Hand Hygiene Practices and Microbial Investigation of Hand Contact Swab among Physiotherapists in an Ebola Endemic Region: Implications for Public Health

Abstract

Background Hand hygiene practices (HHP), as a critical component of infection prevention/control, were investigated among physiotherapists in an Ebola endemic region. Method A standardized instrument was administered to 44 randomly selected physiotherapists (23 males and 21 females), from three tertiary hospitals in Enugu, Nigeria. Fifteen participants (aged 22–59 years) participated in focus group discussions (FGDs) and comprised 19 participants in a subsequent laboratory study. After treatment, the palms/fingers of physiotherapists were swabbed and cultured, then incubated aerobically overnight at 37°C, and examined for microbial growths. An antibiogram of the bacterial isolates was obtained. Results The majority (34/77.3%) of physiotherapists were aware of the HHP protocol, yet only 15/44.1% rated self-compliance at 71–100%. FGDs identified forgetfulness/inadequate HHP materials/infrastructure as the major barriers to HHP. Staphylococcus aureus were the most prevalent organisms, prior to (8/53.33%) and after (4/26.67%) HPP, while Pseudomonas spp. were acquired thereafter. E. coli were the most antibiotic resistant microbes but were completely removed after HHP. Ciprofloxacin and streptomycin were the most effective antibiotics. Conclusion Poor implementation of HPP was observed due to inadequate materials/infrastructure/poor behavioral orientation. Possibly, some HPP materials were contaminated; hence, new microbes were acquired. Since HPP removed the most antibiotic resistant microbes, it might be more effective in infection control than antibiotic medication.

Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review

“…Nine studies [21][22][23][24][25][26][27][28][29] used questionnaires only while four conducted observational studies on HH practices [30][31][32][33] . The remaining fourteen studies employed mixed methods; of these studies, six 20,[34][35][36][37][38] are interventional studies which used quasi-experimental study design, three [39][40][41] combined observation with questionnaires, three [42][43][44] employed both observation and interviews while the remaining two studies conducted focus group discussions which they combined with questionnaires and observations respectively 45,46 .…”

“…Thirteen studies were conducted in Nigeria 21,[23][24][25][26][27][28][29][30]32,38,41,45 , four in Ghana 22,31,33,44 , two in Uganda 35,43 , two in Ethiopia 37,39 , two in Rwanda 20,42 and one each from Mali 34 , Eritrea 46 , Malawi 40 and South Africa 36 .…”

“…Three studies 29,40,41 employed just doctors while one study included only nurses 26 . One study had dentists and dental students 27 , one had medical students 28 , one study involved physiotherapists 45 and the final study included patients alongside HCWs 46 .…”

Impact of Infection Control Training Program in Improving the Quality of Healthcare

“…The healthcare facilities with the higher number of staff trained in infection prevention and control had fewer instances of HAIs as compared to institutions not having IPC trained personnel. Healthcare facilities with one and two IPC trained individual were four and ten times, respectively likely to have an IPC score above the median as compared to those with no IPC trained staff [16]. Quality assurance department can play an important role in implementing IPC training to the medical staff.…”

“…Early evidence indicates that a strict compliance with the hand hygiene regimen can prevent more than half of the HAIs incidence. A simple hand hygiene compliance can reduce half of over 6 million cases of hospital-acquired infections globally every year which in turn can prevent large number of adverse clinical outcomes, and morbidity and mortality among patient and healthcare practitioners [16]. Alarmingly, hand hygiene compliance is often low and overlooked warranting its promotion in every healthcare institution.…”