Knowledge and practice of healthcare-associated infections among Chinese medical students

Abstract

Background: Hospital-acquired infection is a major problem worldwide, particularly in hospitals with limited resources. Hand hygiene is one of the most effective measures to prevent crossinfection but is often practiced poorly, particularly in hospitals in developing countries. Improving hand hygiene behavior amongst hospital staff is difficult. This study aimed to identify obstacles to improved hand hygiene and infection control in a regional hospital.Methods: We conducted a prospective study at a 1000-bed hospital in northeast Thailand from 1th April 2011 to 30th November 2011 using four methods, as following i) directed observation of hand hygiene practices of healthcare workers (HCWs), ii) selfadministered questionnaire to assess personal knowledge and attitude of HCWs toward infection control, iii) focus group discussions to assess culture and group behavior of HCWs towards infection control, and iv) semi-structured interviews to assess obstacles to improvements in infection control.Results: 1,560 hand hygiene opportunities were directly observed amongst HCWs. Hand hygiene compliance was poor and differed markedly among categories of HCWs. Nurses were 3 times more likely to perform hand hygiene following patient contacts than doctors. Of 1,550 HCWs completing the questionnaire, 76% agreed that hand hygiene is effective in preventing HAIs, but the majority showed limited knowledge of infection control (Median score 60% [range 15% to 80%]). For focus group discussions, almost all discussants stated that personal belief about hand hygiene efficacy, and examples and norms provided by senior hospital staff were of major importance for compliance. Some HCWs suggested that improving hand hygiene practice of physicians would be an effective way of improving hand hygiene generally as all HCWs accepted physicians as role models. For semi-structured interviews, the most common suggestions were to enhance engagement with HCWs, and to improve quality and quantity of hand hygiene resources.Conclusion: Norms provided by senior staff and personal beliefs about hand hygiene efficacy were considered to be amongst the most important determinants of hand hygiene behaviour. Physicians were widely considered to be important role models, but had the lowest observed hand hygiene compliance. Hand hygiene knowledge and behaviour amongst HCWs needs to be improved.