Analysis of Compliance and Barriers for Hand Hygiene Practices among Health Care Workers during COVID-19 Pandemic Management in Tertiary Care Hospital of India—An Important Step for Second Wave Preparedness

Introduction: Hands of health care workers play an important part in infection transmission in a healthcare setting infections. Even though it is a simple and effective procedure, it is many times ignored by the health care workers (HCWs) due to lack of knowledge and interest, time constraints, skin irritation, understaffing, etc. There are no specific drugs and vaccines available for COVID-19 pandemic management, so as control measures, hand hygiene is an essential measure. It will be helpful even for the second wave preparedness. So this study was planned for analysis of barriers and practices of hand hygiene among health care workers which determine the adherence of hand hygiene in medical practice. Methods: This was a cross-sectional study designed during COVID-19 pandemic management to analyze the barriers and knowledge, attitude and practices in health care workers for hand hygiene. Semi-structured questionnaires based study based on previous experience of seasonal flu outbreak was make to know barriers as well as to analyze the knowledge, attitude and practices of Health care workers. 215 participants were enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. Results: The “Barriers” related questions’ analysis showed that hand hygiene facilities, with the supply of soap, hand rub, basins with adequate as well as clean water, are available at various places in the Hospital. In knowledge related questions, major gaps are found in 5 moments of hand hygiene and regarding aspects of alcohol-based hand-rub. Majority HCWs show a good attitude towards questions that hand hygiene is an important thing to do along with other works and they feel frustrated when others or they themselves omit hand hygiene. But the attitude toward hand hygiene when hands are not visibly soiled and when working with gloved hand showed a wrong attitude. There is a major gap in practices of hand hygiene. The majority feel hand hygiene is difficult due to work pressure, sometimes they forgot, they feel it difficult to adhere due to more steps during an emergency. Discussion: Hand hygiene is an essential part of COVID-19 pandemic management. Less compliance was observed due to a lack of knowledge and awareness. Such ignorance leads to an increase in Hospital-acquired infection. Conclusion: Good preparedness by Government and Institute for supplying adequate hand hygiene facilities in the work area for health care workers. But there were few gaps found in knowledge and attitude-related questionnaires and major gaps in practices were found which should be corrected by repeated training, awareness programs, demonstrations for hand hygiene and hands-on training. Conducting Periodic Webinar can be the most useful, convenient and safe method to provide training during the COVID-19 pandemic.

Practices and Barriers for Personal Protective Equipment among Health Care Workers during COVID-19 Pandemic Management at Tertiary Care Government Hospital of South Gujarat, India

Introduction: The recent COVID-19 pandemic has prompted concern about the compatibility of IPC guidelines with health care workers, their working practices and behaviours. These guidelines can be difficult and time-consuming to adhere to in practice. By identifying barriers and facilitators to IPC guideline adherence, especially using personal protective equipment (PPE), we can identify focussed strategies that will support health care workers to undertake the IPC measures needed at such a critical time in health care internationally. Material & Methods: This was a cross-sectional study designed during the COVID-19 pandemic management in the South Gujarat region, to analyse the knowledge, attitude and practices of health care workers about their usage of personal protective equipment. A semi-structured questionnaire-based study was prepared, deriving pointers from our previous experience of seasonal flu outbreaks. 225 participants enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. Result: Analysis of the barriers-related questions show good preparedness by the medical institution. Overall we found good knowledge, attitude and practice related to PPE during COVID-19 pandemic management. There are few gaps found in the knowledge of donning of PPE (p-0.0075), N-95 mask related knowledge (p-0.01) and the attitude that PPE use causes discomfort while nursing patients (0.0001).

Knowledge Attitude and Practice towards Infection Control Measures amongst Medical Students in a Medical Teaching Tertiary Care Hospital

Introduction: Health care associated infections (HAIs) are likely to be the most common complication of hospital care. World Health Organization (WHO) estimates these infections to occur among 7% - 12% of the hospitalized patients globally, with more than 1.4 million people suffering from infectious complications acquired in the hospital at any time. Keeping this in mind, the present study was conducted to delineate the level of knowledge, attitudes, and practices (KAP) for the use of proper disinfection procedures among the final year undergraduate medical students in a tertiary care hospital and teaching institute. Methodology: Present study was conducted at Government Medical College, Surat, a tertiary care hospital and teaching institute. The participants who gave consent were provided with a pre-tested questionnaire that included several questions on knowledge attitude and practices on hospital acquired infections and its control practices. Analysis of the answers was done based on KAP score. Result: 80 students who consented were included in the study. 75% of the study population had correct knowledge about the most common health care associated infections (HAIs), being infection of venous access, urinary tract infection, respiratory infections and surgical site infections, based on their current knowledge on hospital acquired infections. Majority of study participants agreed with the fact that the inappropriate application of disinfection procedures increases the risk for a health care worker of either acquiring or transmitting a HAI from/to a patient. >90% participants had a good attitude towards risk of getting or transmitting any infectious disease by a Health care worker (HCW) while working and the utility of the application of disinfection procedures during work would reduce the rates of HAI. Practices of the students towards disinfection during performance of certain medical procedures ranged from 10% to 88% of the times showing poor practices of the medical students in following disinfection practices. Conclusion: In the present study the knowledge of medical students for the most common cause of hospital acquired infection was satisfactory. The overall attitude of the students was satisfactory as the mean score was 8. The practices of the students for the application of disinfection during performance of certain medical procedures were also satisfactory, although time to time training and tutorials of these students can help in increasing their knowledge, attitude and practices.

Evaluation of Contamination of Hands of the Medical Students in a Medical Teaching Tertiary Care Hospital

Background: In the hospital, patients are often exposed to multiple procedures, invasive devices etc., increasing their chances of contracting such potential pathogens. Most of the time these potential pathogens exhibit multiple drug resistance. Aim: In view of the above factors, this study was undertaken to determine the rate of colonization of potential bacterial pathogens in the hands of final year MBBS undergraduate students. As per their clinical teaching curriculum, they visit the wards/ICU/OT, etc. on a daily basis. Method: Samples were collected from the hands of final year MBBS undergraduate students. The samples were collected by rubbing a saline wet swab stick onto the hands of the students and were inoculated onto nutrient agar plates for 18 - 24 hours at 37°C aerobically. Bacterial isolates were identified till species level by performing gram staining and biochemical reactions. Antibiotic susceptibility testing was done by Kirby-baur disc diffusion method as per CLSI guidelines 2016. Conclusion: 103 samples were collected from hands of final year undergraduate MBBS students by swab culture method. 38 showed growth and 65 showed no growth. Out of 38 isolates, 36 were Gram positive cocci and 2 were Gram positive bacilli. No Gram negative bacilli were isolated. Amongst 36 Gram positive cocci, 16 were coagulase positive Staphylococcus aureus and 20 were Coagulase negative Staphylococci (CoNS). 14 Staphylococcus aureus out of 16 were methicillin sensitive and 2 were methicillin resistant Staphylococcus aureus (MRSA). Out of 16 Staphylococcus aureus, 1 isolate showed Inducible Clindamycin Resistance (iMLSB phenotype) and 6 isolates showed complete resistance to erythromycin and clindamycin (constitutive MLSB phenotype). 1 Staphylococcus aureus which was Inducible Clindamycin Resistance (iMLSB phenotype) was also methicillin resistant.