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      Eficacia de un programa educativo para la prevención y el control de infecciones intrahospitalarias en el Instituto Especializado de Enfermedades Neoplásicas, Lima, Perú

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          Abstract

          Objetivo: Evaluar la eficacia de una intervención educativa para la prevención y el control de las infecciones intrahospitalarias (IIH) en el personal de salud del Instituto Especializado de Enfermedades Neoplásicas (INEN), Lima, Perú. Material y métodos: Estudio cuasiexperimental. Antes y después de la implementación de un programa educativo de medidas generales para la prevención y el control de las IIH, se evaluaron los conocimientos, actitudes y prácticas de 378 (45,6%) trabajadores de salud seleccionados en forma aleatoria y estratificada (por profesión) de la población de trabajadores del INEN. Resultados: Después de la intervención, la proporción de trabajadores (total) con bajo conocimiento se redujo de 53,2% a 39,7% y la actitud positiva frente al curso y programas para el control y prevención de las IIH aumentó de 87,8% a 99,2%. También hubo un incremento en el cumplimiento de las buenas prácticas: de 5,6% a 37,0% para el lavado de manos, de 33,9% a 53,2% para la técnica adecuada del lavado de manos, de 33,3% a 49,2% para la técnica adecuada de asepsia y de 37,0 a 59,0% para la técnica de aislamiento. Las tendencias fueron similares en todas las profesiones. Conclusión: La aplicación de un programa educativo ha logrado incrementar tanto los conocimientos y actitudes positivas, como los índices de cumplimiento de las medidas generales de prevención y el control de las infecciones intrahospitalarias en los trabajadores de salud del INEN.

          Translated abstract

          Objective: To assess the efficacy of an educational intervention for prevention and control of nosocomial infections performed in healthcare workers from the Instituto Especializado de Enfermedades Neoplásicas (INEN) in Lima. Material and methods: We assessed knowledge, attitudes and practices of 378 (45,6%) healthcare workers randomly chosen and stratified them according to their professional group before and after the implementation of an educational program about general measures for preventing and controlling nosocomial infections. Results: After the intervention, the rate of healthcare workers with a poor knowledge was reduced from 53,2% to 39,7% and a positive attitude towards the course and programs for control and prevention of nosocomial infections increased from 87,8% to 99,2%. There was also an increase in compliance of good practices: from 5,6% to 37,0% in the case of hand washing, from 33,9% to 53,2% concerning a suitable hand washing technique, from 33,3% to 49,2% in the case of suitable asepses technique, and from 37% to 59% with respect to a suitable isolation technique. These trends were similar for all professions. Conclusion: The implementation of an educational program led to an increase in knowledge and positive attitudes, as well as in compliance of good practices for the prevention and control of nosocomial infections in healthcare workers from the Peruvian National Cancer Institute.

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          The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals.

          In a representative sample of US general hospitals, the authors found that the establishment of intensive infection surveillance and control programs was strongly associated with reductions in rates of nosocomial urinary tract infection, surgical wound infection, pneumonia, and bacteremia between 1970 and 1975-1976, after controlling for other characteristics of the hospitals and their patients. Essential components of effective programs included conducting organized surveillance and control activities and having a trained, effectual infection control physician, an infection control nurse per 250 beds, and a system for reporting infection rates to practicing surgeons. Programs with these components reduced their hospitals' infection rates by 32%. Since relatively few hospitals had very effective programs, however, only 6% of the nation's approximately 2 million nosocomial infections were being prevented in the mid-1970s, leaving another 26% to be prevented by universal adoption of these programs. Among hospitals without effective programs, the overall infection rate increased by 18% from 1970 to 1976.
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            Improving compliance with hand hygiene in hospitals.

            Hand hygiene prevents cross-infection in hospitals, but compliance with recommended instructions often is poor among healthcare workers. Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement. This article reviews reported barriers to appropriate hand hygiene and factors associated with poor compliance. Easy access to hand hygiene in a timely fashion and the availability of skin-care lotion both appear to be necessary prerequisites for appropriate hand-hygiene behavior. In particular, in high-demand situations, hand rub with an alcohol-based solution appears to be the only alternative that allows a decent compliance. The hand-hygiene compliance level does not rely on individual factors alone, and the same can be said for its promotion. Because of the complexity of the process of change, it is not surprising that solo interventions often fail, and multimodal, multidisciplinary strategies are necessary. A framework that includes parameters to be considered for hand-hygiene promotion is proposed, based on epidemiologically driven evidence and review of the current knowledge. Strategies for promotion in hospitals should include reasons for noncompliance with recommendations at individual, group, and institutional levels. Potential tools for change should address each of these elements and consider their interactivity.
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              A multifaceted approach to changing handwashing behavior.

              Few interventions to influence handwashing have had measurable effects. This prospective quasi-experimental study was designed to address predisposing, enabling, and reinforcing factors to improve frequency of handwashing. Over a 12-month time period, a multifaceted intervention including focus group sessions, installation of automated sinks, and feedback to staff on handwashing frequency was implemented in one intensive care unit; a second unit served as a control. Dependent variables observed were handwashing frequency and self-reported practices and opinions about handwashing. Study phases included baseline, three phases of about 2 months each in duration in which sink automation was incrementally increased, and follow-up 2 months after intervention. During 301 hours of observation, 2624 handwashings were recorded. Proportion of times hands were washed varied by indication, ranging from 38% before invasive procedures to 86% for dirty-to-clean procedures (p < 0.00001). Although there were some significant differences between experimental and control units in handwashing during the study, these differences had returned to baseline by the 2-month follow-up. There were no significant differences in self-reported practices and opinions from before to after intervention nor between units. Intensive intervention, including feedback, education, and increased sink automation, had minimal long-term effect on handwashing frequency.
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                Author and article information

                Journal
                rins
                Revista Peruana de Medicina Experimental y Salud Publica
                Rev. perú. med. exp. salud publica
                Instituto Nacional de Salud (Lima, , Peru )
                1726-4634
                January 2004
                : 21
                : 1
                : 37-43
                Affiliations
                [02] Lima orgnameInstituto Especializado de Enfermedades Neoplásicas Perú
                [01] Lima orgnameInstituto Especializado de Enfermedades Neoplásicas orgdiv1Comité de Control y Prevención de Infecciones Intrahospitalarias Perú
                Article
                S1726-46342004000100007 S1726-4634(04)02100107
                b81e5e26-d11a-4de8-8a0f-804c9987e2de

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 7
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                SciELO Peru

                Self URI: Texto completo solamente en formato PDF (ES)
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                Infección Hospitalaria/prevención y control,Personal de Salud,Medidas de Seguridad,Conocimientos, Actitudes y Práctica en Salud,Perú,Cross Infection/prevention and control,Health Personnel,Security Measures,Health Knowledge, Attitudes, Practice,Peru

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