Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Çocuk Hematoloji Servisinde Verilen El Hijyeni Eğitimlerinin Elde Üreyen Bakteriler Üzerine Etkisi: İleriye Dönük Klinik Araştırma
Impact of Hand Hygiene Training on Isolated Bacteria From Hands in a Pediatric Hematology Unit: Prospective Clinical Study
Aslı Ece YAKICI a, Nazan SARPER a, Devrim DÜNDAR b, Fatma Zehra DUYMAZ b, Arzu YILDIZ c, Canan BAYDEMİR d, Sema Aylan GELEN a, Emine ZENGİN a
aKocaeli Üniversitesi Tıp Fakültesi, Çocuk Hematoloji Onkoloji BD, Kocaeli, TÜRKİYE
bKocaeli Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji ABD, Kocaeli, TÜRKİYE
cKocaeli Üniversitesi Tıp Fakültesi, Çocuk Hematoloji Onkoloji Klinik Hemşiresi, Kocaeli, TÜRKİYE
dKocaeli Üniversitesi Tıp Fakültesi, Biyoistatistik ve Tıp Bilişimi ABD, Kocaeli, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2021;30(2):127-37
doi: 10.5336/pediatr.2020-79155
Article Language: TR
Full Text
ÖZET
 Amaç: El hijyeni, hastane enfeksiyonlarının önlenmesi açısından önemlidir. Çalışma, sağlık çalışanlarının ve hasta refakatçilerinin el hijyeni ile ilgili farkındalığının ve bilgilerinin artırılması, elde üreyebilecek patojenler için kanıt oluşturulması, el hijyeni uygulamalarının iyileştirilmesi amacıyla planlandı. Gereç ve Yöntemler: Çocuk hematoloji servisindeki sağlık çalışanları ve akut lösemili hastalarının refakatçileri çalışma grubunu oluşturdu. İlk 6 haftalık dönemde katılımcılardan mesai içinde farklı günlerde, önceden haber verilmeden sıvı besi yeri doldurulmuş büyük boy steril eldiven giymeleri istenerek el kültürleri alındı. Takip eden 4 hafta içinde, haftada 1 kez el yıkama ve alkollü el dezenfektanı kullanma konusunda tekrarlanan eğitimler verildi. Duvarlara; eldeki mikroorganizmaları, el yıkama tekniklerini ve el hijyeni gerektiren işlemleri gösteren posterler asıldı. Takip eden 6 hafta içinde çalışma grubundan el kültürleri tekrar alındı. Üremeler ve bakteri koloni sayımları açısından eğitim öncesi ve sonrası dönem karşılaştırıldı. Bulgular: Eğitim öncesi 200, sonrası 180 el kültürü alındı. Eğitim sonrası bazı bakterilerin üreme oranlarında anlamlı azalma saptandı. Acinetobacter (p<0,02), Bacillus (p<0,012), Methicillin-resistant Staphylococcus aureus (p<0,007), Methicillin-sensitive Staphylococcus aureus (p<0,001), Pseudomonas spp (Pseudomonas aeruginosa dışı) (p<0,043), Staphylococcus epidermidis (p<0,001), Staphylococcus haemolyticus (p<0,005). Eğitim sonrası alınan kültürlerdeki bakteri koloni sayımlarında da eğitim öncesine göre belirgin azalma görüldü (p<0,001). Meslek gruplarına göre karşılaştırma yapıldığında koloni sayımındaki azalmalar anlamlıydı (doktorlarda p<0,001, hemşirelerde p<0,001, temizlik personelinde p<0,002, refakatçilerde p<0,001). Enterobacter cloacae ve S. Epidermidis koloni sayımlarında anlamlı azalma görüldü (p<0,008, p<0,001). Sonuç: El hijyeni konusunda tekrarlanan eğitimler, bu konuda hazırlanan afişler ve el kültürü taramaları sağlık çalışanlarının ve refakatçilerin el hijyeninde iyileşme sağlamaktadır.

Anahtar Kelimeler: El hijyeni; hastane enfeksiyonu; el kültürü
ABSTRACT
 Objective: Hand-hygiene is important for prevention of nosocomial infections. The aim of this study was increasing awareness and knowledge of healthcare workers and caregivers about hand-hygiene, generating evidence about pathogen growth on the hands and improving hand-hygiene. Material and Methods: Healthcare workers and caregivers of patients in pediatric hematology unit was the study group. In a six week period, without informing the timing of the procedure, hand cultures were performed from the study group by requesting wearing sterile gloves filled with liquid culture medium. In the following four weeks, repeated training sessions were performed every week about hand washing and using alcohol hand rub. Posters were placed on the walls showing microorganisms on the hands, hand washing techniques and procedures requiring hand hygiene. In the following six weeks, hand cultures were performed again. Frequency of the bacterial growth and colony counts were compared in the pre-training and post-training cultures. Results: Pretraining 200, post training 180 hand cultures were performed. Significant decrease were seen in post-training samples in Acinetobacter (p<0.02), Bacillus (p<0.012), methicillin-resistant Staphylococcus aureus (p<0.007), methicillin-sensitive Staphylococcus aureus (p<0.001), Pseudomonas spp (out of Pseudomonas aeruginosa) (p<0.043), Staphylococcus epidermidis (p<0.001) and Staphylococcus haemolyticus (p<0.005). Colony counts also decreased significantly in post-training cultures, compared to pre-training cultures (p<0.001). Decrease in colony counts were significant both in healtcare workers and caregivers (physicians p<0.001, nurses p<0.001, cleaning staff p<0.002, caregivers p<0.001). Decrease in colony counts were significant in Enterobacter cloacae and S. epidermidis (p<0.008, p<0.001). Conclusion: Repeated training sessions and posters about hand hygiene and screening with hand cultures improve hand hygiene.

Keywords: Hand hygiene; infection control; hand disinfection
REFERENCES:
  1. Çaylan R. El hijyeni [Hand hygiene]. Hastane Enfeksiyonları Dergisi. 2007;11:54-9. [Link] 
  2. Santy-Tomlinson J. We need to talk about hand hygiene: A time to reflect on compliance. Int J Orthop Trauma Nurs. 2020;39:100819. [Crossref]  [PubMed]  [PMC] 
  3. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al; European Society of Clinical Microbiology. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20 Suppl 1:1-55. [Crossref]  [PubMed] 
  4. Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010;31(3):283-94. [Crossref]  [PubMed] 
  5. Lynch C, Mahida N, Oppenheim B, Gray J. Washing our hands of the problem. J Hosp Infect. 2020:S0195-6701(20)30112-2. [PubMed] 
  6. Wille I, Mayr A, Kreidl P, Brühwasser C, Hinterberger G, Fritz A, et al. Cross-sectional point prevalence survey to study the environmental contamination of nosocomial patho gens in intensive care units under real-life conditions. J Hosp Infect. 2018;98(1):90-5. [Crossref]  [PubMed] 
  7. Montoya A, Schildhouse R, Goyal A, Mann JD, Snyder A, Chopra V, et al. How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis. Am J Infect Control. 2019;47(6):693-703. [Crossref]  [PubMed] 
  8. Tselebonis A, Nena E, Nikolaidis C, Konstantinidis T, Kontogiorgis C, Panopoulou M, et al. Monitoring of frequency and antimicrobial susceptibility of pathogens on the hands of healthcare workers in a tertiary hospital. Folia Med (Plovdiv). 2016;58(3):200-5. [Crossref]  [PubMed] 
  9. Colburn NE, Cadnum J, Flannery E, Chang S, Donskey CJ, Stiefel U. Perception vs reality: methicillin-resistant staphylococcus aureus carriage among healthcare workers at a veterans affairs medical center. Infect Control Hosp Epidemiol. 2016;37(1):110-2. [Crossref]  [PubMed] 
  10. Koçak Tufan Z, Irmak H, Bulut C, Cesur S, Kınıklı S, Demiröz AP. El hijyen ürünlerinin sağlık çalışanlarında MRSA kolonizasyonuna etkilerinin CHROMagar MRSA ile araştırılması [The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA]. Mikrobiyol Bul. 2012;46(2):236-46. [PubMed] 
  11. Akpinar RB, Celebioglu A, Uslu H, Uyanik MH. An evaluation of the hand and nasal flora of Turkish nursing students after clinical practice. J Clin Nurs. 2009;18(3):426-30. [Crossref]  [PubMed] 
  12. Eksi F, Bayram A, Mehli M, Akgun S, Balci I. Microbial flora on the hands of healthcare workers. Afr J Microbiol Res. 2010;4(22):2343-9. [Link] 
  13. Li Y, Ge H, Zhou H, Zhou W, Zheng J, Chen W, et al. Correction to: Impact of environmental cleaning on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii in patients within the intensive care unit in a tertiary hospital. Antimicrob Resist Infect Control. 2021;10(1):46. Erratum for: Antimicrob Resist Infect Control. 2021;10(1):4. [Crossref]  [PubMed]  [PMC] 
  14. FitzGerald G, Moore G, Wilson AP. Hand hygiene after touching a patient's surroundings: the opportunities most commonly missed. J Hosp Infect. 2013;84(1):27-31. [Crossref]  [PubMed] 
  15. Saffari M, Ghanizadeh G, Fattahipour R, Khalaji K, Pakpour AH, Koenig HG. Effect of the Intelligent Health Messenger Box on health care professionals' knowledge, attitudes, and practice related to hand hygiene and hand bacteria counts. Am J Infect Control. 2016; 44(12):e283-e5. [Crossref]  [PubMed] 
  16. Erasmus V, Kuperus MN, Richardus JH, Vos MC, Oenema A, van Beeck EF. Improving hand hygiene behaviour of nurses using action planning: a pilot study in the intensive care unit and surgical ward. J Hosp Infect. 2010; 76(2):161-4. [Crossref]  [PubMed] 
  17. Süzük S, Edis Ç, Çalık A, Akdoğan S, Ünal S. The compliance rates of hand hygiene in intensive care unit and surgical services at a state hospital in Turkey. J Turk Soc Intens Care. 2015;13:107-11. [Crossref] 
  18. Dikiş D, Şimşek S, Kepeli N, Küçükler ND, Ulusoy B, Korkmaz NB, et al. Bir üniversite hastanesindeki sağlık personelinin el hijyeni uyum oranlarının değerlendirilmesi: Prospektif bir çalışma. [Evaluation of hygiene compliance rates among healthcare workers in a university hospital: A prospective study]. Ege Tıp Dergisi. 2020;59(2):91-6. [Crossref] 
  19. Uyan A, Durmus G, Sezak N, Özdemir B, Kaygusuz T, Öztoprak N, et al. Are soap, paper towel and alcohol-based disinfectants easily accessible in intensive care units in Turkey?: Results of the phokai study. Mediterr J Infect Microb Antimicrob. 2018;7:20. [Crossref] 
  20. Yildirim I, Ceyhan M, Cengiz AB, Bagdat A, Barin C, Kutluk T, et al. A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses. Int J Nurs Stud. 2008;45(11): 1572-6. [Crossref]  [PubMed] 
  21. Ulger F, Esen S, Dilek A, Yanik K, Gunaydin M, Leblebicioglu H. Are we aware how contaminated our mobile phones with nosocomial pathogens? Ann Clin Microbiol Antimicrob. 2009;8:7. Erratum in: Ann Clin Microbiol Antimicrob. 2009;8:31. [Crossref]  [PubMed]  [PMC] 
  22. Sadule-Rios N, Aguilera G. Nurses' perceptions of reasons for persistent low rates in hand hygiene compliance. Intensive Crit Care Nurs. 2017;42:17-21. [Crossref]  [PubMed] 
  23. Stone SP, Fuller C, Savage J, Cookson B, Hayward A, Cooper B, et al. Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ. 2012; 344:e3005. [Crossref]  [PubMed]  [PMC] 
  24. Doronina O, Jones D, Martello M, Biron A, Lavoie-Tremblay M. A systematic review on the effectiveness of ınterventions to ımprove hand hygiene compliance of nurses in the hospital setting. J Nurs Scholarsh. 2017;49(2): 143-52. [Crossref]  [PubMed] 
  25. Hernández D, Ors R, Capella JV, Bonastre A, Campelo JC. New contact sensorization smart system for IoT e-Health Applications Based on IBC IEEE 802.15.6 Communications. Sensors (Basel). 2020;20(24): 7097. [Crossref]  [PubMed]  [PMC] 

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