COMPARATIVE STUDY OF THE LEVEL OF HYGIENE PRACTICES IN ULTRASOUND LABORATORIES IN GOVERNMENT HOSPITALS AND PRIVATE CLINICS IN ABAKALIKI METROPOLIS

ABSTRACT 

 Government Hospitals and Private Clinics in Ebonyi State were compared for self-reported differences in the levels of hygiene practices, the standard and methods of cleaning transducers used for cavities and fluid surfaces, comparison of the standard of design and setting of ultrasound laboratories. Hand hygiene practices were also assessed and the specific regulatory guidelines for infection control in ultrasound laboratory. The research was a non-experimental cross-sectional study.  The sample size was 75 Sonographers. The primary sources of data were questionnaire and observation. The result shows that 50% and 62.96% sonographers from Government hospitals and private clinics clean their intracavitory ultrasound transducer at the end of each examination. 20.83% and 3.7% clean the transducers after work each day, while 22.92% and 11.11% clean it whenever they are scanning open wounds. From this findings 11(22.92%) and 5(18.52%) of sonographers from Government hospitals and private clinics agreed that there is availability of regulatory guidelines for infection control in their laboratories while the remaining 37(77.08%) and 22(81.48%) of sonographers said that there is no regulatory guidelines for infection control in their departments. In the study, 29(60.42%) and 26(96.30%) sonographer agreed that they have hand-washing facilities in their laboratories while 19(39.58%) and 1(3.70%) sonographers from Government hospitals and private clinics respectively said there is no hand-washing facilities in their laboratories.  21(72.41%) and 24(92.31) agreed that they wash their hand at the end of each examination.  6(20.69%) and 2(7.69%) said that they wash their hands at closed work and 2(6.90%) and (0.00%) wash theirs at home.

Therefore, there is need for relevant bodies or authorities to constantly monitor and sanitize sonographic practice in Nigeria with their branches and sectorial head offices in the 36 states of the federation. This will help check excessive negligence of working sonographers of proper hygiene practices in the respective laboratories. Thus, ensuring patients total wellbeing and enhanced recovery and comfort.

 

Chapter One

Chapter Two

Chapter Three

Chapter Four

Appendixes I, II, III, IV

First attested in English in 1677s, the word hygiene comes from French-Hygiene, the Latinization of the Greek-hygieine techne, meaning “art of health”, from hugieinos, “good for the health”,1 in the turn from hugies, “healthful, salutary, wholesome.2  In ancient Greek religion, Hygeia, was the personification of health3

Hygiene is a set of practices performed for preservation of health. While in modern medicine, there is a set of standards of hygiene recommended for different cultures, genders and etarian groups. Some regular hygienic practices may be considered good habit by a society while the neglect of hygiene can be disgusting, disrespectful or even threatening.

Sanitation involves the hygienic disposal and treatment by civil authority of potentially human waste, such as sewage and drainage.

This section does not cite any reference or sources. Hygiene is an old concept related to medicine, as well as to personal and professional care practices related to most aspect of living.  In medicine and home (domestic) and everyday life settings, hygiene practices are employed as preventive measures to reduce the incidence and spreading of diseases.  In the manufacturing of food, pharmaceutical, cosmetics and other products, good hygiene is a key part of quality assurance, ensuring that products complies with microbial specification appropriate to its use.  The term cleanliness and hygiene are often used interchangeably, which can cause confusion. In most general term, hygiene most means practices that prevent the spread of disease-causing organisms.  Isolation and quarantine of infectious persons or materials to prevent spread of infections. Sterilization of instrument used in surgical procedures.  Use of protective clothing and barriers, such as gloves, eyewear, gowns, masks, caps, proper bandaging and dressing of injuries.  Safe disposal of medical waste. Disinfection of re-usable (i.e. linen, pads, uniforms) scrubbing up, hand-washing especially in an operating or diagnostic room, but in more general health-care settings as well, where disease can be transmitted are all hygiene practices.4

Hygiene in home and everyday life settings play an important part in preventing spread of infectious diseases5.  It includes procedures used in a variety of domestic situations such as hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene (hygiene of environmental sites and surfaces); care of those who are at greater risk of infection.

Forum on home hygiene has developed a risk-based approach (based on Hazard Analysis critical control point (HACCP), which has come to be known as “targeted hygiene”. Targeted hygiene is based on identifying the routes of spread of pathogens in the home, and applying hygiene procedures at critical points at appropriate times to break the chain of infection.

The main sources of infection in the home6 are people (who are carriers or are infected), foods (particularly raw foods) and water, and domestic animals (in western countries more than 50% of homes have one or more pets). The main “highways” for spread of germs6 in the home and hospitals are the hands, hand and food content surfaces, and cleaning cloths and utensils.  Germs can also spread via clothing and household linens such as towels.  Utilities such as toilets and wash basins, for example, were invented for dealing safely with human waste, but still have risk associated with them, which may become critical at certain times, e.g., when someone has sickness or diarrhea.

Safe disposal of human waste is a fundamental need; poor sanitation is a primary cause of diarrhea disease in low income community. Respiratory viruses and fungal disease also spread via the air.

Good home hygiene means targeting hygiene practices or procedures at critical points, at appropriate times, to break the chain of infection i.e. to eliminate germs before they can spread further6.  Because the “infectious dose” for some pathogens can be very small (10-100 viable units or even less for some viruses), and infection can result from direct transfer from surfaces via hands or food to mouth, nasal mucosal or the eye, ‘hygienic cleaning’ procedures should be sufficient to eliminate pathogens from critical surfaces. Hygienic cleaning can be done by:

• Mechanical removal (i.e. cleaning) using a soap and or detergent. To be effective as a hygiene measure, this process must be followed by thorough rinsing under running water to remove germs from the surface.

• Using a process or product that inactivates the pathogens in situ. Germ kill is achieved using a “micro-biocidal” product i.e. a disinfectant or anti-bacterial product or waterless hand sanitizer, or by application of heat.

• In some cases combined germ removal, with kill is used, e.g. laundering of cloth and household linens such as towels and bed linen.

Hand Hygiene is defined as Hand washing or washing hands and nails with soap and water or using a waterless hand sanitizer.

Hand hygiene is central to preventing spread of infections diseases in home and everyday life settings7.

Correct respiratory and hand hygiene when coughing and sneezing reduces the spread of germs particularly during the cold and flu season5.

Food hygiene is concerned with the hygiene practices that prevent food poisoning. The five key principles of food hygiene, according to WHO, are: 8

• Preventing contaminating food with pathogens spreading from people, pets and pests.

• Separates raw and cooked foods to prevent contaminating the cooked foods.

• Cooked foods for the appropriate length of time and at the appropriate temperature to kill pathogens.

• Store food at the proper temperature.

• Use safe water and raw materials.

Household water treatment and safe storage ensure that drinking water is safe for consumption.  Drinking water quality remains a significant problem, not only in developing countries, 9 but also in developed countries, 10 even in the European region, it is estimated that 120 million people do not have access to safe drinking water.

There is need for hospital environmental hygiene practices. Crisis and pandemic outbreaks are always on the range of spreading.  When the world was hit back in 2003 by SARs, 800 lives were lost.  It is with no doubt we need hospital environment to be clean and hygienic

There is a body of clinical evidence which suggest an association between environmental hygiene and health care associated infection (HCAI); defined as any infection caused by an infection agent acquired as a consequence of the patient’s treatment or which is acquired by healthcare workers in the course of their duties.

None claims that lack of cleanliness is not the only factor behind HCAI, nor that cleanliness is the only solution.  However, a clean environment is the best platform to tackle HCAIS.

In the article, two issues were considered.

• the connection between environmental cleaning and incidence of HCAI;

• the connection between the quality of cleaning and how it is carried outsourced;

It’s worth nothing that there are three categories of clean surfaces:

(1) Visibly clean: surfaces free from obvious visual dirt and soil.

(2) Chemically clean: surfaces free from organic and inorganic residues.

(3) Microbiologically clean: surfaces having a microbial load of an acceptable level.

The issue of hospital infection control is about connections:

• Those that are proven.

• Those that is likely.

• Those that are disputed.

Health care associated infections are related to a range of factors:

• Hand hygiene

• Antibiotic use

• Patient profile and mobility

• Hospital occupancy rate.

About 1.4 million people worldwide are suffering from Health care associated infections.  To minimize this, certain measures are necessary:

 Cleaning should be subjected to strict in-house quality control; quality analysis should be ascertained by authorized bodies.

 Patients should comply with the following rules:

• Regular Hand washing

• Should not contribute to clutter.

• Survey the room, the bathroom and the bed for visual cleanliness.

 Visitors should comply with the following rules:

• Refrain from setting on the bed or handle equipment.

• Should not use patient’s bathroom.

• Should not visit if they have had any symptoms within the last 3 days; including nausea, vomiting, diarrhea or uncontrolled cough or rash.

 Should not bring food from outside to the patients

• The hospital should supervise the cleaning process in accordance with the national and international cleaning standards and procedures.

In advanced countries, the choice between these options of in-house cleaning versus contracting out is a hotly debated subject. For every option, the argument of those for it and those against it were listed.  In lesser advanced countries of the Middle East, this problem is hardly an issue.  In both cases, an assessment will be recommended.

Analysis in Advanced Countries

General Considerations

 Cleaning has not yet been afforded scientific status.

 Measurement of cleanliness is a contested area.

 Infection control depends on a variety of different measures and policies running and applied concurrently.

 It is difficult to isolate and measure the effectiveness of cleaning in order to prevent HCAI.

 Hospital cleaners should perceive themselves to be different from more general building cleaners.

In-House cleaning: Factors to be considered.

• It is relatively easy to get additional cleaning done during an outbreak.

• The level of integration between domestic and clinical staff is fairly high.

• In an integrated work place, the opportunities to move from one ring of the job ladder to the other exist. This allows both the employer and the individual employee to benefit.

• It is difficult to recruit and retain cleaners. Reasons being low pay, level of hard work and discomfort working in hospital environment.

• The division of staff into clinical and non clinical groups can create institutional apartheid which might be detrimental to staff morale and the patients.

• The hierarchy within hospital is headed by personnel who care (doctors and their assistants who may be nurses or technicians).  At the bottom of the hierarchy come those responsible for hygiene (cleaners, sterilizers and launderers) and health maintenance (food services).

Outsourcing:  Factors to be considered:

• It improves control and monitoring of the level and quality of service through the obligation to formally specify a contractor for services.

• It is cheaper on average than services provided in-house.

• Maximum savings is possible by rendering out services, like cleaning, laundering and catering.

• Might-make it difficult for manages and matrons to control cleaning.  Nurses might find themselves unable to direct private cleaners.

• Ruptures any job ladder connecting skilled cleaners to a position higher than janitorial staff.

• If contractors don’t recruit and retain, if they don’t provide proper training to their staff, if they don’t have an appropriate skill mix, if they don’t pay the going rate; service quality will be inferior to that of in-house cleaning.

• Replaces public services with private gain.

• Contracts cannot be readily altered to respond to a change in infection hazard requirement.

Hospital management should carefully assess the pros and cons of both options and decide upon the course to be taken; and mix between the two can always offer a third option.

Prime consideration should be given to the standard of healthcare offered and to the control of infection especially HCAI.  Saving money, though important, should not be the main goal.

Analysis in developing countries – status quo: In countries of the Middle East, the factors determining assessment are drastically different from that of developed countries.  Hence, it was found useful to discuss each option on the lines of developed countries; but rather to pinpoint the general conditions prevailing in most of the lesser developed Middle East countries.

• Awareness of a clean Hospital environment and of healthcare associated infections (HCAIs) is non existent amongst administrators or at best of very low priority. The hospital administrators are not well-trained, inefficient and overwhelmed with their day-to-day affairs to pay attention to matters of cleaning.

• The health establishment considers cleaning to be peripheral as compared to major problems of healthcare.

• National cleaning standard and codes of practices are unavailable.

• HCAI are not diagnosed, never documented and rarely assessed. The management does not take the effort to understand the relationship of cleanliness to the incidences of HCAI nor to the standard of cleaning provision.

• Standard of cleaning amongst the people at large is very low. Patients and their visitors are not an exception.

• Hospital cleaning is overwhelmingly performed by working class women who are not provided with any training. The cleaning knowledge is limited to what they carry out in their own homes. Moreover, they are poorly paid and rated very low in the hierarchy of task carried out by women within the hospital.

• There are no private sector contracting companies specializing in hospital cleaning as they consider this activity to be unrewarding financially.

Against such background, a concerted joint effort has to be initiated by the government, the media and indeed private businesses to bring the issue of hospital cleanliness and HCAIs to the forefront of attention.