A step-wise approach towards introduction of an alcohol based hand rub, and implementation of front line ownership- using a, rural, tertiary care hospital in central India as a modelReport as inadecuate




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BMC Health Services Research

, 15:182

Health systems and services in low and middle income settings

Abstract

BackgroundAppropriate hand hygiene is a gold standard to combat healthcare associated infections HAIs. The World Health Organization WHO has recommended alcohol based hand rub ABHR as the most effective tool to maintain hand hygiene. In resource poor settings commercially available ABHR is not -economically accessible-. The objectives of this study were to assess the acceptability of, and to build confidence for an in-house prepared based on WHO guidelines alcohol based hand rub among healthcare workers HCWs using a rural, tertiary care hospital in central India as an example.

MethodsA series of activities were developed and conducted based on the Precede-Proceed model, the Trans Theoretical model of behaviour change, Front line ownership and Social marketing. A modified WHO-ABHR formulation, the ‘test product’ and ‘WHO product evaluation form’ were used for self assessment of acceptability of the ‘test product’. Confidence building activities, as finger tip culture, visual portrayal method and handmade posters, were used in high-risk wards for HAIs, to build confidence for the ‘test product’ in removing transient flora from the hands. A locally developed feedback from was used to evaluate the impact of the activities conducted.

ResultsOverall 183 HCWs were enrolled for the assessment of the ‘test product’ 130- doctors and 53 nurses. Out of these 83% 108-130 doctors and 94% 50-53 nurses were satisfied with the ‘test product’. The confidence building activity was conducted with 116 participants 49 doctors. After single use of the ‘test product’, overall a significant reduction was observed for the CFUs on the blood agar plates 0.77 Log, p < 0.001. A complete reduction 100% in colony forming units on incubated blood agar plates was seen for 13% 15-116 participants. Eighty two percent 95-116 participants expressed their confidence in the ‘test product’.

ConclusionThe self reported acceptance level for the ‘test product’ was high. The use of finger tip culture coupled with the visual portrayal was perceived as a convincing and highly effective way to develop confidence in HCWs. Thus, is the foremost step towards successful introduction of ABHR and can be seen as a model for similar settings.

KeywordsHand hygiene In-house prepared alcohol based hand rub Confidence building Finger tip culture-visual portrayal Front line ownership Behaviour change Tertiary care hospital India AbbreviationsABHRAlcohol based hand rub

CFUColony forming unit

CONSCoagulase Negative Staphylococci

C. R. Gardi hospitalChandrikaben Rashmikant Gradi hospital

FLOFront line ownership

HAIHealthcare associated Infection

HCWHealth care worker

HHHand hygiene

HRHand rub

HWHand washing

IH-ABHRIn-house prepared alcohol based hand rub

ISOInternational organization for standardization

R. D. Gardi Medical CollegeRuxmaniben Deepchand Gardi Medical College

UVUltra violet

WHOWorld Health Organization

Megha Sharma and Rita Joshi contributed equally to this work.

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Author: Megha Sharma - Rita Joshi - Harshada Shah - Ragini Macaden - Cecilia Stålsby Lundborg

Source: https://link.springer.com/







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