Journal of Infectious Diseases and Medicine

Background: Hands of healthcare personnel are known to be the main route of cross transmission of pathogens in healthcare facilities and it is known that hand hygiene is the most effective preventive measure against healthcare-associated infections (HAIs). WHO Hand Hygiene Improvement Strategy is being implemented in a University Teaching Hospital of Butare (CHUB) since November 2011 to improve patients and staffs safety. Methods: This quasi-experimental study was conducted in Butare University Teaching Hospital, a tertiary academic hospital, between November 2011 and November 2015. We implemented the WHO's Multimodal Hand Hygiene Improvement Strategy and assessed the compliance of hand hygiene before and after the interventions. The entire project included five steps: (1) facility preparedness, (2) baseline evaluation, (3) implementation, (4) follow-up evaluation, and (5) on-going planning and review cycle. Baseline evaluation of multimodal hand hygiene self-assessment and hand hygiene compliance was performed, using the WHO Multimodal Hand Hygiene Self-Assessment Framework tool and the WHO's direct observation method. Data was analysed using Ms Excel. Results: The baseline hand hygiene compliance was measured at 6.25%. The Hand Hygiene Level of the hospital was 100 at the baseline, which means inadequate level. The intervention was conducted during 2012 and 2013 and it included provision of hand hygiene supplies, training of healthcare workers, and display of reminders in the workplace. The post intervention hand hygiene programme evaluation was conducted in 2015. Hand hygiene audit was conducted in 6 wards (Neonatology, Intensive Care Unit, Paediatrics, Surgical, Internal Medicine and Gynaeco-Obstetrics) and revealed an average score of 20.86%. There were 58 hand hygiene actions from 278 hand hygiene opportunities, with an average of 46 hand hygiene opportunity per ward. The compliance ranged from 1.9% (Internal Medicine) to 57.8% (ICU). An improvement of 14.61% of hand hygiene practice (6.25% in 2012 to 20.86% in 2015) was noted. Alcohol-based hand rub (ABHR) was the most used procedures and it was used in 89.66% (52/58) of performed indications. Hand hygiene practice among professional categories was 24.6% (33/134) actions for nurses’ opportunities, 22.7% (25/110) actions for medical doctors and there was no action among allied health professionals (0/8) or caretakers (0/26). Hand hygiene self-assessment tool was completed and the score was 355 which mean intermediate level. 60.46% (159/263) of hand washing basins were in good conditions (means working and not damaged) and availability of water was 40.30% (106/263). Conclusion: It is feasible and possible to implement WHO Hand Hygiene Improvement Strategy even in healthcare facilities with limited resources. The findings from the study showed the improvement from the basic level to intermediate level of hand hygiene and improvement in hand hygiene compliance of 14.61% (from 6.25% to 20.68%) in three year period. There is a need to continue with the implementation of the WHO Multimodal Hand Hygiene Improvement Strategy by sustaining what have been achieved and putting more effort in areas of improvement such developing SMART plans for staff training and education, patient involvement and infrastructure improvement plan.

Objective: The wide access of antiretroviral treatment has led to an increase in the number of people living with HIV who aged 50 or older. This study aims to understand the clinical profile of HIV/AIDS in older adults thereby attempting to close the knowledge gap that prevents early detection and prompt therapy in this particular age group. Materials and methods: A total of 41 patients’ ≥ 50 years of age admitted to medical wards of a tertiary care centre diagnosed to have HIV infection were included in this prospective cross-sectional study. Results: Majority of the patients belonged to the age group of 50-55 years with a male: female ratio of 2.15:1. Ninety percent were married with good family support and reported adherence to drug regimens. 68% of males had multiple sexual partners. Most of the patients belonged to a low socioeconomic status, were illiterate and had no knowledge of the disease prior to initial diagnosis. Fever and weight loss were the commonly reported symptoms and pallor, generalized lymphadenopathy and hepatosplenomegaly were the common signs at presentation. Twenty patients were newly diagnosed with AIDS. The mean CD4 count in treatment naïve and treatment experienced patients were 159.03 cells/μl and 265.13 cells/μl respectively. In our study population, 32 subjects presented two or more concurrent opportunistic infections at clinical presentation. Conclusion: HIV awareness programs must be directed to include not only high risk groups and young adults but also the elderly and women, especially those of poor socioeconomic strata.