INTRODUCTION
Health-care-associated infection (HCAI), also referred to as “nosocomial” or “hospital” infection, is an infection occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission.[1
Infection prevention and control (IPC) is a practical, evidence-based approach which prevents patients and health workers from being harmed by avoidable infections. Effective IPC programs lead to more than a 30% reduction in HCAI rates. Improving hand hygiene practices may reduce pathogen transmission in health care by 50%. Some of the major aspects that can be applied for the infection control in the dialysis unit are hand hygiene, use of gloves, personal protection, environmental issues including equipment and consumables, cleaning of dialysis machines and chairs/beds, disinfection of HD machines, proper handling of needle and sharps, blood spill management, and proper preparation of access for cannulation. Training of manpower, provision of proper resources and equipment, and timely supervision and indulgence from seniors can save a great amount of such incidences.[2
With the above background, the present study was carried out in a dialysis unit of a tertiary health-care teaching institute with the aim to assess the impact of appropriate interventions on key hospital infection control (HIC) parameters subsequent to baseline assessment. The key HIC parameters taken in the study are hand hygiene practices, use of personal protective equipment (PPE), aseptic technique of vascular access and environmental cleaning, and Biomedical Waste Management (BMWM) practices. The objectives of the study were (1) to ascertain the current status of knowledge, attitude, and practice (KAP) vis-a-vis the hand hygiene practices, use of PPE, aseptic technique of vascular access and environmental cleaning, and BMWM practices in HD unit through appropriately designed tool; (2) to develop and execute appropriate intervention plan to augment compliance rate with respect to hand hygiene practices, use of PPE, aseptic technique of vascular access and environmental cleaning, and BMWM practices in HD unit, if needed; (3) to assess the impact of interventions (introduced as above) on key HIC parameters, through previously designed tool; and (4) to recommend, based on analysis of data thus obtained, an evidence-based HIC module on key HIC parameters for use in HD unit in an institutional setting.
METHODOLOGY
An interventional, longitudinal hospital-based study was conducted for the duration of 13 months from April 2018 to May 2019 in dialysis unit of SGPGIMS, Lucknow, India. The study samples were consisting of all the nursing staff (57) and dialysis technicians (23), posted at dialysis unit during the study duration. An evidence-based tool (questionnaire), in both English and Hindi languages, was designed to ascertain the current status of knowledge and attitude. Answers to every question were scored on a scale of 0, 1, 2, 3, and 4. The correct response was accorded maximum score, i.e. 4, and incorrect response with the lowest score was given 0. In between 0 and 4 scores, 1, 2, and 3 scores were given as per the decreasing order of the response to the question asked. To ascertain the current status of practices for all the objective elements among nursing staff and dialysis technicians, a structured observation checklist was drafted and evaluated by obtaining scoring criteria as score “0” for noncompliance, “5” for partial compliance, and “10” for full compliance. The adherence rate was calculated by using the formula: adherence rate = (actions performed/opportunity present) ×100.
The questionnaire was personally distributed and collected and observations were carried out by interviews and physical inspection as per predesigned checklist within the duration commencing from September 2018 to January 2019. To nullify the effect of shift to some extent on the outcome of the study, the tool was distributed during morning and evening shifts. The questionnaire was based on following key Hospital Infection Control Parameters and their objective elements: [Table 1 ].
Table 1: Key hospital infection control parameters
The deficit/s present in knowledge, attitude, and practice, as observed along the predesigned tool (structured observation checklist and questionnaire) that needs improvement, were identified and interventions were planned accordingly. The interventions were as follows:
Educational intervention: it was planned in the form of on-site capacity-building program (from February 2019 to March 2019) and an awareness workshop on hand hygiene practices
Displays: IEC (posters/handouts on hand hygiene and BMWM): Hand hygiene posters/handouts (as per WHO and CDC guidelines as appropriate) and BMWM posters/handouts (as per BMWM Rules 2016, amended up to 2019) were made available for display at appropriate locations in the dialysis unit
One hand rub at entrance of dialysis unit and at each dialysis station:
It was made necessary for everybody to perform hand hygiene prior to entering in dialysis unit and every bed to be provided with a hand rub, and staff/relatives were instructed for appropriate use of it
This intervention aided in reducing the burden of HCAIs and builds a safe environment for health-care providers, patients, and their relatives.
One month after the interventions, postevaluation was done through a previously designed tool. Data analysis was done by using Microsoft Excel and SPSS 23 IBM (International Business Machines Corporation), Amonk, New York, United States. Normality of data was tested and a variable was considered normal when standard deviation (SD) was <½ mean value. For normally distributed data of the study, Descriptive Statistics was presented in the form of mean ± 2 standard deviation. Paired Sample t-test was used to compare the mean score and Chi Square test was used to compare the Knowledge between pre and post-intervention. To compare the attitude and practice between preintervention and postintervention, paired sample t -test was used.
Inclusion criteria
All nursing staff and dialysis technicians of dialysis unit who consent to participate in the study were included in the study.
Exclusion criteria
Staff not willing to participate in the study
Staff on leave in dialysis unit during the study period were excluded from the study.
RESULTS
Demographic characteristics of the study population
The KAP survey questionnaire was distributed to 86 health-care personnel in dialysis unit. A total of 80 respondents completed the survey (response rate of 93.02%). Out of total 80 study subjects, 51.3% (41) were male while 48.8% (39) were female. Half of the study population 50% (40) fall under the age group of 30–44 years, followed by the age group of 18–29 years, 41.3% (33). Majority of the study subjects worked on a rotation basis 78 (97.5%), i.e. morning, evening, and night shifts, and only 2.5% (2) of study subjects were on general duty. Three-fourth of the study subjects 77.5% (62) were permanent employee. Majority (71.3%) of the study subjects belong to nursing category followed by technician category (28.8%). Most of the study participants, around 41.3% (33) had work experience of 3–7 years in their current specialty. 21.3% of total participants were having experience of more than 13 years, 20% were having 8–12 years, and rest 17.5% participants had 1–2 years of experience.
Comparison of pre- and postintervention knowledge level
Hand hygiene
Following intervention, there was a significant increase (statistically significant) in number of respondents providing correct answer about the hand hygiene knowledge questions. Preintervention, 48.8% of respondents knew the importance of hand hygiene that was increased by 25% after intervention (P = 0.000). Knowledge about the WHO-recommended seven steps of hand hygiene was 26.3% during preintervention and was 68.8% postintervention (% change = 42.5; P = 0.000). Knowledge about the WHO-recommended five moments of hand hygiene was enhanced by 22.5% (P = 0.004). About 16% rise in knowledge was seen about the various agents used for hand hygiene and the best agent prior to vascular access (P = 0.008% 0.011, respectively). Knowledge about duration of hand hygiene by using soap and water was a rise from 41.3% to 70% [P = 0.000, Table 2 ].
Table 2: Change in knowledge on key hospital infection control parameters following intervention
Use of personal protective equipment
Postintervention, awareness about the use of PPE was enhanced by 25% (P = 0.001). Knowledge about what comes under PPE was 37.5% prior to intervention and was 56.3% after intervention (% increase 18.8%: P =0.003). Knowledge about correct order of donning and doffing of PPE was increased by 28.7% and 22.5%, respectively [P = 0.000 and 0.001, Table 2 ].
Vascular access: Aseptic technique
Prior to intervention, with respect to aseptic technique of vascular access, only 30% of respondents had knowledge about optimum agent used for skin antisepsis, and after intervention, it was 55% (% increase 25%; P = 0.001). Although 65% knew that they were using 2% chlorhexidine solution as the first-line skin antisepsis agent during site preparation, it was also increased by 13.8% (P = 0.014), and awareness about key parts in hemodialysis which were not supposed to be touch with unsterile hands in order to prevent HCAI was increased from 55% to 70% [P = 0.017, Table 2 ].
Environmental cleaning and Biomedical Waste Management
After intervention, with respect to environmental cleaning and BMWM, about 12.5% and 7.5% rises in knowledge were seen regarding the importance of surface decontamination and cleaning of dialysis machine after every procedure, respectively. Knowledge of study participants regarding use of optimum agent to disinfect noncritical surfaces in dialysis unit was increased by 18.8% and knowledge of appropriate agent to clean blood contaminated surfaces was increased by 15%. Knowledge about infectious and noninfectious waste was just doubled, from 30% to 61.3% (P = 0.000). Knowledge about color-coded bins as per BMWM Rules 2016 and awareness about sharp waste containers were increased by 13.7% and 25%, respectively [Table 2 ].
Postintervention, the mean knowledge score about key HIC parameters was found to be increased from 8.54 ± 0.241 to 14.35 ± 0.293 (% increase 5.81%) out of a maximum possible of 20 and it was statistically significant [P = 0.000, Table 3 ].
Table 3: Comparison of pre- and postintervention mean knowledge score
Comparison of pre- and postintervention attitude level
Hand hygiene
On domain-wise evaluation, the mean scores were 4.61 ± 0.562, 4.63 ± 0.582, and 4.36 ± 0.889 for domains such as moment of hand hygiene, beneficence, and firm adherence regarding hand hygiene, respectively, prior to intervention. Following intervention, the mean scores were 4.69 ± 0.493, 4.76 ± 0.428, and 4.64 ± 0.621, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores [P < 0.005, Table 4 ].
Table 4: Change in attitude on key hospital infection control parameters following intervention
Use of personal protective equipment
On domain-wise evaluation, the mean scores were 4.49 ± 0.675, 4.40 ± 0.789, and 4.44 ± 0.793 for domains such as importance to use PPE, competency assessment of health-care worker (HCW) regarding the use of PPE, and correct sequence of donning and doffing of PPE, respectively, prior to intervention. Following intervention, the mean scores were 4.74 ± 0.443, 4.73 ± 0.449, and 4.66 ± 0.615, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores [P < 0.005, Table 4 ].
Vascular access: Aseptic technique
On domain-wise evaluation, the mean scores were 4.54 ± 0.779, 4.33 ± 0.823, and 4.40 ± 0.756 for domains such as single-use sterile needle and syringe for each vascular access, staff competency assessment, and adherence to aseptic technique of vascular access, respectively, prior to intervention. Following intervention, the mean scores were 4.73 ± 0.595, 4.64 ± 0.557, and 4.73 ± 0.503, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores [P < 0.005, Table 4 ].
Environmental cleaning and Biomedical Waste Management
On domain-wise evaluation, the mean scores were 4.48 ± 0.693, 4.10 ± 0.821, and 4.23 ± 1.055 for domains such as adequate cleaning and disinfection of dialysis machines and equipment between all patients, proper cleaning followed by disinfection of reusable dialyzer, and segregation at source of biomedical waste generated in dialysis unit, respectively, prior to intervention. Following intervention, the mean scores were 4.75 ± 0.563, 4.35 ± 0.553, and 4.59 ± 0.610, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores [P < 0.005, Table 4 ].
Prior to intervention, the mean scores for selected key HIC parameters were 20.49 ± 5.699, 48.75 ± 18.185, 63.25 ± 22.376, and 23.03 ± 10.036 for HIC parameters such as hand hygiene, use of PPE, aseptic technique of vascular access and environmental cleaning, and BMWM, respectively, prior to intervention. Following intervention, the mean scores were 22.98 ± 6.614, 52.81 ± 19.074, 68.00 ± 21.955, and 31.06 ± 13.400, respectively, for the corresponding HIC parameters [Table 5 ].
Table 5: Comparison of pre- and postintervention adherence rate for practice on key hospital infection control parameters
DISCUSSION
In the present study, the HIC parameters identified to assess the compliance rate were hand hygiene practices, use of PPE, vascular access: aseptic technique and environmental cleaning, and BMWM in dialysis unit of SGPGIMS.
Hand hygiene
Knowledge
The postintervention compliance rate of key HIC parameters had shown improvements as compared to baseline (preintervention) observations. Following intervention, there was a significant increase (statistically significant) in number of respondents providing correct answer about the hand hygiene knowledge questions. Preintervention, 48.8% of respondents knew the importance of hand hygiene that was increased by 25% after intervention (P = 0.000). Knowledge about WHO-recommended seven steps of hand hygiene was 26.3% during preintervention and was 68.8% postintervention (% change = 42.5; P = 0.000). Knowledge about the WHO-recommended five moments of hand hygiene was enhanced by 22.5% (P = 0.004). About 16% rise in knowledge was seen about the various agents used for hand hygiene and the best agent prior to vascular access (P = 0.008% 0.011 respectively). Knowledge about duration of hand hygiene by using soap and water was a rise from 41.3% to 70% (P = 0.000).
A KAP study on infection control parameters for nurses conducted by Abou El-Enein and El Mahdy in a university hospital in Alexandria, Egypt, showed a similar finding as in the present study that <½ of study population (47.1%) of the nurses knew that they had to wash their hands before and after caring for a patient and the remaining (52.9%) knew that they had to wash their hands after caring for a patient only.[3
Many other studies have investigated the reasons preventing health-care providers to comply with standard guidelines. In addition to the negative influence on the part of the professional serving as role models, some investigators highlight that the origin of the low compliance, especially regarding hand hygiene, lies in the academic training. In this study also, none of the nurses and technicians received training about infection control measures earlier. Hence, much work needs to be carried out to educate HCWs on the need for infection control and to ensure that adherence is also monitored.[4 , 5
Attitude
On domain-wise evaluation, the mean scores were 4.61 ± 0.562, 4.63 ± 0.582, and 4.36 ± 0.889 for domains such as moment of hand hygiene, beneficence, and firm adherence regarding hand hygiene, respectively, prior to intervention. Following intervention, the mean scores were 4.69 ± 0.493, 4.76 ± 0.428, and 4.64 ± 0.621, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores (P < 0.005).
In the above-quoted study,[4
Attitude toward hand hygiene significantly changed due to multimodal strategies of interventions, and the above study findings validate the findings of the present study with approximately similar results.
Use of personal protective equipment
Knowledge
Postintervention, awareness about the use of PPE was enhanced by 25% (P = 0.001). Knowledge about what comes under PPE was 37.5% prior to intervention and was 56.3% after intervention (% increase 18.8%: P =0.003). Knowledge about correct order of donning and doffing of PPE was increased by 28.7% and 22.5%, respectively (P = 0.000 and 0.001).
In this study, there was very little improvement in knowledge about PPE after intervention. This might be due to already skilled staff of dialysis unit and active participation of staff.
Attitude
On domain-wise evaluation, the mean scores were 4.49 ± 0.675, 4.40 ± 0.789, and 4.44 ± 0.793 for domains such as importance to use PPE, worker of PPE, and correct sequence of donning and doffing of PPE, respectively, prior to intervention. Following intervention, the mean scores were 4.74 ± 0.443, 4.73 ± 0.449, and 4.66 ± 0.615, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores (P < 0.005).
A study conducted by Shimokura et al . stated that most HCWs “strongly agreed” with doing what is needed to protect their patients (68%) and themselves (55%) from becoming infected with a blood-borne pathogen. Forty-six percent of respondents “strongly agreed” that they are at risk of becoming infected with hepatitis C virus (HCV) by working in hemodialysis. In contrast, only 35% of respondents “strongly agreed” that HCV can be spread from patient to patient in the hemodialysis facility. This finding validates the finding of the present study.[6
Vascular access: Aseptic technique
Knowledge
Prior to intervention, with respect to aseptic technique of vascular access, only 30% of respondents had knowledge about optimum agent used for skin antisepsis, and after intervention, it was 55% (% increase 25%; P = 0.001). Although 65% knew that they were using 2% chlorhexidine solution as the first-line skin antisepsis agent during site preparation, it was also increased by 13.8% (P = 0.014) and awareness about key parts in hemodialysis which were not supposed to be touch with unsterile hands in order to prevent HCAI was increased from 55% to 70% (P = 0.017).
A research conducted by Ntlhokoe in Johannesburg, 2016, showed a similar result as in the present study that a significant rate of vascular access infections in patients by new or inexperienced dialysis staff. This might be due to nurses having insufficiently knowledge in accessing the patient's circulation and may not follow the correct arteriovenous access techniques, or apply the infection control procedures, or adhere to the standards in sterile catheter care.[7
Attitude
On domain-wise evaluation, the mean scores were 4.54 ± 0.779, 4.33 ± 0.823, and 4.40 ± 0.756 for domains such as single-use sterile needle and syringe for each vascular access, staff competency assessment, and adherence to aseptic technique of vascular access, respectively, prior to intervention. Following intervention, the mean scores were 4.73 ± 0.595, 4.64 ± 0.557, and 4.73 ± 0.503, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores (P < 0.005).
A study conducted by Karkar et al . in Saudi Arabia also has the same recommendation regarding aseptic technique of vascular access that education and training in IPC should be provided to all HCWs upon hire, and should be repeated regularly (at least on a yearly basis). Basic principles and practices for preventing the spread of infections should be covered and staff competencies should be assessed and documented upon orientation to the facility, and this should be repeated as appropriate for the specific staff and position. The patient (s) and/or caregiver (s) should also be educated on the care of new access and whenever there is a change in access type, and this should be repeated at least every year.[8
Environmental cleaning and Biomedical Waste Management
Knowledge
After intervention, with respect to environmental cleaning and BMWM, about 12.5% and 7.5% rises in knowledge were seen regarding the importance of surface decontamination and cleaning of dialysis machine after every procedure, respectively. Knowledge regarding optimum agent used to disinfect noncritical surfaces in dialysis unit and agent used if surfaces were contaminated with blood was increased by 18.8% and 15%, respectively. Knowledge about infectious and noninfectious waste was just doubled, from 30% to 61.3% (P = 0.000). Knowledge about color-coded bins as per BMWM Rules 2016 and awareness about sharp waste containers were increased by 13.7% and 25%, respectively.
The above-quoted study also has the same recommendation regarding environmental cleaning as the present study to clean and disinfect the external surfaces of the HD machine after each dialysis session. A low-level disinfectant or any EPA-registered disinfectant solution labeled for use in a health-care setting is recommended to be used for noncritical items (including HD machines), if visible blood spills or other infectious materials are present on the external surface of an HD machine, it should be cleaned separately (not to spread) before applying the disinfectant solution. In such cases, it is recommended to use an intermediate-level disinfectant or tuberculocidal agent (with specific label claims for hepatitis B virus [HBV] and HIV) or a 1:100 dilution of a hypochlorite solution (500–600 ppm free chlorine).[8
Attitude
On domain-wise evaluation, the mean scores were 4.48 ± 0.693, 4.10 ± 0.821, and 4.23 ± 1.055 for domains such as adequate cleaning and disinfection of dialysis machines and equipment between all patients, proper cleaning followed by disinfection of reusable dialyzer, and segregation at source of biomedical waste generated in dialysis unit, respectively, prior to intervention. Following intervention, the mean scores were 4.75 ± 0.563, 4.35 ± 0.553, and 4.59 ± 0.610, respectively, for the corresponding domains. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores (P < 0.005).
During the intervention phase, multimodal strategies were developed and applied to augment the compliance of HIC practice parameters among different groups of employees wherein in-service training sessions, workshops, display of posters, distribution of handouts, and on-site training were given.
Postintervention, the mean knowledge score about key HIC parameters was found to be increased from 8.54 ± 0.241 to 14.35 ± 0.293 (% increase 5.81%) out of a maximum possible of 20 and it was statistically significant (P = 0.000).
A similar study conducted by Al Qahtani and Almetrek in 2015 in Abha City, Saudi Arabia, stated that the overall mean percentage score on the knowledge scale was 60.2 ± 17.5 with a minimum of 22.7 and a maximum of 86.4.[9
In the present study, the mean knowledge was very less (8.54%) preintervention that was increased significantly postintervention (14.35%). It reflects that IPC practices can be improved by regular training and continuous surveillance.
Pre- and postintervention: compliance rate of practice of study subjects with respect to key hospital infection control parameters
While education and knowledge are obviously important, studies have shown that education and knowledge improvement, by them, does not always translate to improved compliance. However, in this study, the postintervention compliance was improved due to multimodal approach of training which translates to improved compliance.
Compliance with all the parameters was found statistically significant in repeated observation (pre- and postintervention). Prior to intervention, the mean scores were 20.49 ± 5.699, 48.75 ± 18.185, 63.25 ± 22.376, and 23.03 ± 10.036 for selected key HIC parameters such as hand hygiene, use of PPE, aseptic technique of vascular access and environmental cleaning, and BMWM, respectively, prior to intervention. Following intervention, the mean scores were 22.98 ± 6.614, 52.81 ± 19.074, 68.00 ± 21.955, and 31.06 ± 13.400, respectively, for the corresponding HIC parameters.
A similar study conducted by Rosetti and Tronchin stated that hand hygiene by health professionals in dialysis unit presented one of the worst rates. The study suggested that the component related to hand hygiene deserves more deep analysis, especially on behavioral dimension, of both professionals and users.[10
Another study conducted by Borah et al ., in 2017, in a tertiary care hospital of NEIGRIHMS, Shillong, similarly reported that the overall compliance of hand hygiene was 28.57%. The present study has the similar results. It may be due to inaccessibility of washbasin in patient care area.[11
The extent of HCW in the use of PPE was unsatisfactory in this study as the compliance rate was only 52% postintervention. The health-care facility must ensure the availability of PPE and its proper use also.
The review of literature conducted by Bublitz has shown that renal dialysis nurses are at considerable risk of per-mucosal (splash) contamination with increased likelihood of acquisition of major communicable diseases including HBV, HCV, and HIV. Bublitz emphasized that the availability of facial protective equipment and their suitability to HCWs is of significant importance for adherence to their use.[12
In the present study, more than half of the respondents (68%) practiced aseptic technique of vascular access. The same findings reported the above-quoted study where the compliance rate was 96.33%. This was due to experienced staff in that dialysis unit.
Another study conducted by Elshatby Moursy and Sharaf in Egypt reveals that concerning care of vascular access site for prevention of infection, the present study indicated that the majority of the studied nurses in both shifts did not use to clean access arm for a minute with soap and water or antiseptic soap and placing access limb on a sterile drape or barrier was done inappropriately. In this regard, the National Kidney Foundation (2011) emphasized that the nurse should wash the access site with soap and water and then place the access limb on a sterile drape before cannulation to decrease the invasion of the microflora into the bloodstream.[13
CONCLUSIONS
HCAIs are considered frequent threats to the safety of patients on dialysis setting. Hemodialysis patients are vulnerable to severe infections for many reasons in dialysis setting including the failure to use proper hand hygiene, contamination of the instrument, or improper disinfection. This study showed that there are gaps in standard performance of nurses in dialysis unit that warrant the control of the spread of infections between patients and HCWs. Training in infection control independently predicted better performance, especially among those who received recent training. On job training in infection control should be frequent and emphasize shaping nurses' attitudes in addition to the delivery of sound knowledge and standard practice.
Hospital administrators should strive to create an organizational atmosphere in which adherence to recommended HIC practices is considered an integral part of providing high-quality care. For such an approach to be successful, hospitals must provide visible support and sufficient resources in the form of continuous education and training programs. These programs should be innovative, educational, and motivational and tailored to specific health-care personnel. The strategies should be designed to suit the specific needs and the expected outcome for that particular category of HCWs.
This study showed that there were different levels of KAP of HIC among various HCWs. It also showed the strengths and weakness of each category of HCWs that will be helpful in conducting focused training programs to address the weak areas. Thus, this study has attempted to highlight the issues that are to be addressed with regard to IPC policies. This will also be helpful in better utilization of resources in organizing training programs and workshops.
Regular educational and training programs on HIC, standard and transmission-based precautions, and ward-based teaching programs on various care bundles must be included in in-house training. Such training includes the execution of educational and induction programs that are designed to overcome any shortcomings in the KAP of infection control by HCWs. An institutional culture that focuses on infection control practices will reduce the incidence of hospital-acquired infections.
Evidence-based international guidelines are of great value and are instrumental in helping reduce HCAIs. The cornerstone toward risk reduction is to be aware and abreast with the latest guidelines and be keen in implementing them reliably and consistently, as well as being conscientious and alert/active in engaging in quality improvement projects. The decision to follow any guideline statement must be made individually, by each HD unit at different locations with varying conditions, according to the incidence and prevalence of any type of infection. However, patients' safety and well-being deserve top priority in whatever decision is to be made.
Recommendations
The discussion and the forthcoming conclusions presented in the previous section warrant initiation of active surveillance with regard to hospital IPC. Keeping in view the observations and findings made during the study, certain recommendations are offered:
Organized surveillance and control activities, integrated education and training program, employee and patient/family education along with a protocol for standard precaution, appropriate use of PPE, aseptic technique of vascular access, and BMWM at source of its generation and other infection controls should be used in the unit, e.g. wall charts and handouts. The infection control committee should develop and update annually all relevant protocols as new information becomes available on the best practice. There should be availability of all facilities and equipment that are required for infection prevention in dialysis unit.
All staff along with patients must be encouraged to use alcohol-based hand rub (ABHR), especially while connection and disconnection of HD machine. Avoid touching of dialysis machine with ungloved hand/without hand hygiene when it gives alarms during HD procedure. If it is very urgent, use ABHR before and after touching the machine. Correct protocol for disposal of sharps in their area of work. Advice HCWs to avoid using their hand to break needles and ampoules. Instructions on all necessary control measures in the event of an outbreak or other infection control emergencies. One infection control practitioner for every high-dependency unit of institute like dialysis unit can be employed to monitor the infection rate periodically. Targeted solution tool method for hand hygiene can be applied for appropriate resolution to noncompliance and its sustenance.
It is recommended that the infection control nurse capture accurate data related to infection control on a database and that the data be updated to monitor the compliance of HCWs to reporting, treatment, and follow-up testing. Having a good tracking system in place could provide baseline information for future research endeavors. The infection control team should be responsible for the implementation of infection control guidelines, policies, and procedures by all health-care personnel in the health-care setting.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
