الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Patients receiving HD continue to experience an unacceptably high frequency of severe infections. A failure to follow recommended infection control guidelines, such as hand hygiene and environmental cleaning, has been linked to gaining infections. Acquisition of infections in HD facilities is frequently the result of suboptimal infection control practices, so 100% adherence to recommended environmental infection control guidelines is essential to prevent infection in this high-risk population.
Nurses in particular should go through training on safe practices and precautions to prevent infection, they must be knowledgeable and skilled in caring for patients. As a result, update knowledge and nursing competence are vital in environmental infection control practices.
In Egypt, HD centers are found in governmental, military, and university hospitals as well as in the private sector
The current study aimed at examining the infection control regulations and knowledge and practices of nurses at the hemodialysis unit at the main insurance hospital in Alexandria to assess their competency with the guidelines of cleaning and disinfection.
A cross-sectional study to assess the environmental cleaning and disinfection processes at the dialysis unit of the main insurance hospital.
The required information was collected by two methods: A pre-designed pre-coded interviewing questionnaire was checked for validity and reliability to collect data from nurses and workers to assess: Knowledge (scoring details (yes, no, don’t know)). Attitude (scoring details (strongly agree, agree, uncertain, disagree, strongly disagree)). Practice (scoring details (do, don’t do)). Also, socio-demographic data of the health workers including (age, sex, education level, marital status, and years of experience), questions about the importance of cleaning and disinfection surfaces and medical equipment, the role of cleaning and disinfection in reducing HAI, importance, and ways of hand washing and how to deal with blood spills. They were asked also about the frequency and schedules of cleaning, types of disinfectant used, their concentration, materials, and equipment used (including cleaning cloths, dust mops, and disinfectants).
The observational checklist, on the other hand, contains observations on important aspects of the basic precautions in the hemodialysis unit. Record practical activities performed by the nurses and workers, including general precautions during care of HD patients, which include (hand washing, wearing PPE, and removal of gloves properly) during two different shifts. Observe the status of the cleaning processes of the indoor environment, methods and frequency of cleaning, tools used in cleaning and disinfection, and ways of cleaning. Observe the specific precaution including insertion and care of a vascular catheter, initiation of the dialysis session, care of the exit site of a vascular catheter, and steps of skin cleansing of the vascular catheter. Environmental swabbing samples were obtained from different sites in the unit to measure the bacteriological load.
Twenty nurses were recruited for this study. Their mean age was 39.85 ± 10.8 years, ranging from 25 years to 50 years, while many of them (60%) were in middle age (26-45 years). Concerning their marital status, 65% of them were married. Nine nurses (45%) graduated from nursing high school, six (30%) had Bachelor’s degrees in nursing and five (25%) had health technician diplomas.
Regarding their years of experience at the dialysis unit, half of the sample, 50%, had less than or equal to 5 years of experience, while just only one nurse (5%) had the maximum experience of 33 years at the dialysis unit. The median years of experience in this studied group were 6.5 years, ranging from (1-33 years). Regarding causes of environmental pollution and the spread of infection in healthcare facilities, about 80 % answered the correct answers which are (weak immunity of the patients, patients may have infectious disease while coming, facing some surgical procedures inside the healthcare unit, insufficient healthcare workers, malpractice of the healthcare workers and companions of the patients, shortage of equipment’s and human resources, and about the disease could be transmitted through infectious environment, nearly 20 % answered fully correct answers which are blood-borne microbial infection, entry site infection. While 90% and 95 % correctly answered the instructions for reprocessing tools and machines and cleanliness of the environment in the dialysis units; respectively.
On the other hand, nurses’ knowledge about factors that impede the application of standard precautions to maintain the health of the environment in dialysis units was varying between 35% and 100% complete correct answers. By asking them about their role to maintain a healthy environment and prevent the spread of infection, all nurses answered the correct answers, thus they know their role correctly. Concerning nurses’ knowledge about hospital waste and its safe disposal, all of them (100%) reported that this type of hospital waste is contagious waste and agreed that cleaning must be applied to the containers in which the bags are placed. While 85% informed that, there is no necessity to dispose of bags designed for waste when it reaches 1/3 of its size. On the contrary, 50% only reported the possibility of the dialysis machine transmitting disease.
The healthcare workers in the morning shift and in the evening shift performed hand washing before donning gloves; before the dialysis session but they didn’t wash their hands after removing gloves after finishing the dialysis session. As regards hand washing technique before donning gloves, results showed that in the morning shift, healthcare workers ’ fingernails were clean and short, jewelry was not worn and their hands were rubbed. Additionally, from the swabs taken from the nurse’s counter, the minimum count from the nurse’s counter swabs before and after cleaning were 11, 7 CFU/100cm2and the maximum counts were 18, 10CFU/100cm2; respectively. Also, it showed that the bacterial count is high on the floors, as it increased after cleaning and reached 95CFU/100cm2. Results also showed the lack of cleaners as they worked under a cleaning company in addition to their wrong manners in cleaning. Also, it showed an increase in the doorknob bacterial count as it reached 85 CFU/100cm2 before cleaning and 90 CFU/100cm2. As mentioned also, there was a marked reduction in the bacterial count of beds and a mild reduction in the machines after cleaning.
5.2. Conclusion
People undergoing hemodialysis are more susceptible to infections, Due to their weakened immune systems and increased risk of environmental infection exposure. Each dialysis unit should adopt and adhere to basic infection control and prevention procedures in order to safeguard patients, staff, and visitors from possible infections.
According to this study’s results, we have concluded the following:
1. There were specified cleaning rules installed in the hospital yet, with a low degree of commitment.
2. Hand washing, as well as gloves wearing during dealing with blood-borne wastes, were not used appropriately during the night and morning shifts except during the formal inspections.
3. Most of the studied nurses had good knowledge and positive attitude towards environmental infection control regulations but they were with fair practice regarding applying it.
4. There was a significant relationship between nursing attitude and years of experience
5. The study results indicate limited training for the temporal cleaning personnel as detected by our observation about the cleaning practices.
6. There was a gap between the actual performance of the cleaning personnel and the cleanliness guidelines.
7. Work overload and shortage of nurses as well as a shortage of housekeepers during the holidays and weekends have led to inadequate follow of the recommended guidelines.
8. Misconduct of cleaning regulations was confirmed by bacteriological inspection of samples taken from the floors and door knobs in different sites of the hospital.
5.3. Recommendations
Based on our study results, are divided into three levels:
On individual levels
1. An Adequate number of nurses as well as housekeeping personnel should be obtained during the week, weekends, and during holidays.
2. A good nurse-to-patient ratio must be maintained in order to provide high-quality treatment.
3. Providing posters for a septic technique of hand washing and hand hygiene all over the unit proved to be the most effective pathway for preventing the spread of infection and decreasing the microbial load.
4. Housekeeper numbers should be permanent in the assigned units, to avoid any turnover, also provide them with training programs periodically, with the cleaning materials needed to complete their work in a good manner.
5. Provide porters for moving patients and helping rather than the housekeepers.
6. Educational programs as well as workshops to improve health care workers’ knowledge and practice.
On hospital and HCWs levels
1. Hospital doors, door knobs, windows, walls, ceilings, and floors should be kept occasionally checked for maintenance or replacement to ensure a clean unit.
2. Floors and walls should be adequately built from layers that avoid bacterial and fungal growth, especially on the entrance floors as they are always crowded with the patients and their families.
3. Hospital administration should be more involved in ensuring environmental infection control guidelines for improved application of the program.
4. Distribute instruction materials regarding infection control practices throughout the hemodialysis unit
5. Samples should be taken frequently from environmental surfaces to regulate the hygiene level.
6. The sanitation protocols should be revised frequently and linked to all sanitation staff.
7. Signs and banners for the importance of PPE and wearing gloves should be provided all over the health center.
8. Use of Environmental Protection Agency (EPA) disinfectants should be followed.
Further studies
1. Constant training programs should be regularly introduced to all the cleanliness staff to improve the cleanliness actions and increase their environmental awareness.
2. Advisable studies are recommended to cover underprovided points in the current study including; larger sample size and species of bacterial and fungal infections predominating in the unit so the specific disinfectant can easily be detected.