Evaluating hand hygiene practices at the new-born unit of Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

New-borns, especially preterm new-borns are at risk of developing bloodstream infections shortly after birth or later. This study aimed to evaluate the infection prevention & control measures through hand hygiene practices and determine the procedures associated with risk of infection to small and sick new-borns at the Newborn Unit of Moi Teaching and Referral Hospital. This was a hospital-based cross-sectional study carried out at the neonatal unit of the largest tertiary hospital of western Kenya. It included quantitative data collection using a standardized checklist for each of the procedures observed during day and night shifts for a period of 6 weeks, which represented a sample unit. Data were analysed using Statistical Package for the Social Sciences version 20.0. Categorical data were described using frequency and percentage. The values less than 0.05 was judged statistically significant. Out of the 553 observed contacts, the nurses did 52.4%. The intravenous cannula insertion was the most frequent procedure (11.2%), followed by newborn examination (10.7%) and medication administration (10.5%). About 69% of the procedures were classified as low risk procedures whereas high-risk procedures accounted for 31%. Most of the procedures were performed during daytime shifts. Poor hand hygiene procedures were statistically associated with risk of infection to small and sick new-borns. This risk were 2 times increased when the procedures were carried out by nurses (pv=<0.001, 95% confidence interval =1-2.9); and 6 times higher when the procedures were carried out by registrars (pv=0.008; 95% confidence interval =1.6-23). Newborn examination was statistically associated with reduced risk of infection, even after reduction of confounders (pv=0.001, odd ratio=0.0, 95% confidence interval=0.0). Hand hygiene compliance was scored at 42% and rated as poor compared to the standard (<75%) for all the service providers. However, newborn examination was the most independent risk factor. This study highlights the importance of hand hygiene compliance to prevent hospital-associated infections among small and sick newborns.