Measuring the observance of contact precautions when treating Buruli ulcer patient in a tertiary hospital in Benin

Abstract

Background: Buruli ulcer, caused by Mycobacterium ulcerans, remains a public health issue in Benin. Treatments are based on antibiotics and surgery. Good hygiene is important for its management.Objective: assess the observance of contact precautions practices by healthcare workers.Methods: between 1st March and 30th October 2015 an investigation was carried out that involved the promotion of hands hygiene and basic infection prevention practices in health care. An effective education system was implemented to improve healthcare workers knowledge and compliance. The study period was divided in two. Period I corresponds to the promotion of standard precautions, based on training, direct observation and providing hygiene equipment and materials. Period II: hand hygiene audits were conducted using the World Health Organization ‘five moments for hand hygiene’ observational tool. Samples; taken from hands of medical personnel, and various hospital environment were screened for presence of pathogens bacteria. Susceptibilities to antimicrobial agents were tested by the disk diffusion method.Results: before and after intervention there is no significant change for hand hygiene compliance globally, from 24.2%; (95% CI 21·1−36·9) to 33·3% after (31·8−41·3, but hand hygiene technique improved significantly. About 95% of personnel preferred hand washing with soap and water more than hand rubbing with alcohol based solutions. Pathogens bacteria were still present on hands (89%) and environment samples (42%) despite good knowledge of hand hygiene by 80% of medical personnel. Multi resistance bacteria represented 76% of strainsConclusion: Inadequate compliance was noticed despite good knowledge of standard precautions. Antimicrobial resistance is particularly harmful to the Buruli ulcer secondary wound infection treatment. The lack of qualified personnel and financial resources allocated for this program is one of the causes of weak compliance.Key words: Benin, hand hygiene, observance, Healthcare workers, Buruli ulcer, Multiresistance.