Hand hygiene practices among nursing staff in public secondary care hospitals in Kuwait: self-report and direct observation

To assess the compliance with hand hygiene guidelines among nursing staff in secondary care hospitals in Kuwait. A cross-sectional study was conducted through direct observation using the Lewisham observation tool and self-administered questionnaire in six major public secondary care hospitals in Kuwait. Only patient care activities that are described as 'dirty contacts' by the Fulkerson scale were considered as indications for hand hygiene while any attempt for hand hygiene was considered as compliance. A self-administered questionnaire was prepared and pilot tested and then distributed to nursing staff at each ward immediately after conducting the inspection; 550 were distributed and 454 were completed and returned. Among 204 observation sessions, a total of 935 opportunities and 312 hand hygiene practices were recorded. The overall compliance was 33.4%. The observed compliance significantly varied between different ward categories from 14.7% in emergency to 55% in medical wards. Of the 454 nursing staff who participated in self-reported compliance, 409 [90%] indicated that they always washed their hands upon practicing patient care activities. Nurses consistently reported higher compliance after conducting patient care activities rather than before. Being busy with work [42.2%], having sore/dry hands [30.4%] and wearing gloves [20.3%] were the most frequently reported hindrances to improving hand hygiene. Observed hand hygiene compliance among nursing staff in secondary care hospitals in Kuwait was poor. High self-reported compliance may reflect a high level of awareness of hand hygiene but may also suggest that improving compliance through increasing awareness has probably reached saturation

Perception of the educational environment by medical students undergoing a curricular transition in Kuwait

The aim of this study was to measure the students' perceptions of the educational environment in a medical school undergoing curricular transition from a traditional to a problem-based learning [PBL] program in the academic year 2006-2007. The Dundee Ready Education Environment Measure [DREEM] was used to evaluate perception of the educational environment. Multivariate logistic regression models were used to identify the factors related to educational environment perception that differ between students following a traditional curriculum to those following a PBL program at Kuwait University Medical School. Mean DREEM score was 53%. When students moved from the traditional curriculum to the PBL system, Academic Self-Perception deteriorated, while Perception of Atmosphere improved. Academic Self-Perception deteriorated because conventional strategies of learning were perceived as no longer useful, while Perception of Atmosphere improved because of increased relevance of the studies. Our findings suggest that curricular changes require careful planning and thinking, with particular attention upon how they influence the educational climate. When new teaching strategies are introduced, new factors that may lead students to develop an adverse perception of their educational environment may be introduced as well. Identification of such factors can lead to an improved educational outcome