Assessment of a Dialysis Unit Compliance with the Guidelines for Environmental Infection Control Procedures in One of the Biggest Health Insurance Hospitals in Egypt

Abstract

Background: Hemodialysis patients are at high risk of getting hospital-acquired infections (HAIs). Effective environmental cleaning and disinfection measures are crucial to reduce the incidence of HAIs. Poor knowledge, attitude, and practice (KAP) of the healthcare workers towards infection control precautions could increase the rate of HAIs. Objective: The current study aimed to assess nurses' KAP regarding infection control measures in a dialysis unit and to evaluate the disinfection protocol effectiveness in the dialysis unit by assessing bacterial counts in the different environmental surfaces and machines. Methods: A cross-sectional survey was conducted at the dialysis unit of one of the biggest health insurance hospitals in Egypt. An interview questionnaire and observational checklists were used to assess the KAP of nursing staff. Microbiological swabs were taken from the environment of the dialysis unit (before and after cleaning) to evaluate the disinfection effectiveness. Results: Twenty nurses agreed to participate in the research. The study revealed over 80% of the nurses had good knowledge (≥80.0% correct response), 85% had a positive attitude, 85% had fair practices, and only 5% had good practices. We found a significant positive correlation between nurses' attitudes and their years of experience. High bacterial counts were reported on the floors and doorknobs of the dialysis unit even after cleaning. The bacterial counts of the machines and nurse's counter reduced significantly after cleaning and disinfection (GM ± Log SD before cleaning and disinfection was 29.40±0.92 CFU/100 cm² and 14.99±0.49 CFU/100 cm² and after cleaning and disinfection became 23.83±0.94 CFU/100 cm² and 8.68±0.10 CFU/100 cm², respectively, (p<0.05)). Conclusion: Although most of the nurses in the study demonstrated good knowledge and a positive attitude toward environmental infection control precautions, their practices were not at the same level, so the bacterial counts were high on the floors and doorknobs regardless the cleaning process.