The Uganda Ministry of Health has supplied alcohol-based hand gel (ABHG) to health facilities but its use is still limited due to short supply. Good hand hygiene practice is crucial to the effectiveness of bedside ABHG and reduced healthcare associated infections (HAIs). However, evidence of hand hygiene practice and HAIs is sparse in the resource limited setting. In preparation for introduction of ABHG to a rural Uganda hospital, we conducted a baseline survey to evaluate hand hygiene practices of health care providers (HCPs) and the incidence of HAIs.
Hand hygiene compliance among HCPs and incidence of HAIs were assessed at a referral hospital in rural Uganda. Following CDC’s definitions of HAIs and considering locally available resources, a surveillance form for inpatients was created. Inpatients on obstetrics/gynecology (OBGYN), pediatric and surgical departments were followed during their hospital stays. Hand hygiene compliance was determined by observed frequency of HCPs washing their hands.
1949 inpatients (864 adults (44.3%) and 1085 children (55.7%)) were enrolled over 12 weeks of the survey from October 2014 to January 2015. 892 (45.8%), 863 (44.3%) and 194 (9.9%) patients were on OBGYN, pediatric and surgical departments, respectively. Median length of hospital stay was 2 days (range 1 - 31 days). 95 patients (4.9%) met Systemic Inflammatory Response Syndrome (SIRS) criteria since hospital day 3. The incidence rate of SIRS was 0.011 cases per 1000 person-days. Among SIRS cases, pneumonia was most commonly diagnosed (19 patients, 20.0%), followed by surgical site infections (7 patients, 7.4%). Weekly hand hygiene compliance rate ranged from 2.4% to 24.5% and varied across the departments.
HAIs are little known in the resource limited countries, particularly in Africa. To our knowledge, our study is one of the largest studies that address HAIs in Africa. During the survey, about 1 in 20 patients developed SIRS, indicating the incidence of HAIs may be as high as that in high-income countries. Pneumonia was the most common HAI, though diagnostic criteria by CDC were often difficult to apply due to resource limitation. Hand hygiene practice among HCPs was not desirable at baseline. The effectiveness of ABHG as well as hand hygiene practice on HAIs needs to be evaluated in the resource limited setting.
J. Ditai, None
B. Wanume, None
J. Abeso, None
A. Weeks, None
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