hospitals across the country. The practice in powdering surgical gloves was given by chiefs of the central sterile supply department (CSSD). A powdering machine was produced by the researchers in consultation with CSSD personnel in a hospital. The quality of powdering surgical gloves was evaluated by infection control nurses in the hospital. Cost comparison was done by a health economist. RESULTS: The study in 2002 revealed that all of the 29 hospitals used recycled surgical gloves. Powdering of surgical gloves was done by hand in 27.6% and by powdering machine in 62.10%. Corn powder was used in 55.2% and talc in 41.4%.Defects in powdering ranged from 1.1% to 51.7%. No defects was found in surgical gloves powdered by the machine produced by the researchers. The costs for powdering and one pair of reused surgical gloves were 0.10 and 5.59 baht respectively. CONCLUSION: Surgical gloves were reused in all hospitals in Thailand The powdering machine was effective and was not difficult to make.

Effectiveness and microbial contamination of an in-house alcohol-based hand rub.

OBJECTIVES: To evaluate the effectiveness and contamination of an in-house alcohol-based hand rub in a real clinical setting and to compare its effectiveness in bacterial reduction with that of a commercial product. MATERIAL AND METHOD: Effectiveness of the hand rub in bacterial reduction was compared to a commercial product using the modified antiseptic/disinfectant testing method of European Standard (EN 1500) in 12 volunteers. In-house alcohol-based hand rub in 50 clinical wards were serially collected and cultured to determine contamination. RESULTS: The bacterial reduction factor of the hand rub was comparable to that of the commercial product. There was no organisms grown from serial cultures of the in-house alcohol-based hand rub in use for 28 days. CONCLUSION: The in-house alcohol-based hand rub was effective and there was no contamination up to 28 days in use.