الفهرس 
INTRODUCTION AND AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
Distinguishing the variables that increment patients‟ susceptibility to acquire infection
will allow medical staff to perceive dangers and perform essential infection prevention and
control measures to prevent infection occurrence. The new PHC Astana declaration affirms
the “commitment to the fundamental right of every human being to the enjoyment of the
highest attainable standard of health without distinction of any kind”, and reaffirms the
commitment to the Alma-Ata core principles. The Astana declaration recognizes that
remaining healthy is challenging for many people, particularly the poor, and states that it is
“unacceptable that inequity in health and disparities in health outcomes persist”. „Astana‟
commits itself to prioritizing disease prevention and health promotion and aims to meet all
people‟s health needs across the life course through comprehensive promotive, preventive,
curative, rehabilitative services and palliative care. (Kluge et al., 2019; The, 2018; Walraven,
2019)
Aim of the study:
The aim of the present research was to evaluate an interventional training program on
infection prevention and control in family health centers in Alexandria governorate by:
1. Assessing infection prevention and control measures and procedures in Alexandria family
health centers.
2. Constructing an interventional training program for family health personnel based on the
assessment results of the previous assessment and re-evaluate them after program
implementation.
To conduct the present study, the following techniques were used:
3. An infection prevention and control assessment tool for primary health care facilities
designed by United States Agency for International Development in 2013 was modified
was to match the structure of the family health centers/units as a model of primary health
care and utilized to assess the infection prevention and control situation.
4. Observation checklists for assessment of hand hygiene practices, correct hand washing
practices, hand washing station supplies and sink status and injection administration
practices.
5. An in-service interventional training program was constructed, based on pre-intervention
score in the aforementioned infection prevention and control assessment tool. It had been
implemented for all health staff in two family health centers (those with lowest infection
prevention and control scores) which were Borg Al Arab FHC in Borg Al Arab health
district and El Amrawy FHC in El Montaza health district.
6. Several educational sessions for health care personnel were conducted in a series of three
sessions including suitable tools and materials were used. Different educational methods
used as lectures using power point presentation and videos, group discussions and role
play.
7. The previously mentioned family health centers were re-assessed three months later using
the previously The results of the present study could be summarized as follows:
1. All managers of the family health centers and units (FHC/Us) were familiar with the
Ministry of Health policies covering infection control policies and guidelines through
direct training courses before holding their managerial position or during their
responsibilities.
2. There were unification of follow up documents, policies, procedures and observation
checklists of infection prevention and control in the family health centers and units
according to directions and instructions from the head office of Ministry of Health in
Alexandria. There were a hard and soft copy of the infection prevention and control
materials distributed in the studied FHC/Us.
3. All FHC/Us adopted the Ministry of Health policies governing infection control but
implementation of policies and procedures varied from one facility to another according
to available manpower, financial budget and managerial follow up.
4. Regarding total score level of all modules, most of FHC/Us (75%) had good level (50% -
75 %) of practices while none of FHC/US had excellent level (>75%) of practices.
5. All studied FHC/Us had good level of practices for the employee health module while all
studied FHC/US had poor level of practices for the isolation and standard precautions
module.
6. For cleaning the health facility assessment, 44% of the studied FHC/Us had excellent
level of practices while 56% of studied FHC/Us had good level of practices.
7. For hand hygiene assessment, less than half of the studied FHC/Us (44%) had poor level
of practices while 56% of studied FHC/Us had good practices.
8. Most of the studied FHC/Us (88 %) had good level of practices for waste management
and sterilization and disinfection of equipment while the majority (94%) of the studied
FHC/Us had poor level of practices for preparation and administration of parenteral
medications.
9. Regarding health facility information, more than half of the FHC/Us (56%) had excellent
level of practices while 25% of FHC/Us s have poor level of practices.
10. The total score percentage of all modules improved after interventional training program
in El Amrawy FHC and Borg Al Arab FHC from 51.8% to 58.1 % and from 38.9 % to
50.6 % respectively.
11. There was an improvement in the score of all modules individually after intervention
training program in both El Amrawy FHC and Borg Al Arab FHC. The only statistically
significant improvement was related to the waste management module.According to the previous results and conclusion, the following are recommended:
I. Recommendations for Ministry for Health:
1. To develop and maintain infection prevention and occupational health programs
matching with international standards of health care in primary health care centers and
units.
2. To assure availability of sufficient and appropriate supplies necessary for adherence to
standard precautions (e.g., hand hygiene products, personal protective equipment and
injection equipment).
3. To ensure at least one trained individual in infection prevention and control to be
employed and regularly available to manage the infection prevention and control
program.
4. To perform regular audits for assessment of compliance level of staff of family health
centers and units to infection prevention and control practices.
II. Recommendations for managers of family health centers and units:
1. To ensure implementation of the recommendations of infection prevention and control
committee in way appropriate for the medical services provided and updated upon
evidence-based guidelines, regulations, or standards.
2. To ensure that reusable medical devices (e.g., blood glucose meters and other point-ofcare devices, surgical instruments) are cleaned and reprocessed appropriately prior to use
for another patient.
3. To assign responsibilities for reprocessing of medical devices to nurses who have the
appropriate training.
4. To maintain copies of the manufacturer‟s instructions for reprocessing of devices in use
at the area of medical care; post instructions at locations where reprocessing is
performed.
5. To assure that sufficient and appropriate PPE is available and readily accessible to health
care providers.
6. To assure supplies for performing hand hygiene in or near patients’ waiting areas.
7. To offer masks, tissues and no-touch receptacles for disposal of tissues for patients with
cough symptoms upon their entry to have medical service during periods of increased
respiratory infection in the community.
8. To provide job specific training related to infection prevention and control and training
for all health care staff involved in health care services provisions.
9. To provide training for infection prevention and control upon hiring of any new medical
staff and repeated annually and on revision or update of policies or procedures.
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10. To document and update competencies of health care staff following each training and
update the job privileges accordingly to the updated competencies.
11. To educate patients who have undergone medical procedures at the facility regarding
signs and symptoms of infection that may be associated with the medical procedure and
instruct them to notify the treating physician if such signs and symptoms occur.
12. To assure availability of on job training for policies and procedures related to
decontamination of spills of blood or other potentially infectious materials for all medical
staff.
13. To educate medical staff on the importance of infection prevention and control measures
to deal with respiratory secretions to prevent the spread of respiratory pathogens.
14. To educate all staff in family health centers and units on proper selection and how to use
PPE.
15. To publish posters and signs at the entrances of family health centers and units which
give instructions to patients with symptoms of respiratory infection to do the following:
a. Inform health care provider of symptoms of a respiratory infection when they first
register to have medical care service,
b. Cover their mouths and noses when coughing or sneezing,
c. Use and dispose of tissues,
d. Perform hand hygiene after hands have been in contact with respiratory secretions.
III. Recommendations for medical staff of family health centers and units:
1. To promote “Clean care for all – it’s in your hands” as a daily practice according to WHO
recommendation for hand hygiene key situations.
2. To avoid wearing the same pair of gloves for the care of more than one patient.
3. To avoid washing gloves for the purpose of reuse.
4. To wear a gown to protect skin and clothing during procedures or activities where contact
with blood or body fluids is expected.
5. To avoid wearing the same PPE for the care of more than one patient.
6. To wear mouth, nose and eye protection equipment during procedures that are likely to
generate splashes or sprays of blood or other body fluids as when placing a catheter or
injecting material.
7. Medical staff should wear a facemask (e.g., surgical mask).
8. To encourage using aseptic technique when preparing and administering medications.
9. To dispose used sharps at the point of use in a sharps container that is closable, punctureresistant, and leak-proof.
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10. To clean and reprocess (disinfection or sterilization) and maintain reusable medical
devices according to the manufacturer‟s instructions. If the manufacturer does not
provide such instructions, the device may not be suitable for multi-patient use.
11. To follow manufacturer‟s recommendations for the use of cleaners and disinfectants (e.g.,
amount, dilution, contact time, safe use, and disposal).
12. To provide space and encourage patients with symptoms of respiratory infections to sit
far away from others as possible.
13. To assure wearing appropriate personal protective equipment when handling and
reprocessing contaminated medical devices.
14. To implement respiratory hygiene” cough etiquette” measures to contain respiratory
secretions in patients and accompanying individuals who have signs and symptoms of a
respiratory infection, beginning at point of entry to the facility and continuing throughout
the duration of the visit.