PDF(Pubmed)
Abstract：
Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC.
摘要：
医疗保健获得性感染是世界各地医疗机构环境中的主要问题。刚果民主共和国（DRC）每年有超过200万腹泻患者住院。这些医疗机构成为传播霍乱等腹泻疾病的高风险环境。霍乱预防干预7天（PICHA7）计划的目标是开发基于证据的水，卫生，和卫生（WASH）干预措施，以减少刚果民主共和国的霍乱和其他严重腹泻疾病。研究目的是评估PICHA7计划交付在医疗机构中腹泻患者和患者服务员的粪便/呕吐和食物相关事件中增加清洁剂洗手的有效性。从2020年3月至2021年11月，在刚果民主共和国南基伍省布卡武市的27个医疗机构中的284名参与者中进行了PICHA7计划的试点。标准机构收到了刚果民主共和国向腹泻患者提供的关于使用口服补液溶液的标准信息和医疗机构出院时的基本WASH信息。PICHA7手臂接受了由健康促进者提供的PICHA7WASH图片模块，该模块专注于在医疗机构的腹泻患者的床边用清洁剂洗手，并提供肥皂水瓶（水和洗涤剂粉）。在干预交付的24小时内，在腹泻患者及其护理人员的医疗设施中,对大便/呕吐和食物相关事件(关键事件)时的洗手行为进行了3小时的结构化观察.与标准臂相比，在PICHA7组的关键事件中，用清洁剂洗手的次数明显增多(40%vs.15%)(比值比:5.04;(95%置信区间(CI):2.01,12.7))。这些发现表明，向腹泻患者及其服务员交付PICHA7WASH图片模块并提供肥皂水瓶是一种有希望的方法，可以在刚果民主共和国东部医疗机构的这一高风险人群中增加清洁剂的洗手。
