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
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