Evaluation of infection prevention and control practices at the hemodialysis unit in Moi Teaching and Referral Hospital Eldoret.

Abstract

Background: Catheter-associated bloodstream infection is the second leading cause of morbidity and mortality in dialysis patients. In Kenya, the expansion of hemodialysis services over the past decade has been paralleled by rising infection rates, underscoring the need for strengthened infection prevention and control (IPC) measures. Adherence to IPC guidelines is critical in minimizing infection transmission. This study evaluates the current IPC practices in the hemodialysis unit (HD) at Moi Teaching and Referral Hospital (MTRH). Main objective: To evaluate the infection prevention and control practices at the hemodialysis unit of MTRH. Specific objectives:(1) To describe IPC measures practiced by healthcare workers at the HD unit in MTRH. (2) To assess the level of compliance to MTRH and center for disease control (CDC) IPC guidelines in the HD unit. (3) To explore individual and system level factors influencing compliance to IPC guidelines at the HD unit in MTRH. Methods: A convergent parallel mixed-methods study was conducted in the HD unit at MTRH. The study had 3 components: (1) Questionnaires to describe IPC measures (2) Observations using MTRH and CDC IPC checklists to evaluate healthcare workers' adherence to IPC guidelines; (3) in-depth interviews with key informants to identify system and individual level factors influencing IPC implementation. Descriptive statistics, such as means and medians, summarized continuous variables while frequency distributions described categorical data. Compliance was measured using proportions. Qualitative data were coded into themes aligned with the six domains of the Health Belief Model (HBM). Results: Biodata:75% were female. Majority, 69.4% were nurses, with the remaining cadres evenly distributed and 87.5% had nephrology training. On IPC measures practiced by health care workers (HCWs): 100% participants reported the availability of hand hygiene supplies, 75% had training on proper personal protective equipment selection, 91.7% acknowledged availability of environmental cleaning policies and 81.2% reported that they applied antibiotic ointment on HD catheter exit sites with every dressing change. Compliance with IPC guidelines was varied: 88% compliant to hand hygiene guidelines, 100% noncompliant to both catheter connection/disconnection and exit site care guidelines. Systemic factors influencing compliance were inadequate staff numbers, few trainings on IPC and availability of consumables, individual level factors included staff attitude and insufficient knowledge in IPC. Conclusion: HCWs had insufficient knowledge of the recommended guidelines for effective IPC practices. The overall compliance to IPC among healthcare providers in the HD unit of MTRH was suboptimal. Systemic level factors like inadequate staff, insufficient training on IPC and availability of consumables influenced compliance. Additionally, individual level factors like staff attitude also contributed to compliance levels. Recommendations: The hospital management to organize educational programs to keep staff updated on IPC best practices including hands-on training sessions to bridge gap between knowledge and practice. The management to ensure constant availability of supplies for IPC and deploy sufficient numbers of HCW to the HD unit to improve compliance. HCWs to be more proactive at individual level in championing IPC.