INTRODUCTION: Healthcare associated infections (HCAI) continue to be major problems in our institution. Studies have shown that hand hygiene remain to be the primary measure that prevents HCAI. This study aimed to measure hand hygiene compliance rate and determine factors affecting compliance.

METHODS: Healthcare workers in the medicine wards and intesive care units (ICU) were directly observed for compliance to the World Health Organization hand hygiene guidelines. In a month period, subjects were selected by convenience sampling. Factors affecting hand hygiene compliance was investigated. Survey of infrastructure and hand hygiene products was concurrently done. Thereafter, self-administered survey was distributed to assess knowledge, attitudes and perceptions toward hand hygiene.

RESULTS: Overall hand hygiene compliance was 11%. Compliance was less likely for doctors, in the ward, and before patient contact. On the other hand, compliance was likely among nurses, in the ICU, before aseptic procedure, after exposure to body fluid, and after patient contact. Demand for hand hygiene was high with mean of 35 (SD=nine) opportunities per hour of patient care. Hand hygiene products are less available in the wards than in the ICU. Sinks are not in convenient locations. Hand hygiene posters were either not visible or lacking. Majority of the survey respondents know at most only two of the five hand hygiene indications.

DISCUSSION: Access to hand hygiene products, training and education, and reminders in the workplace are among the basic requirements in the implementation of hand hygiene programs. With problems related to these three components, hand hygiene compliance is expected to be low.

CONCLUSION: Low compliance to hand hygiene was associated with professional status, location and indication. Barriers to hand hygiene include inadequate and inaccessible sinks and hand hygiene products in the ward, high demand for hand hygiene, poor knowledge of hand hygiene, and lack of reminders in the workplace.

Human ; Male ; Female ; Hand Hygiene ; Cross Infection ; Workplace ; Health Personnel ; Patient Compliance ; Health Facilities ; Patient Care ; Attitude ; Intensive Care Units ; Body Fluids

Objectives: To describe the clinical profile and factors associated with mortality among the first 200 patients confirmed to have COVID-19 infection admitted in the University of the Philippines – Philippine General Hospital (UP-PGH) Methodology: We conducted a retrospective review of adult patients with confirmed COVID-19 infection admitted in PGH, a designated COVID-19 referral center. Demographic, clinical data, and clinical outcomes were extracted from medical records. Frequencies and distributions of various clinical characteristics were described, and factors associated with mortality were investigated. Results: Of the 200 patients in our cohort, majority were male (55.5%), and more than half (58%) were over 60 years old. Underlying co-morbid illnesses (67.5%) included hypertension (49.5%), diabetes mellitus (26.5%), and cardiovascular disease (20.5%). Most frequent presenting symptoms were cough (69.0%), fever (58.5%), or shortness of breath (53.0%). Most patients presented with mild (n=41, 20.5%) to moderate illness (n=99, 49.5%) and only 60 were considered severely (n=32, 16.0%) or critically ill (n=28, 14.0%). Many (61%) received empiric antibiotics, while 44.5% received either repurposed drugs or investigational therapies for COVID-19. Bacterial co-infection was documented in 11%, with Klebsiella pneumoniae commonly isolated. In-hospital mortality was 17.5%, which was highest for critical COVID-19 (71.4%). Mortality was observed to be higher among patients age 60 and above, those requiring oxygen, ventilatory support and ICU admission, and among those who developed acute kidney injury, acute stroke, sepsis, and nosocomial pneumonia. Conclusion: Our study confirms that COVID-19 affects males, older individuals and those with underlying co-morbid conditions. Empiric antimicrobial treatment was given for majority of patients, despite documentation of bacterial infection in only 11%. K. pneumoniae was commonly isolated, reflecting local epidemiology. Mortality rate during this early period of the pandemic was high and comparable to other institutions. Factors associated with mortality were related to critical COVID-19 and are similar to other studies.
COVID-19 ; Philippines