Assessment of hand hygiene compliance after hand hygiene education among health care workers in Cambodia.

Health care-associated infection (HCAI) is the most frequent adverse event for hospitalized patients. Hand hygiene is a simple and effective solution to protect patients from HCAI. This study aimed to introduce hand hygiene to health care workers based on the World Health Organization guideline for reducing HCAI in Cambodia and to assess their behavioral patterns on hand hygiene. All health care workers at Kampong Cham provincial hospital had lectures and practice on hand hygiene in January 2012. The surveys for hand hygiene compliance (HHC) were performed after 6 months, 1 year and 2 years, respectively. The number of surgical site infections (SSI) was counted in 2011 and 2014. Our analysis used the data of 58 workers, who were observed at all three points, although 139 workers were observed during the study period. The average of HHC at 6 months, 1 year and 2 years were 62.37%, 85.76% and 80.36%, respectively. The improved group (HHC 2 years/1 year≧1) had 32 workers, whereas the worsened group (HHC 2 years/1 year<1) had 26. There was a significant difference in departments of the two groups (P=0.011) but not in sex, age or occupations. The improved group had more workers of General (31.2% vs. 19.2%), Surgical (25.0% vs. 11.5%) and Infection (21.9% vs. 11.5%) categories compared to the worsened group. The incidence of SSI was improved from 32.26% in 2011 to 0.97% in 2014. Our results suggest that the education and the survey on hand hygiene are effective for reducing HCAI in Cambodia.

Surveillance of post-caesarean surgical site infections in a hospital with limited resources, Cambodia.

INTRODUCTION: In Cambodia, we implemented a pilot surveillance of superficial surgical site infections (SSSI) following caesarean deliveries (CD) in a provincial hospital, to estimate their incidence, describe their clinical management, and determine their causative pathogens. METHODOLOGY: Between October 2010 and February 2011, all women admitted for CD were included in the surveillance. Their clinical condition was monitored for a post-operative period of 30 days, including two assessments performed by surgeons. Cases were clinically diagnosed by surgeons, with bacterial cultures performed. RESULTS: Of the 222 patients admitted for CD, 176 (79.3%) were monitored for 30 days. Of these, 11 were diagnosed with a SSSI, giving an incidence rate of 6.25% (95% CI 3.2-10.9). Four of the cases (36.4%) were detected after hospital discharge. Length of hospitalization was significantly longer for the SSSI cases. All 222 patients were prescribed antibiotics. Ampicillin was administered intravenously to 98.6% of them, with subsequent oral amoxicillin given to 82.9%. Three of six pus samples collected were positive on culture: two with Staphylococcus aureus and one with Staphylococcus lugdunensis. One S.aureus was methicillin resistant (MRSA). The other was clindamycin and erythromycin resistant. CONCLUSION: Surveillance of health-care associated infections in a setting with limited resources is challenging but feasible. Effective post-discharge surveillance was essential for the estimation of the incidence rate of SSSI following caesarean deliveries. This surveillance led to a peer-review of medical practices.