الفهرس 
Title pageOnly 14 pages are availabe for public view
Abstract
Healthcare- associated infections (HCAI) have a great risk impact onmorbidity, length of hospital stay and treatment.
HH is an effective simple way for reducing HCAI and cross transmission of pathogens in the health care facilities. The Center for Disease Control and Prevention (CDC) classifies that nearly 1.7 million hospitalized patients every year gain HCAIs while being cured for other health matter and that more than 98,000 patients die because of them.
Hemodialysis (HD) units symbolize a hotspot of HCAIs due to patient characteristics. The use of invasive devices (i.e. the perforations of AV fistula or the connections of central venous dialysis catheters) is one of the greatest vital risk factors for obtaining HCAI.
The environment in HD units is mainly liable to contamination with blood-borne pathogens such as HBV, HCV and HIV, and other infectious means so mixture of the cleaning and disinfection procedures is aimed to eliminate and kill harmful microorganisms on surfaces.
from this point of view, the aim of the present study is to observe and compare the performance of hemodialysis health care workers before and after the application of proper hand hygiene and environmental cleaning education according to the latest published guidelines of center for disease control and prevention.
The study was observational and interventional one as we observed the effect of hand hygiene and environmental cleaning on preventing infection in hemodialysis unit through observational checklist, hand prints and environmental swabs to determine the amplitude of the problem to apply preventive strategies to reduce the rate of infection in the hemodialysis unit.
The study was conducted in the hemodialysis unit of MRI for a period of 9 months started from 1/7/2018 to 31/3/2019 and was divided into 3 phases each one carried out in 3 months as follows:
- Phase 1 pre interventional period started from 1/7/2018 to 30/9/2018.
- Phase 2 Interventional or (education) period started from 1/102018 to 31/12/2018.
- Phase 3 post interventional period started from 1/1/2019 to 31/3/2019.
The results of the present study revealed that:
1- The overall compliance rate of hand hygiene (for the 5 moments) increased from 27.99% in pre interventional phase to 63.77% in post interventional phase through all categories of health care workers (nurses, doctors, and housekeepers).
2- The highest compliance rate of hand hygiene was among nurses 30.36% in pre interventional phase and reached 65.64% in post interventional phase, followed by doctors from 19.54% to 61.94% then housekeepers from 15.37% to 55.69%.
3- At Pre interventional phasethe nurses compliance rate to moment 3 was the highest (39.05%),followed bymoments 2 and 4 ( 33.53and 33.02%), then moment 1 was (31.62%) and the lowest compliance rate was to moment 5 (25.90%).while in post interventional phase (phase III )the highest compliance rate was shifted tomoment 2 (73.15%)., followed by moment 3 (68.48%), moment 5 (71.38%), moment 4 (65.08%), and the lowest wasmoment 1 (60.35%).
4- Regarding the doctors only moments 1and 4 were applicable. The results showed that compliance rate increased from 13.05% in pre interventional phase to 53.86% in post interventional phase for (moment 1) and from 26.04% to 70.03% for (moment 4).
5- Regarding the housekeepers only moments 3and 5 were applicable. The results showed that the compliance rate was increased from 16.49% to 53.15% for moment 3 and from 14.41% to 57.76% for moment 5 during pre and post-interventional phases respectively.
6- Hand prints from the 38 HCWs showed that 26 and 13 of the HCWs had heavy growth of Staphylococcus spp. and Bacillus spp. respectively in the pre-interventional phase compared to zero HCWs in the post-interventional phase. Moderate growth of both bacteria was found in 11 and 9 of HCWs hands in pre-interventional phase compared to 3 and 1 Staphylococcus spp. and Bacillus spp. respectively in post-interventional, While mild growth of both bacteria spp. was found in the hands ofonly 2 and 1 HCWs in pre-interventional phase compared to 19 and 5 in post-interventional phase. Finally during the pre-interventional phase none of the hands of HCWs showed no growth of Staphylococcus spp. While in the post-interventional phase no growth of both Staphylococcus Spp. and Bacillus Spp. was found in 14 and 32 of the 38 HCWs hands.
7- The results of environmental cleaning observational checklist included the high touch and low touch surfaces at the hemodialysis unit showed that there was an improvement in the total percentage of adherence to cleaning from 50% in the first observational phase to 95% in post interventional phase.
8- At the first observational phase, the lowest percentage of cleaned surfaces was the light switches, door knobs, water faucet and chairs 0% followed by bed side rails 6.3% then telephones 12.5% and then by sinks 50% while the highest percentage was the dialysis machines 65%. But at the post interventional phase most of the high and low touch surfaces as (beds, bedside rails, dialysis ) cleanliness percentage were 100%, followed by 81.3% for chairs, then 43.8% for BR light switch, and the lowest was 37.5% for the light switch of the unit.
9- The environmental swabs cultures in pre interventional phaseshowed that, 60% of sampled areas (dialysis machines-beds-nursing stations- emergency cupboard) had heavy growth of Staphylococcus spp. and Bacillus spp. compared in the post-interventional phase (through five visits).to 50% of these sampled areas showed mild growth, while 32% of them showed no growth of both bacteria in the post-interventional phase through five visits.