A study found that healthcare workers at Jigme Dorji Wangchuck National (JDWNRH) had only moderate-level knowledge about hand hygiene.

The observational cross-sectional study carried out by Zimba Letho, the hospital’s clinical nurse, found that about 24 percent of the healthcare workers had high-level hand hygiene knowledge. Those with low level of knowledge constituted about 8.0 percent.

The study was carried out to explore the healthcare workers’ level of knowledge about hand hygiene, to examine the association between demographic characteristics and the level of hand hygiene knowledge and also to observe hand hygiene and determine hand hygiene compliance among health workers at JDWNRH.

Zimba Letho said that hand hygiene was of great significance in the modern era. “It is a proven practice that helps to prevent healthcare-associated infections (HCAI) or hospital-acquired infections.”

It was found that 82.3 percent of the respondents used liquid soap and alcohol-based hand rub available in their workplace, 17.7 percent reported that such sanitizers were not available at their workplace.

The study found that hand hygiene compliance was “very” poor in all the wards/units.

Of the 16 departments from where the data was collected in April last year, the highest number of respondent was from critical care (12.6 percent), followed by gynaecology and obstetrics (9.2 percent) and medical (6.5 percent) departments. Respondent from psychiatric department was mere 2.7 percent.

Majority of the respondents were nurses, technicians and doctors, followed by support staff.

The study found that nurses, healthcare workers in critical care units with master’s degree and higher having 10 to 15 years of experience and those who did not have any formal training on hand hygiene had higher mean scores of knowledge about hand hygiene.

Observation of 380 healthcare workers with1,102 hand hygiene opportunities yielded overall hand hygiene compliance rate of just 33.4 percent in JDWNRH. Only 26.3 percent of healthcare workers maintained hand hygiene before patient contact.

In terms of education, 36.3 percent of the respondents had diploma. About 27.8 percent have bachelor’s degree and 23.2 percent certificate. Only 22 respondents had master’s degree or higher level of education (3.9 percent).

The average length of working experience of the healthcare workers was 6.59 years. About 65 percent had zero to five years of working experience, and 6.2 percent more than 20 years of experience.

Almost 60 percent of the respondents had not received any formal training on hand hygiene in the last three years.

Zimba Letho said that training and education along with monitoring and evaluation were needed to improve hand hygiene compliance among the healthcare workers in the hospital. “Poor hand hygiene compliance of healthcare workers increases the risk of HCAIs and have impact on patients.”

According to WHO, in developing countries, the risk of HCAI is two to 20 times higher than in developed countries and the proportion of patients affected by HCAI can exceed 25 percent. In intensive care units, HCAI affects about 30 percent of patients and attributable mortality could reach 44 percent.

According to annual point prevalence surveillance (PPS) carried out at the JDWNRH in September 2016, overall hospital-acquired infection rate was 9.2 percent. Surgical site infection was the highest, followed by catheter-associated urinary tract infection and sepsis.

Zimba Letho said that HCAI was recognised as one of the major challenges in the healthcare system. “Health care workers are professionally and ethically accountable for the care and safety of their patients and should adopt effective hand hygiene practices.”

He said that any healthcare worker, caregiver or person involved in patient care should be concerned about hand hygiene. “We must perform hand hygiene to protect the patients against harmful germs carried on our hands.”

The study recommends a dedicated infection prevention and control unit with trained professionals urgently.

He said that continuous strict monitoring and supervision of the infection control practices should be put in place at the hospital and training on hand hygiene or washing on regular basis given to all health workers.

Regular microbial surveillance of the staff hands and more research on infection control practices in the hospital were some of the other recommendations.

Zimba Letho said that regular international collaboration and exposure were important for Infection Prevention and Control Unit staff to keep themselves abreast of the latest know-how.

“The study results can be used as baseline data to enhance knowledge about hand hygiene,” he said.

Dechen Tshomo