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