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|Title||Evaluation of Environmental Infection Control at Intensive Care Units in Gaza Governorates|
Background: Patient safety is one of the most important aspects in evaluating the quality of healthcare. However, healthcare associated infection is a major cause of morbidity and mortality in the critical care units. It is imperative for health care administrators to ensure implementation of the infection control program in healthcare facilities. This study aimed to evaluate the environmental infection control (EIC) measures in the general intensive care units in Gaza. Methodology: A three-months descriptive cross sectional study was done to evaluate the two main general ICUs in Gaza "Shifa Complex and European Gaza Hospital (EGH)". Walk around fitness checklist was developed to evaluate existing EIC measures. A total of 196 microbiological samples for air, water, and inanimate surfaces were surveyed. Both ambient air and inspiratory air from mechanical ventilator machines (MV) were sampled and cultured for bacterial and fungal count. Also, 20 water specimens were tested for bacterial presence. In addition, 120 swabbed cultures from surfaces and equipments were growing in a pre-enrichment media before incubation. Moreover, a total of 516 reading for temperature and relative humidity were gathered as the most important factors assist in bacterial multiplication. On the other hand, self-administered questionnaire was constructed to assess the health care providers (HCPs) knowledge and attitude toward EIC. Furthermore, HCPs practices were evaluated through an observation checklist. Results: The study revealed that 62% of the infection prevention and control (IPC) measures in Shifa ICU were unfit, in comparison with EGH ICU (53%). Also, the total bacterial count within indoor air in both ICUs ranged from (1170 to 1470) cfu/m3 (standard is less than 50 cfu/m3 ). Moreover, results revealed the presence of bacterial count that ranged from 73 to 90 cfu/m3 in the inspired air from MVs of the two units. However, fungal count was 830 cfu/m3 at Shifa MVs, while free at EGH MVs. The temperature average during day hours was significantly far than the standard in about 4oC, thus 79.73% of HCPs (P=0.000) saw that their provided care was affected negatively by unsatisfactory temperature. Relative humidity average was 59% in both units, at a high limit of the international standard. On the other hand, count of total and fecal coliform in all water sources were negative. Although, the study supported using of pre-enrichment media rather than direct culture, (96%) of all inanimate pre-enriched swabbed cultures in Shifa were positive, closely the same as EGH ICU (93%). Bacterial findings were: Pseudomonas 48% (n=15), E-coli 35% (n=11), and klebsilla 12% (n=4) in Shifa ICU. However, both Pseudomonas and E-coli were 29% (n=9) in EGH ICU, followed by klebsilla 19% (n=6) and then Staph arues 16.1% (n=5). Self-administered questionnaire results revealed that nearly 40% of the HCPs acquired influenza followed by chest infection more than twice in the same year. In addition, about 68% of their answers confirm knowledge deficit. Regarding HCPs attitude headed for EIC, 80.68% agreed to use hand rub instead of hand washing (P-value 0.001). Also 85% (P=0.000) considered the unavailability of aid nurses as a barrier against EIC measures application. HCPs practices were in about 50% compliance. However, nurses were more adherent than physicians in about 7.5%. Nearly 80% of HCPs hadn't experienced supervision of their practices regarding IPC implementation. Both hand hygiene practices and invasive procedures IPC measures were not applied in both ICUs with a percentage of 60%. Healthcare waste disposal remained the highest malpractices reported in the two ICUs. Conclusions: Periodic monitoring of ventilation system efficiency is needed to ensure optimal indoor air quality. Urgent interventions are required to improve methods of disinfecting the hospital environmental surfaces and equipments especially MVs. Educational courses, auditing and monitoring programs are advised to be more assertive. Addition of the influenza vaccine for all HCPs working in ICUs seems to be an obligatory need as the same as aid nurse and hand rub availability. Advanced healthcare waste and laundry systems necessitate to be developed.
|Publisher||الجامعة الإسلامية - غزة|
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