Developing and Evaluating Effective Interventions to Reduce Healthcare-Associated Infection in A Resource-Limited Hospital in Thailand

Hongsuwan, Maliwan (2018). Developing and Evaluating Effective Interventions to Reduce Healthcare-Associated Infection in A Resource-Limited Hospital in Thailand. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000d7f3

Abstract

The burden of disease due to hospital-acquired infections in developing countries is poorly quantified. Moreover, hand hygiene compliance (amongst the most effective control measures) is often low and high quality research into how to improve it is largely lacking outside high income settings.

I aimed to: I) describe the burden and trends in healthcare associated infections in Northeast Thailand; 2) investigate knowledge and beliefs amongst healthcare workers in a tertiary hospital in Northeast Thailand about hand hygiene and identify obstacles to improving it; 3) evaluate an intervention to improve hand hygiene compliance in this hospital based on World Health Organization guidelines.

To address the first aim, a retrospective study was conducted using data from 10 provincial hospitals in Northeast Thailand (2004-2010). This demonstrated a high and increasing incidence of hospital-acquired and healthcare-associated bacteraemia, an increasing proportion of extended spectrum beta-lactamase -producing isolates, and high associated mortality.

To address the second aim, a prospective study was conducted using qualitative and quantitative methods. This found that hand hygiene compliance was poor and differed markedly among categories of healthcare workers. Obstacles to good hand hygiene behaviour included intra-personal, inter-personal, and institutional factors.

The third aim was addressed with a cluster-randomized trial to evaluate a multimodal intervention. The intervention was associated with small increases in hand hygiene compliance (OR 1.12; 95% CI 1.01 to 1.24, p = 0.027), though lack of adherence to the intervention was a major problem. Larger improvements were seen in some units (obstetrics and gynecology: OR 3.96; 95% CI 1.88 to 8.31, p < 0.001) and for some types of opportunities (before patient contact: OR 1.72; 95% CI 1.32 to 2.25, p < 0.001).

The findings show that improvements in hygiene are possible, but multiple organizational factors need to be addressed to achieve acceptable hand hygiene levels in this setting.

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