P110
Multidrug resistant organism surveillance project: assessing patients and healthcare providers attitudes; knowledge and beliefs regarding multidrug resistant organism infection, surveillance and infections control practices at Chu Kigali
Olivier M. Manzi
University of Rwanda/ CHUK, Kigali, Rwanda
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P110
Introduction: Nosocomial infections caused by multi-drug resistant organisms (MDRO) contribute significantly to mortality and pro- longed length of stay among hospitalized patients, A significant proportion of MDRO infections are transmitted between patients via healthcare workers hands, methicillin resistant staph aureus (MRSA) and extended-spectrum beta-lactamase producing (ESBL) organisms are recognized as principal pathogens that are easily transmitted in healthcare settings.
Objectives: This study aims to assess patients and healthcare pro- viders attitudes, knowledge or beliefs around multi-drug resistant surveillance and infection control practices at CHU Kigali.
Methods: Questionnaires were administered to both healthcare providers as well as patients hospitalized on various department of the hospital. Healthcare providers self-administered questionnaires while patient respondents were guided on how to fill them by study investigators. Afterwards, data was collated for final analysis. Simple descriptive statistics were used to report study findings.
Results: Overall, 250 healthcare providers and 245 patients com- pleted the survey. The study found that while 128/250 (51,2%) of HCWs had limited knowledge about MDROs, there was a significantly lower knowledge about them among surveyed patients (P < 0.05). While 236 HCWs (94.4%) agree with the of soap and water as being appropriate for hand hygiene, only 174 (69.6%) HCWs reported that they routinely wash their hands after handling patients. A majority of patients (64,9%) were not satisfied with HCWs hand hygiene prac- tices. Regarding surveillance procedures, 71 patients (29%) reported discomfort with accepting rectal swab for screening of colonization with ESBL producing organisms and 74% of HCWS still believe that beta-lactam antibiotics can be used in MDRO infections.
Conclusion:This study showed the low level of knowledge by pa- tients and limited knowledge by healthcare providers regarding nosocomial infections caused by MRSA and ESBL producing organisms, these knowledge gaps about MDRO and their surveillance is
concerning and should inform future efforts to educate patients and their providers about this public health problem.
Disclosure of Interest
None Declared
P111
An observational study on the knowledge and adherence of personal protective equipment removal guidelines in intensive care unit nurses
Hyun Ju Chun1, 2, Jae Sim Jeong3, Hye-Ran Choi1, Ihn Sook Jeong4 1
Department of Clinical Nursing, University of Ulsan, Ulsan;2Department of Nursing, Asan Medical Center, Seoul;3Department of Clinical Nursing,
College of Medicine, University of Ulsan, Ulsan;4College of Nursing, Pusan National Univeristy, Pusan, Korea, Republic Of
Correspondence:Jae Sim Jeong
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P111
Introduction: Proper and precise removal, as well as wearing personal protective equipment (PPE) after contact with an infectious disease is essential to prevent infection transmission. However, there are no studies reported in Korea and the medical environment is different from that of foreign countries.
Objectives:This study is to investigate the nurses’ knowledge and adherence of PPE removal guidelines for patients on the contact pre- cautions and to explore ways to improve the adherence of the PPE removal guidelines by identifying the factors that affect them.
Methods:The 43 nurses working in two medical intensive care units and one surgical intensive care unit of Asan Medical Center (Seoul, Korea) were observed at least twice about the adherence of PPE removal guidelines in October 2016. The general characteristics and knowledge on the adherence of the PPE removal guidelines were identified with self-reported questionnaires.
Results: The general characteristics of 43 subjects were 86.0% for female and 86.0% for 4-year bachelor graduates. 97.7% were staff nurses and the total hospital career was 3.56 ± 3.71 years. The aver- age daily need for PPE was 21.44 ± 14.11 per patient. The knowledge of PPE removal guidelines was 82.36 ± 10.32 points on a scale of 100 points. The observed adherence of the PPE removal guideline was 83.54 ± 9.95 points on a scale of 100 points. But 9.8% of the nurses correctly performed the entire removal instructions. The knowledge of the PPE removal guidelines was significantly higher in nurses with above the master's degree (p = .001) and nurses who was confident on the accuracy of the removal guideline (p < .001). There was a difference in the observed adherence of the PPE removal guidelines depending on the type of gloves (p = .001). The reason of not cor- rectly removing PPE was that they‘did not know the proper method’ (48.1%).
Conclusion: Knowledge and adherence scores for PPE removal guidelines were high for each item, but few nurses accurately per- formed the entire removal instructions, and confidence in correct re- moval instructions was low. The factors that influence the adherence on the PPE removal guidelines are not clearly identified and need further clarification.
Disclosure of Interest
None Declared
P112
Improvement of behaviors and practices for infection control in West Africa: observation of early trends on the success factors
Babacar Ndoye ICAN, Dakar, Senegal
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P112
Introduction:The gradual change in the behaviors and practices of health workers in infection prevention and control (IPC) is currently one of the main challenges faced by the first structured programs
being implemented in the African region. The author presents his ex- perience, based on the results of some projects to improve hand hy- giene and health care waste management in some West African hospitals.
Objectives:The aim is to identify some key success factors for easier implementation of the numerous current projects on IPC in the re- gion, with a situation of huge and diversified gaps.
Methods:Observational study on the results of improvement of per- formances obtained on two projects, carried out in three different countries:
- A project to improve hand hygiene performance in 21 Senegalese hospitals based on the multimodal strategy and the tools proposed by the WHO (using the hand hygiene self-assessment framework tool, and then the five components of the strategy)
- A project to improve the healthcare waste management perform- ance in 10 Sierra Leonean hospitals and 8 Liberian hospitals, based on a similar strategy: situational analysis (using a simplified rapid as- sessment tool), training and raising awareness of technical staffs and administrators, and providing equipment (autoclave for Treatment of infectious waste), followed by implementation and monitoring and evaluation with a supervisory grid to quantify the evolution of performances.
Results: - Senegal: the National Armed Forces Training Hospital re- corded the best performances
- Sierra Leone: the two hospitals managed by the Italian and Dutch cooperation performed best and were the only ones to regularly use the autoclaves supplied to treat infectious waste
- Liberia: the hospital managed with the Chinese cooperation sup- port, achieved the second best overall performance and was the only hospital to have regularly used the autoclave provided for the treat- ment of infectious waste
Conclusion:Hospitals not administered directly by health ministries but, either by another national institution such as the military or through international cooperation support, have consistently re- corded the greatest progress in changing behavior and practices. Resources and leadership will undoubtedly be determining success factors for the implementation of ICP projects in Africa.
Disclosure of Interest
None Declared
P113
Qualitative analysis of perceptions, attitude and behaviors of healthcare workers and researchers regarding an automated hand hygiene monitoring technology
Clément Tarantini
Social Sciences, Aix-Marseille Université-Inserm, MARSEILLE, France Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P113
Introduction:The infectious disease unit of North Hospital, Marseille, has set up automated monitoring of the hand hygiene of healthcare workers (HCWs) (1) in order to provide a better understanding of their behaviors.
Objectives: To assess HCWs perceptions and attitudes toward re- search and development of technological devices to improve hand hygiene practices in hospital ward.
Methods:In-depth interviews and ethnographic fieldwork.
Results:To the HCWs these technologies can introduce health risks and social risks due respectively to electromagnetic waves and principle of traceability on which these devices are based (2). They expressed that these devices strongly decontextualizes their practices from the realities of their daily work. HCWs also criticize scientific re- searches. They felt tensions and contradictions with the goals, the priorities and the values of team researchers (3). To conclude this study showed that the implementation of scientific researches in this ward emphasizes the hierarchical order and the power strug- gles within the department and disrupt the negotiated order in the ward (4).
Conclusion: Innovative technologies in the field of scientific re- search should be adapted to the routine practices of HCWs in the complex hospital environment and specific care constraint. Re- searchers have to take into account the social and the professional issues of HCWs.
References
(1) Boudjema S et al.. MediHandTrace (R): a tool for measuring and understanding hand hygiene adherence. Clin Microbiol Infect 2014 Jan;20(1):22-8
(2) Fisher, J & Monahan, T. Tracking the social dimensions of RFID systems in hospitals. Intern J of Med Inf 2008, (77): 176-183.
(3) Sutton E et al. Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people. BMJ Open 2016; 6:e010988.
(4) Strauss, A et al. Social organization of medical work. 1985, Chicago and London: The University Chicago Press.
Disclosure of Interest
None Declared
P114
The behaviour of health care workers on infection prevention and control practices and its impact on nosomial infections
Angeline Chiotcha
Quality Management, MINISTRY OF HEALTH, LILONGWE 3, Malawi Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P114
Introduction:One of the fundamental principles of patient safety in hospital settings is the reduction of cases of nosocomial infections. Infections acquired during hospitalization have been reported in lit- erature, what has not been given attention is how social and psycho- social behaviour of health workers contribute to these infections
Objectives:
· To determine how social bonding can lead to negative behaviour and its consequence on IPC practices
- To understand if effective infection prevention and control practices is behaviour-driven rather than mere lack of knowledge and awareness
Methods: Descriptive qualitative research design was deployed to uncover the health care workers behaviour in infection control and prevention phenomena using an in-depth interview guide. A purpos- ive sample of 12 Health Workers, with different levels of experience from Operating Theatres was interviewed. Interviews were recorded and transcribed verbatim. Thematic analysis was done to identify dominant themes that described behaviours in infection control practices.
Results: Respondents stated that they changed to inappropriate practices in order to see themselves as belonging to a group and they would bring behaviour to align with the group norms. Inconsist- encies in behaviour and attitudes were identified where some health workers influence others within their space to behave in a particular way. Even if some of the respondents have positive attitude towards Infection Control by doing what is right, their behaviour will still be weakened when others in the practice setting do not conform to standards of hygiene.
It was also discovered that individual behaviour depends on the en- vironment, punishment and rewards associated with engaging or not engaging in the desired IPC guidelines.
Conclusion: Results suggest how psychosocial factors influence HCWs behaviour thus compounding concerns about the risk of HCAI. Addressing psychosocial and motivation is an important step in effective infection prevention and prevention of HCAI.
Although the study took place in a small developing country, it is possible that the issues raised cuts across boundaries.
Disclosure of Interest
None Declared
P115
Knowledge, attitude & practices vis-a-vis needle stick injuries amongst nurses: a pilot study in a tertiary care hospital in India
Vipin Koushal1, NAVIN PANDEY1, Pranay Mahajan1, Yashpal Sharma2
1
Hospital Administration, Post Graduate Institute of Medical Education & Research, Chandigarh;2Deen Bandhu Chotu Ram Institute, Karnal, India
Correspondence:Vipin Koushal
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P115
Introduction:Needle stick injuries can be a major source for blood- borne diseases among the health care workers.
According to Centre for disease control, 600,000 to one million NSIs occur each year. More than 50% of these NSIs go unreported. Lack of SOPs by healthcare organizations further compound this problem.
Objectives:To assess incidence, awareness and perception regarding needle stick injuries amongst nurses of PGIMER.
Methods: Cross sectional KAP study on a sample of 164 Nurses working at PGIMER
Using Semi structured, self administered questionnaire.
Results:65% of nurses had correct knowledge of diseases spread by NSIs.
80% nurses were aware of procedures to be followed post NSI. 34.1% nurses practiced re-capping of needles. Only 50.6% nurses admitted to wearing gloves.
42.07% of nurses encountered NSI during their career.
84.05% nurses of those suffering NSIs enquired about the patient’s disease history.
39.1% nurses had NSIs during administrating injection, 8.6% nurses during manipulation of I.V. line, 20.2% nurses during recapping, 26% nurses during discarding needle, & 10.1% nurses during clean-up. 11.5% nurses suffered NSI in the palm, 92.7% nurses in fingers & 2.8% nurses in the arm. 58.18% nurses did not report Needle Stick Injuries.
14.4% of nurses were unaware of reporting procedure post NSI. 4.3% of nurses felt they might get into administrative trouble on reporting a Needle Stick Injury. 4.3% nurses felt it was not important to report a NSI.10.1% of nurses did not report considering the prick as minor.
Only 10% of those suffering NSI had taken Post Exposure Prophylaxis.
Only 7% of nurses suffering NSI completed the recommended PEP course.
59.4% nurses felt that they did not get adequate psychological sup- port from the hospital.
Conclusion:Incidence of NSIs in this study was 42%.
Only 72% nurses washed their hands with water & soap after NSI. PEP was not taken by 88.2% nurses.
All this indicate a lack of adequate awareness which can be achieved by rigorous Continuous Medical Education.
Hospital management has to devote resources to address this problem.
Training, training and training is the mantra.
Disclosure of Interest
None Declared
P116
Knowledge, attitudes and practices of the hospital staff towards the respect of the standard precautions of hygiene
Héla Ghali, Nabiha Bouafia, Asma Ammar, Sabrine Ben Abdallah, Mohamed Mahjoub, Asma Ben Cheikh, Olfa Ezzi, Radhia Helali, Wadia Bannour, Mansour Njah
Hospital Hygiene Department, Sousse, Tunisia
Correspondence:Mohamed Mahjoub
Introduction:Patient safety is receiving attention worldwide growing and is now being considered as a human rights issue. One important indicator of patient safety is the rate of nosocomial infections (NI) among hospital patients. However the prevention of NI needs a bet- ter knowledge of the risk factors, such as the application of standard precautions defined by the "Centers for Disease Control" (CDC).
Objectives:Our study aimed to evaluate the knowledge, attitudes and practices of nurses towards the respect for Standard Precautions of Hygiene (SPH) in a Tunisian teaching hospital.
Methods: It was a cross-sectional study conducted during two months (February and March 2016), in a hospital of the center-east of Tunisia, among nurses working in 13 services deemed to have a high risk of NI because of the workload and profile of patients hospi- talized in these units. We used for the collection of data, a self- administered questionnaire inspired of the Protocol of "The audit Standard Precautions" adopted by the Coordination Centers and the fight against the Nosocomial Infections of France. The statistical ana- lysis was performed using the SPSS software 18.
Results: The response rate was 88.6%. 61.3% said that they have already received training on SPH. 32.3% of nurses thought that they are well aware of the components of the SPH. The majority of re- spondents knew that these precautions are intended to protect pa- tients and caregivers. 78.1% of the paramedical personnel responded that the hygiene of the hands is the most effective measure to limit the transmission of infectious agent in a care institution and 93.5% felt that it is necessary to disinfect hands before and after contact with a patient. However, less than half believed that the hygiene of hands must be respected between two cares given for the same pa- tient. 68.4% made a flush of physiological serum in case of projection of blood or biological fluid on the mucous membranes. 69% of respondents washed their hands or used an antiseptic in case of an accident of exposure to blood.
Conclusion:Our study has shown that there are many shortcomings which require the implementation of certain measures such as awareness and training sessions.
Disclosure of Interest
None Declared
P117
Difficulties in using personal protective equipment: training experiences with the 2015 outbreak of Middle East respiratory syndrome in Korea
Jahyun Kang1, Eun Jin Kim2, Jeong Hwa Choi3, Hae Kyung Hong4,
Si-Hyeon Han5, In Soon Choi6, Jae Geum Ryu1, Jinwha Kim7, Jae Yeun Kim8, Eun Suk Park9
1
Seoul National University, College of Nursing;2Seoul National University Hospital;3Konkuk University Medical Center, Seoul;4Soonchunhyang
University Bucheon Hospital, Bucheon-si;5Dankook University Hospital, Cheonan-si;6Chung-Ang University Hospital;7Soonchunhyang University
Seoul Hospital, Seoul;8Konyang University Hospital, Daejeon-si;9Yonsei University Severance Hospital, Seoul, Korea, Republic Of
Correspondence:Jahyun Kang
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P117
Introduction:The inter- and intra-hospital outbreak of Middle East respiratory syndrome (MERS) in South Korea resulted in 38 deaths, 186 confirmed cases, and 16,693 quarantines from May to December 2015. As 39 healthcare personnel (HCP) were infected, HCP can be at risk of contracting infectious diseases.
Objectives:For HCP safety through the correct use of personal pro- tective equipment (PPE), this study aims to evaluate practical barriers to PPE use during- and post-MERS outbreak.
Methods: With Institutional Review Board approval, a focus group interview with infection control nurse leaders was conducted with consent and a brief survey on demographics and hospital character- istics. Participants’ narrative responses and interactive discussions
were recorded and categorized by theme. A fishbone diagram on summarized outcomes was reviewed by all participants and 2 board members of the Korean Association of Infection Control Nurses.
Results: From Seoul and Chungcheongnam-do, 7 leaders partici- pated. Their hospitals (1,122 average beds [706-1980]) had at least 3 probable MERS cases (range: 3-5,300; 0-82 confirmed) during the 2015 outbreak. Leaders reported PPE training for 50-4,095 HCP during- and post-MERS using PPE sets and fluorescent markers (6 of the 7). All reported difficulties in developing hospital-customized PPE protocols and trainings despite variations in PPE and inconsistent donning/doffing ordering in guidelines. Difficulties observed in PPE use were anxiety, unfamiliarity, confusion from unstandardized proto- cols, doubts about PPE quality and effectiveness, complexity in PPE combinations, and a lack of personnel and budget.
Conclusion:Evidence-based gold-standard PPE guidelines should be formulated to reduce the burdens at each hospital. Thereafter, re- peated training with standardized guidelines would increase HCP competencies in PPE use.
Disclosure of Interest
J. Kang Grant/Research support from: The Seoul National University Invitation Program for Distinguished Scholars, E. J. Kim: None Declared, J. H. Choi: None Declared, H. K. Hong: None Declared, S.-H.