RESUMO
Hand hygiene is a critical practice to prevent healthcare associated infections (HCAIs). However, compliance to it among healthcare workers is very low. The study aims to assess hand hygiene practices in various situations among the healthcare workers of different departments in a tertiary care hospital in Nepal. The study is a hospital-based cross-sectional observational study among 260 healthcare workers selected using the stratified Proportionate random sampling method. Healthcare workers eligible for the study were those in ward rounds, doing procedures, and having actual contact with the patients and their surroundings. Using a WHO-developed checklist, an observation technique was used to collect the hand hygiene practice data among the healthcare workers. A total of 1068 hand hygiene opportunities were observed among 260 healthcare workers. The overall hand hygiene compliance was 30%, and the compliance was observed differently among the healthcare workers, where compliance of hand hygiene for doctors, nurses, and paramedics were 37%, 35%, and 23%, respectively. The WHO "5 moments" for hand hygiene compliance, "after body fluid exposure," was found to be higher (83%), followed by "after touching the patients' surroundings" (79%), and only 11% compliance was found "before touching the patient." Hand hygiene procedures were missed by 36% of paramedics, 30% of doctors, and 20% of nurses. The study reflects the need to promote hand hygiene practices among healthcare workers to prevent HCAIs, as compliance with hand hygiene action was only 30%.
RESUMO
Background: End-Stage Renal Disease (ESRD) is a significantly increasing condition warranting renal replacement therapy. Gaining vascular access for catheter placement for this procedure is of paramount importance. These can be done by temporary and permanent cuffed tunnelled catheters. The present study aims to analyze the outcome of permanent hemodialysis catheters and their efficacy in the case of patients suffering from end-stage renal disease. Materials and methods: A cross-sectional study was conducted on 32 patients who underwent permanent tunnelled catheter intervention along with details of follow-up from January 1st, 2021 till December 31st, 2021. Results: Among 32 patients, the mean age of the patient was 50.25 ± 18.10 years with 62.5% females. The site of insertion was right 27(84.37%) and left internal jugular vein in 4 (12.50%) and 1 patient (3.12%) in the left common femoral vein. Bleeding the peri-catheter site was observed in 4 (12.5%), infection was found among 2 patients (6.25%), thrombosis in the catheter in 7 (21.87%) patients. Indication for the procedure was due to failure of arteriovenous fistula in 21 (65.62%), lack of maturation of the AVF in 9 (28.12%) and patients awaiting transplantation in 2 (6.25%). The mean months of follow-up of the patients were 5.9 months (SD 4.4 months, range 1 month-12 months). Total 25 (78.1%) of the catheters were patent till the time of follow-up. Seven (21.9%) of the patients required manipulation once after which they also had functioning permanent catheters. The mean month on which manipulation was required was 4.1 months (SD 2.3months, range one month to seven months). Conclusion: Permanent cuffed tunnelled catheter has good patency and can be an alternative to an arteriovenous fistula.