Environmental Infection Control in Intensive Care Units at Gaza Governorates: KAP Study

Abstract

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 intensive care units (ICUs). Undoubted, adhering to recommended infection prevention and control (IPC) practices could decrease most of these infections through IPC strategies. These strategies  have been shown to be both clinically effective and cost-effective. It is anticipated that all healthcare providers (HCPs) adhere to standards in their practices. The standards must be part of the knowledge, attitude, and practice KAP of all the health facilities to obtain the clients safety and protection. This study aimed to evaluate the KAP of the HCPs at general ICUs toward environmental infection control (EIC) in Gaza. Methodology: A three-months descriptive cross sectional study was done to evaluate the KAP of the two main general ICUs in Gaza "Shifa Complex and European Gaza Hospital (EGH)". Self-administered questionnaire was fulfilled by 73 HCPs to assess the knowledge and attitude toward EIC. Furthermore, 68 HCPs practices were evaluated through an observation checklist. Results: 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 58% of their answers confirm knowledge deficit. Regarding HCPs attitude headed for EIC, 80.68% agreed to use hand rub instead of  hand washing (P=0.001). 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. The study discovered insufficient level of performance for hand hygiene, and cleaning of environment, both hand hygiene practices and invasive procedures IPC measures were not applied in a percentage of 60%. Moreover, healthcare waste disposal and laundry system remained the highest malpractices reported. Conclusions: The study recommend educational courses and applying of monitoring and auditing programs depending on checklist system. Written Arabic protocols have to be available. Influenza vaccination for all ICUs HCPs should be mandatory to decrease earn rate of influenza. Advanced healthcare waste and laundry systems necessitate to be developed. The study recommend sufficient level of performance for hand hygiene, and cleaning of environment.

Key words: Infection, Knowledge, Attitude, Practices, environment, hand hygiene.