Prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among obstetrics and gynaecology workers in rural China

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Summary

This study identified the prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among rural obstetrics and gynaecology workers in two poor counties in Anhui, China. A cross-sectional survey was conducted using a self-administered anonymous semi-structured questionnaire. The study population included all health workers in the departments of obstetrics and gynaecology in township hospitals and county health facilities. Among the 137 participants, the rate of non-compliance with glove utilization was 61%, the rate of non-compliance with hand hygiene was 40%, and the rate of non-compliance with both was 67%. ‘Unnecessary and inconvenient’ accounted for 66% of the reasons for not always using gloves and 71% for not always washing hands. ‘Short of gloves or water’ accounted for 15% and 22% of reasons, respectively. Two variables were associated with non-compliance: county [odds ratio (OR)=11.56, P<0.001] and knowledge (OR=0.10, P=0.033). After removing county from the regression model, institutional level (OR=2.34, P=0.059), institutional support (OR=3.85, P=0.009) and knowledge (OR=0.05, P=0.007) were associated with non-compliance. The prevalence of non-compliance with glove utilization and hand hygiene was high. The risk factors for non-compliance were institutional level, institutional support and knowledge. These variables incorporated both subjective and objective reasons for non-compliance.

Introduction

Universal precautions have been recommended by the US Centers for Disease Control and Prevention, and the Chinese Ministry of Health to minimize exposure to blood and body fluids, which are associated with transmission of blood-borne diseases such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis B and hepatitis C. Glove utilization and hand hygiene are two important personal behavioural components of universal precautions.

Obstetricians, gynaecologists and midwives are at risk from exposure to blood and body fluids. However, there are few reports in the literature on compliance with universal precautions among these healthcare workers, especially in developing countries. Reports on other health professionals have shown that compliance rates vary widely among different health professions, as well as by location, study period, etc. However, different measures for compliance have been used by different researchers.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11

Anhui province is located in the north–west area of East China, extending across the basins of the Yangtze and Huaihe Rivers. It has an area of 0.13 million km2, with 17 cities, 61 counties and 1841 towns/townships, and a total population of about 62.78 million in 2000. Seventy-two percent of the population is rural. In Anhui province, there are 20 poor counties as defined by the central government according to the national poverty criteria, and 10 poor counties as defined by the provincial government.12 Ten poor counties (nine at national level and one at provincial level) have been part of the Health VIII World Bank Loan Project since 1998, which focuses on basic health services in poor rural areas in China.

Like other rural areas in China, the 10 project counties have a three-tier health service network that provides health services to the rural population. At county level, there are county hospitals using Western medicine, county hospitals using traditional Chinese medicine, anti-epidemic stations, and county maternal and child health stations (MCH stations). Both county hospitals and MCH stations have a department of obstetrics and gynaecology (OG department). At town/township level, there is a town/township hospital that combines all the functions of the four county institutions. At village level, there is a village clinic providing primary health care to villagers. In addition to general OG services, OG departments provide perinatal care until 42 days after delivery and family planning services.

The objective of this study was to identify the rate of and risk factors for non-compliance with glove utilization and hand hygiene regulations among rural grass-roots health workers who provide OG services, perinatal care and family planning services in two poor counties in Anhui, China. Here we will refer to these health workers simply as ‘OG workers’.

Section snippets

Methods

This was a cross-sectional survey using a self-administered anonymous semi-structured questionnaire. The target population was all the health workers who worked in the OG departments in county health institutions and township hospitals in poor counties in Anhui, China.

Results

One hundred and forty-nine OG workers were recruited in the two counties, and 145 (97%) participated in the survey. The reason given for most refusals was ‘busy with patients’. At many township hospitals, there were only two OG workers. The refusal rate was 3%. Among the questionnaires received, eight were incomplete. The final response rate was therefore 95%.

Discussion

This is the first report on the prevalence of and risk factors for compliance with universal precautions among rural OG workers in China, although there have been reports on other health professionals. Evanoff et al.3 observed that 3% of emergency department personnel did not wear gloves when performing invasive procedures. Madan et al.1 reported that the prevalence of glove utilization among healthcare workers involved in trauma resuscitations was 85%. They and others reported much higher

Acknowledgements

The authors would like to thank all the OG workers who took part in the study, Ms Lingxiu He and Ms Haiyan Chu who helped conduct the survey, Dr Roger Detels, Department of Epidemiology, School of Public Health, the University of California at Los Angeles for his advice, and Wendy Aft for preparation of the manuscript.

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