Assessment of Infection Prevention and Control Practices at Operating Rooms in NGOs Hospitals Gaza-Governorates

BYJehad Nasri Elmadhoun

Supervised by Dr. Nihaya Al-Telbani

The overall aim of this study is to assess the adherence of healthcare provider's practices at the operating rooms in NGOs hospitals in Gaza governorates to the infection prevention and control protocols and guidelines.

To assess the infection prevention and control practices at the operating rooms.

To determine the relationship between the individual factors and the infection prevention and control practices at the operating rooms.

To determine the relationship between the organizational factors and the infection prevention and control practices at the operating rooms.

To explore the relationship between the physical environmental factors and the infection prevention and control practices at the operating rooms.

To explore the differences in the answers of the respondents concerning their infection prevention and control practices.

To develop suitable and applicable recommendations to encourage the healthcare providers compliance with infection prevention and control protocol.

Descriptive analytical cross sectional with triangulation between quantitative and qualitative approach.

Quantitative Qualitative

The population of the quantitative part of the research consisted of all ORs physical environment and HCPs working at the ORs in the selected NGOs hospitals (surgeons, anesthesiologists, OR nurses or anesthesia technicians). The total number of the HCPs at the ORs was 184 persons, 15 of them were drawn to the pilot study and the rest (169) participated in the study.

The population of the quantitative part of the research consisted of all ORs physical environment and HCPs working at the ORs in the selected NGOs hospitals (surgeons, anesthesiologists, OR nurses or anesthesia technicians). The total number of the HCPs at the ORs was 184 persons, 15 of them were drawn to the pilot study and the rest (169) participated in the study.

The population of the qualitative part of the research entitles conducting in-depth interviews with 6 selected persons from the different hospitals under investigation.

The population of the qualitative part of the research entitles conducting in-depth interviews with 6 selected persons from the different hospitals under investigation.

Study Sample

The study was conducted on 6 NGOs hospitals in Gaza governorates according to the inclusion criteria. The hospitals are Al-Awda hospital, Patient's Friends hospital, Public aid hospital, Yafa hospital, Dar Essalam hospital and Al-Kuwait hospital. It is important to mention that Al-Ahli hospital refused to be included in the study sample

The study was conducted from February to November 2011, it was started by preparing research proposal and designing the data collection instruments, and then get the approval from the University to complete the study, pilot study and data collection was done in august and September and then data analysis and completing the research in October and November.

The study was conducted from February to November 2011, it was started by preparing research proposal and designing the data collection instruments, and then get the approval from the University to complete the study, pilot study and data collection was done in august and September and then data analysis and completing the research in October and November.

Inclusion criteriaInclusion criteria Exclusion criteriaExclusion criteria

The hospital which carries out general surgery

The hospital that has two ORs and more.

The hospital which does the largest number of surgical operations (more than 100 surgeries per month).

The hospitals that has the largest number of ORs staff.

All the surgical team members (surgeons who frequently do operation, anesthesia team either physicians or technicians, and nurses) irrespective of the type of hiring.

The hospital which carries out general surgery

The hospital that has two ORs and more.

The hospital which does the largest number of surgical operations (more than 100 surgeries per month).

The hospitals that has the largest number of ORs staff.

All the surgical team members (surgeons who frequently do operation, anesthesia team either physicians or technicians, and nurses) irrespective of the type of hiring.

Workers of the ORs, because they haven't the IPC knowledge to answer the questions of this research.

The hospitals that have less than two ORs, because they don’t do general surgery.

The two hospitals (Al-Quds &Al-Amal) which are aff i l iated to the Palestinian red crescent society because they are considered national hospitals.

Jordanian hospital in Gaza because it is a relief and temporary hospital.

Workers of the ORs, because they haven't the IPC knowledge to answer the questions of this research.

The hospitals that have less than two ORs, because they don’t do general surgery.

The two hospitals (Al-Quds &Al-Amal) which are aff i l iated to the Palestinian red crescent society because they are considered national hospitals.

Jordanian hospital in Gaza because it is a relief and temporary hospital.

Self-administered questionnaire Observation checklist for the physical

environment Observation checklist for the health care

providers In-depth interviews for key persons

Self-administered questionnaire Observation checklist for the physical

environment Observation checklist for the health care

providers In-depth interviews for key persons

Ethical approval was obtained from Helsinki Committee to carry out the study.

An approval letters were obtained from the NGOs hospitals directors .

Informed consent was also obtained from participants.

Participation in the research was optional.

In the quantitat ive part, the researcher used three instruments: self-administered questionnaire, observation checklist for ORs, and observation check l ist for HCPs. All the three data collection instruments were developed by the researcher in the l ight of IPC protocols, and were reviewed by experts. The questionnaire was f i l led by the HCPs themselves under the researcher supervision. Both of the checklists were observed by the researcher himself three t imes in different t imes and in different working shifts.

In the qualitat ive part the researcher used in depth interviews including 6 HCPs, whom were purposively chosen. Those were in managerial posit ions such as: hospital medical director, nursing director, and head nurse from different NGOs hospitals. The main factors that inf luence the practices of the IPC wil l be discussed.

In the quantitat ive part, the researcher used three instruments: self-administered questionnaire, observation checklist for ORs, and observation check l ist for HCPs. All the three data collection instruments were developed by the researcher in the l ight of IPC protocols, and were reviewed by experts. The questionnaire was f i l led by the HCPs themselves under the researcher supervision. Both of the checklists were observed by the researcher himself three t imes in different t imes and in different working shifts.

In the qualitat ive part the researcher used in depth interviews including 6 HCPs, whom were purposively chosen. Those were in managerial posit ions such as: hospital medical director, nursing director, and head nurse from different NGOs hospitals. The main factors that inf luence the practices of the IPC wil l be discussed.

Response rate

Of the 169 HCPs who constitute the study population 154 responded with a response rate of 91%

P-Value (Sig.) Pearson Correlation

Coefficient

Field

Knowledge.170 0.018*

Attitudes.237 0.002*

Training &

education.208

0.005*

P-Value (Sig.) Pearson Correlat ion

Coeff icient

Field

Availability of the

protocols.0.047

0.283

Materials and equipment 5.183 0.007

Supportive policies0.023 0.388

Supervision, Monitoring and Evaluation -0.124 0.062

Workload and workforce0.039 0.318

Dependent

variable

Independent

variable

Test value P-value(Sig.)

Practices Hospital 0.814 0.541Gender 1.213 0.227

Age 0.243 0.866

Marital status 1.339 0.249

Profession 2.153 0.077

Education 1.521 0.199

Experience

 2.747 0.067

Current position

 1.451 0.230

No Field Test value P-value(Sig.)

1.  

Hospital name 2.185 0.059

2.  Profession Mean

86.642 0.000*

Surgeon1.40

Nurse1.56

Anesthesiologist0.72

Anesthesia technician0.65

1. Training courses and education sessions regarding IPC should be implemented for al l HCPs to increase their awareness towards this issue.

2. More attention must be given to hepatit is B vaccination.

3. The HCPs have to comply with SPs to protect themselves and others.

4. NGOs hospitals must increase the coordination and mutual cooperation with the MOH to get i ts role as a supervisory body.

1. Training courses and education sessions regarding IPC should be implemented for al l HCPs to increase their awareness towards this issue.

2. More attention must be given to hepatit is B vaccination.

3. The HCPs have to comply with SPs to protect themselves and others.

4. NGOs hospitals must increase the coordination and mutual cooperation with the MOH to get i ts role as a supervisory body.

5. Every hospital should have an IPCC to be responsible for all activit ies of infection prevention and control.

6. The MOH should activate its role as it is considered the main health care provider in Palestine.

7.The IPC protocols must be developed and updated to meet all aspects of health care especially the procedures at the ORs.

8. The role of management in supervising, monitoring and evaluation the practices of IPC, must be strengthened

5. Every hospital should have an IPCC to be responsible for all activit ies of infection prevention and control.

6. The MOH should activate its role as it is considered the main health care provider in Palestine.

7.The IPC protocols must be developed and updated to meet all aspects of health care especially the procedures at the ORs.

8. The role of management in supervising, monitoring and evaluation the practices of IPC, must be strengthened

9. At the ORs level a high quality practit ioner have to be designated to practice the role of in-service training and education.

10. As much as possible hospitals have to modify the physical environment of ORs to be suitable for IPC standards.

11. Workers of the ORs must be undergoing comprehensive training and education regarding infection control.

9. At the ORs level a high quality practit ioner have to be designated to practice the role of in-service training and education.

10. As much as possible hospitals have to modify the physical environment of ORs to be suitable for IPC standards.

11. Workers of the ORs must be undergoing comprehensive training and education regarding infection control.