Hand hygiene knowledge, training and practice: A cross-sectional study in a tertiary health institution, North-central Nigeria.

BACKGROUND: Hand hygiene (HH) is the single most important means of preventing hospital-acquired infections. We set out to determine the knowledge, training gaps, and practice of HH in a tertiary health institution in a resource constrained setting. METHODS: This cross-sectional study was conducted among health care workers in a 600-bed capacity tertiary health centre. The study was conducted between April and November 2013. A multi-stage randomized sampling method was used to self-administer 322 WHO HH knowledge questionnaires. Information on HH training in the past 3 years, knowledge and practice of HH were obtained, and data were analysed using Epi-Info version 3.5.1. RESULTS: A response rate of 98.5% was obtained for the HH knowledge assessment. Mean age of the study population was 39 ± 9.8. About 64% were females. Of all the respondents, only 16% had good knowledge of HH, 52% had moderate knowledge while 32% had poor knowledge. About 24% had formal training on HH. In terms of practice, only about 22% of the respondents self-reported routine practice of HH. CONCLUSIONS: The findings in this study suggest that there is sub-optimal HH knowledge, practice and training. It is imperative to improve the HH training and retraining of health care workers with a focus on attendants. Administrative controls and bold signage in healthcare institutions are also recommended.

An audit of diagnosis and treatment of sepsis in north-central Nigeria.

BACKGROUND: We audited the diagnosis and antibiotic therapy of patients admitted with sepsis in a resource-limited Nigerian hospital setting in order to improve the quality of sepsis care. METHOD: We conducted a retrospective analysis of the records of medical patients admitted for sepsis at the Jos University Teaching Hospital between September 2011 and August 2012. Data analysis included age, sex, appropriateness of sepsis diagnosis/severity, comorbidities, utility/yield of sample cultures, antibiotic therapy, duration of hospital stay and treatment outcome. RESULT: Only 94 out of 142 cases (66.2%) were judged to meet the diagnostic criteria for sepsis. Out of the 94 patients, 77 (82%) were appropriately classified for sepsis severity. Nineteen patients (20%) met criteria for severe sepsis/septic shock. The commonest comorbidity was HIV/AIDS (57.3%). All the patients received empirical antibiotic therapy but in 23 cases (24.5%), the empirical prescriptions were judged inappropriate and none was administered within one hour of diagnosis. Blood cultures were available to guide definitive antibiotic therapy in only 12.5% of cases. The median (range) duration of hospital stay was 12 (1-70) days while the in-hospital mortality rate was 53%. CONCLUSION: The management of sepsis was suboptimal in our setting and mortality was high. We recommend adoption of standard sepsis guidelines to ensure optimal management and improved outcome.