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Infection Control Knowledge, Attitudes, and Practices among Healthcare Workers in Addis Ababa, Ethiopia

Published online by Cambridge University Press:  02 January 2015

Admasu Tenna*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
Edward A. Stenehjem
Affiliation:
Department of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Salt Lake City, Utah
Lindsay Margoles
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Ermias Kacha
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
Henry M. Blumberg
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Departments of Epidemiology and Global Health, Emory Rollins School of Public Health, Atlanta, Georgia
Russell R. Kempker
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
*
Tikur Anbessa Specialized Hospital, 8th Floor, Office A-825, PO Box 24792, code 100, Addis Ababa, Ethiopia ([email protected])

Abstract

Objective.

To better understand hospital infection control practices in Ethiopia.

Design.

A cross-sectional evaluation of healthcare worker (HCW) knowledge, attitudes, and practices about hand hygiene and tuberculosis (TB) infection control measures.

Methods.

An anonymous 76-item questionnaire was administered to HCWs at 2 university hospitals in Addis Ababa, Ethiopia. Knowledge items were scored as correct/incorrect. Attitude and practice items were assessed using a Likert scale.

Results.

In total, 261 surveys were completed by physicians (51%) and nurses (49%). Fifty-one percent of respondents were male; mean age was 30 years. While hand hygiene knowledge was fair, self-reported practice was suboptimal. Physicians reported performing hand hygiene 7% and 48% before and after patient contact, respectively. Barriers for performing hand hygiene included lack of hand hygiene agents (77%), sinks (30%), and proper training (50%) as well as irritation and dryness (67%) caused by hand sanitizer made in accordance with the World Health Organization formulation. TB infection control knowledge was excellent (more than 90% correct). Most HCWs felt that they were at high risk for occupational acquisition of TB (71%) and that proper TB infection control can prevent nosocomial transmission (92%). Only 12% of HCWs regularly wore a mask when caring for TB patients. Only 8% of HCWs reported that masks were regularly available, and 76% cited a lack of infrastructure to isolate suspected/known TB patients.

Conclusions.

Training HCWs about the importance and proper practice of hand hygiene along with improving hand sanitizer options may improve patient safety. Additionally, enhanced infrastructure is needed to improve TB infection control practices and allay HCW concerns about acquiring TB in the hospital.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Allegrarci, B, Pittet, D. Healthcare-associated infection in developing countries: simple solutions to meet complex challenges. Infect Control Hosp Epidemiol 2007;28(12):13231327.CrossRefGoogle Scholar
2.Allegranzi, B, Bagheri Nejad, S, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377(9761):228241.Google Scholar
3.Borg, MA. Prevention and control of healthcare associated infections within developing countries. Int J Infect Control 2010;6(1):16.Google Scholar
4.World Health Organization (WHO). First Global Patient Safety Challenge: Clean Care Is Safer Care. WHO Guidelines on Hand Hygiene in Health Care. Geneva: WHO, 2009.Google Scholar
5.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130(2):126130.Google Scholar
6.Sethi, AK, Acher, CW, Kirenga, B, Mead, S, Donskey, CJ, Katamba, A. Infection control knowledge, attitudes, and practices among healthcare workers at Mulago Hospital, Kampala, Uganda. Infect Control Hosp Epidemiol 2012;33(9):917923.CrossRefGoogle ScholarPubMed
7.Gandhi, NR, Weissman, D, Moodley, P, et al. Nosocomial transmission of extensively drug-resistant tuberculosis in a rural hospital in South Africa. J Infect Dis 2013;207(1):917.Google Scholar
8.Kanjee, Z, Catterick, K, Moll, AP, Amico, KR, Friedland, GH. Tuberculosis infection control in rural South Africa: survey of knowledge, attitude and practice in hospital staff. J Hosp Infect 2011;79(4):333338.Google Scholar
9.Christopher, DJ, Daley, P, Armstrong, L, et al. Tuberculosis infection among young nursing trainees in South India. PLoS ONE 2010;5(4):e10408.Google Scholar
10.Gandhi, NR, Moll, A, Sturm, AW, et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 2006;368(9547):15751580.Google Scholar
11.World Health Organization (WHO). WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households. Geneva: WHO, 2009.Google Scholar
12.Dagnew, AF, Hussein, J, Abebe, M, et al. Diagnosis of latent tuberculosis infection in healthy young adults in a country with high tuberculosis burden and BCG vaccination at birth. BMC Res Notes 2012;5:415.CrossRefGoogle Scholar
13.Teixeira, EG, Menzies, D, Comstock, GW, et al. Latent tuberculosis infection among undergraduate medical students in Rio de Janeiro state, Brazil. Int J Tuberc Lung Dis 2005;9(8):841847.Google Scholar
14.Eyob, G, Gebeyhu, M, Goshu, S, Girma, M, Lemma, E, Fontanet, A. Increase in tuberculosis incidence among the staff working at the Tuberculosis Demonstration and Training Centre in Addis Ababa, Ethiopia: a retrospective cohort study (1989-1998). Int J Tuberc Lung Dis 2002;6(1):8588.Google Scholar
15.World Health Organization (WHO). Guide to Local Production: WHO-Recommended Handrub Formulations.> Revised April 2010. Geneva: WHO, 2010. http://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf.+Revised+April+2010.+Geneva:+WHO,+2010.+http://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf.>Google Scholar
16.Gould, DJ, Moralejo, D, Drey, N, Chudleigh, JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2010;9:CD005186.Google Scholar
17.Huis, A, van Achterberg, T, de Bruin, M, Grol, R, Schoonhoven, L, Hulscher, M. A systematic review of hand hygiene improvement strategies: a behavioural approach. Implement Sci 2012;7: 92.Google Scholar
18.Ling, ML, How, KB. Impact of a hospital-wide hand hygiene promotion strategy on healthcare-associated infections. Antimicrob Resist Infect Control 2012;1(1):13.Google Scholar
19.Edwards, R, Charani, E, Sevdalis, N, et al. Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. Lancet Infect Dis 2012;12(4):318329.Google Scholar
20.Tavolacci, MP, Merle, V, Pitrou, I, Thillard, D, Serra, V, Czernichow, P; Alcohol-Based Hand Rub Commission of Infection Control Committee. Alcohol-based hand rub: influence of healthcare workers' knowledge and perception on declared use. J Hosp Infect 2006;64(2):149155.Google Scholar
21.García-Gavín, J, Pérez-Pérez, L, Zulaica, A. Hand eczema due to hygiene and antisepsis products: not only an irritative etiology. Actas Dermosifiliogr 2012;103(9):845846.Google Scholar
22.Suchomel, M, Kundi, M, Pittet, D, Weinlich, M, Rotter, ML. Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efficacy. Am J Infect Control 2012;40(4):328331.Google Scholar
23.Pittet, D, Allegranzi, B, Sax, H, et al; World Health Organization Global Patient Safety Challenge Alcohol-Based Handrub Task Force. Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability. Infect Control Hosp Epidemiol 2007;28(12):13441351.Google Scholar
24.Blumberg, HM, Watkins, DL, Berschling, JD, et al. Preventing the nosocomial transmission of tuberculosis. Ann Intern Med 1995;122(9):658663.CrossRefGoogle ScholarPubMed
25.World Health Organization (WHO). WHO Three Vs Meeting: Intensified Case Finding (ICF), Isoniazid Preventive Therapy (IPT) and TB Infection Control. Report of a Joint WHO HIV/AIDS and TB Department Meeting. Geneva: WHO, 2008.Google Scholar
26.Biscotto, CR, Pedroso, ER, Starling, CE, Roth, VR. Evaluation of N95 respirator use as a tuberculosis control measure in a resource-limited setting. Int J Tuberc Lung Dis 2005;9(5):545549.Google Scholar
27.Escombe, AR, Oeser, CC, Gilman, RH, et al. Natural ventilation for the prevention of airborne contagion. PLoS Med 2007;4(2):e68.Google Scholar
28.Memarzadeh, F, Olmsted, RN, Bartley, JM. Applications of ultraviolet germicidal irradiation disinfection in health care facilities: effective adjunct, but not stand-alone technology. Am J Infect Control 2010;38(5suppl 1):S13S24.Google Scholar
29.Nardell, EA, Bucher, SJ, Brickner, PW, et al. Safety of upper-room ultraviolet germicidal air disinfection for room occupants: results from the Tuberculosis Ultraviolet Shelter Study. Public Health Rep 2008;123(1):5260.Google Scholar
30.Monkongdee, P, McCarthy, KD, Cain, KP, et al. Yield of acid-fast smear and mycobacterial culture for tuberculosis diagnosis in people with human immunodeficiency virus. Am J Respir Crit Care Med 2009;180(9):903908.CrossRefGoogle ScholarPubMed
31.Bruchfeld, J, Aderaye, G, Palme, IB, et al. Evaluation of outpatients with suspected pulmonary tuberculosis in a high HIV prevalence setting in Ethiopia: clinical, diagnostic and epidemiological characteristics. Scand J Infect Dis 2002;34(5):331337.Google Scholar
32.Steingart, KR, Ng, V, Henry, M, et al. Sputum processing methods to improve the sensitivity of smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis 2006;6(10):664674.CrossRefGoogle ScholarPubMed
33.World Health Organization (WHO). Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF System; Policy Statement. Geneva: WHO, 2011. http://apps.who.int/iris/handle/10665/44586. Accessed May 10, 2013.Google Scholar
34.Sissolak, D, Bamford, C, Mehtar, S. The potential to transmit Mycobacterium tuberculosis at a South African tertiary teaching hospital. Int J Infect Control 2010;14:e423e428.Google Scholar
35.Menzies, D, Joshi, R, Pai, M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 2007;11:593605.Google Scholar
36.Joshi, R, Reingold, AL, Menzies, D, Pai, M. Tuberculosis among health-care workers in low- and middle-income countries: a systematic review. PLoS Med 2006;3(12):e494.Google Scholar