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Influence of hand hygiene on IPC in Kenya
4th Nov 2014,
5th ICAN/ICAZ conference
Division of Global Disease Detection and Emergency Response
Center for Global Health
Dr. Linus Ndegwa, MPHE, HCS,SHEA Amb
Infection Control, Manager
Global Disease Detection-GDD
Centers for Disease Control and Prevention-Kenya
Introduction • Pathogens transmitted in hospitals responsible for
substantial morbidity and mortality in Kenya
• Infection control crucial to reducing hospital
transmission of existing and emerging diseases
• Challenges in Kenya:
- Lacks infrastructure
- Few resources
- No standardized training
• Hand hygiene (HH) is one of the most effective ways
of preventing healthcare associated
infections(HAIs).
Scientists estimate that up to 80% of all infections
are transmitted by our hands
Hand hygiene is the most effective ways to
prevent infections from occurring in Hospitals,
families and communities.
can use soap and water or waterless
hand rubs
HAND HYGIENE
Methods-1
Prospective monitoring
– A direct observation by a trained observer (K 0.63-0.76)
– Observation occurred during the day only
– No observations were done at night or weekends
– At least 8 opportunities per audit per ward per month was completed
– A trained observer checked whether a sample of the HCW in the study wards routinely performed HH according to the WHO guidelines
– Three hospitals were selected
Methods-2
Opportunities were defined as the points in time within the care of patient when HH should be performed
HH was defined successful if the healthcare worker (HCW ) performed HH as indicated by WHO five moments of hand hygiene (Hand wash / Hand rub)
Hand Hygiene Compliance Calculations
Method for calculating compliance:
Note: “Attempt w/o success” is lumped with “No Attempt”
when calculating compliance
# Total Opportunities Observed
(# Successful Attempts +
# Attempts w/o Success +
# No Attempts)
# of Successful Attempts
Methods: Hand Hygiene Audit tool
Methods: Hand Hygiene Audit Tool
Local production of HH
HH Label
60%
26%
21%
42%43%
49%
1.3%
2.1%
4.1%
9.0%
4.4%
3.5%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
0%
10%
20%
30%
40%
50%
60%
70%
2009 2010 2011 2012 2013 2014
HH
PE
RC
EN
TA
GE
YEARS
HH rates Vs Cases of HAI/100Adm Medical Wards
MedAll-HH Med-HAI
↑
ABHR
production↑
ABHR
production
HH rates Vs Cases of HAI/100Adm Paed Wards
0
20
40
60
80
100
120
140
160
180
0%
10%
20%
30%
40%
50%
60%
2009 2010 2011 2012 2013 2014
HA
I C
AS
ES
Paeds-HH Paeds-HAI
IPC in Kenya Shared the data with MoH and other stake
holders
MoH has set up a division of IPC with 4
departments: AMS, HCWM, HAI
surveillance, general IPC
National IPC policy and guidelines
developed
National IPC strategic plan 2014-2018,
launched in August
National Strategic priority 2014-18
Management, Leadership and Governance of IPC
services
– IPC coordination at all levels
– Strengthen leadership skills
Advocacy, Behavior Change and Communication
for IPC
Promotion /advocacy of IPC practices
National Strategic priority 2014-18
Health Worker Education and Capacity-Building
for IPC
– Training and curriculum
Patient and HCWs Safety in the Healthcare
Settings
– Risks of HAIs for patients, clients and public
National Strategic priority 2014-18
Availability of IPC Supplies, Equipment and
Infrastructure
– Improve IPC comodities and supplies
IPC Surveillance, Notification and Research
– Establish a surveillance and notification system for
HAIs and AMR
Monitoring and Evaluation for IPC Programs
– Strengthen routine monitoring and regular
evaluation of IPC programs
18
CONCLUSIONS Every effort need to be done to improve HH to
reduce HAI.
Clinicians whose compliant to HH practices is low
need to be more involved
Provision of HH supplies, education and behaviour
change is paramount to improving HH practices in
all health care facilities .
A few facilities now are locally producing ABHR
References1. Pittet D,Boyce J.Hand Hygiene and patient care: pursuing the Semmelweiss
legacy. The Lancet Infectious Diseases 2001:April:9-20
2. Centre for Disease Control and Prevention. “Guideline for Hand Hygiene in health
care settings: recommendations of the Healthcare Infection Control practices
Advisory Committee and the HICPAC/SHEA/APIA/IDSA Hand Hygiene Task
force”,
Morbidity and Mortality Weekly Report, 2002:51(No.RR-16)
3. Victorian Quality Council Hand Hygiene Project. “A practical model for
implementing hand hygiene in hospitals”. Austin Health Coordinating centre, First
edition 2004.
. History of infection Control and its Contributions to the Development and Success
of Brain Tumour Operations. Miller et al, 2005. Medscape article
5.Larsen EL.APIC Guideline Committee. APIC guideline for hand washing and hand
antisepsis in health care settings. Am J Infect control 1995:23:251-69
6. HHA, 5 Moments for Hand Hygiene, Advanced draft, version 4,2008
Acknowledgements
ICAN president: Prof. Shaheen
ICAN president: prof Val
Founder and president OASIS: Prof SolomKin
Kenyatta National Hospital
Mbagathi District Referral Hospital
New Nyanza Provincial Hospital
Ministry of Health – Kenya
CDC – Kenya
Div. Healthcare Quality Promotion
CDC – Atlanta
The findings and conclusions in this presentation/report are those of the
author and do not necessarily represent the views of the Centers for
Disease Control and Prevention
21
THE POWER TO PREVENT & CONTROL INFECTIONS IS IN OUR HANDS
Clean Hands
Save Lives
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