title: Healthcare-associated infections in children: knowledge, attitudes and practice of paediatric healthcare providers at Tygerberg Hospital, Cape Town.
abstract: Healthcare (HC) providers' knowledge, attitudes and practices with regard to infection control (IC) may positively or adversely affect rates of institutional healthcare-associated infection (HAI).
  
  
  
  To determine paediatric HC providers' knowledge, attitudes and practices regarding HAI and guide IC interventions in a resource-limited setting.
  
  
  
  Paediatric HC providers at Tygerberg Children's Hospital, Cape Town, South Africa completed an anonymous, self-administered, 37-item questionnaire.
  
  
  
  Questionnaires (201, 66.6% participation rate) were completed by medical (90, 44.7%), allied health (16, 8%) and nursing providers (95, 47.3%). Median age was 34 years (IQR 27-43), and 84% were female. Knowledge scores were low [57% correct, mean (SD) 7.7 (1.7)/14 questions] but higher in the medical/allied category (P ≤ 0.001) and those qualified for ≥ 10 years (P = 0.008). Providers lacked knowledge of the main routes of infection transmission and misunderstood hand hygiene and terminal cleaning recommendations. Nurses scored higher for attitude questions [63% desired responses, mean 5 (1.2)/8 questions] (P = 0.02). Only 38% reported adequate undergraduate teaching on HAI and most (93%) wanted more in-service IC training. Providers agreed with punitive measures for colleagues ignoring IC recommendations (89%). Nurses scored higher for practice questions [53% desired responses, mean 3.2 (1.2)/6 questions] (P ≤ 0.001). Self-reported adherence to IC recommendations was high, 88% for hand hygiene and 74% for use of personal protective equipment. However, there was poor uptake of annual influenza vaccination (25%) and N95 respirator fit-testing (28%), and many felt obliged to report for work when sick (67%).
  
  
  
  Expanded in-service and undergraduate training in IC should emphasize methods of hand hygiene and routes of infection transmission. Paediatric providers support mandatory reporting of HAI events and stricter enforcement of IC recommendations.
authors.affiliation: a Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Childrens' Hospital.
authors.forename: Angela
authors.initials: A
authors.lastname: Dramowski
authors.affiliation: b Department of Medical Microbiology , Stellenbosch University and the National Health Laboratory Service (NHLS) , Cape Town , South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.affiliation: a Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Childrens' Hospital.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D010372:Pediatrics; D013019:South Africa; D011795:Surveys and Questionnaires
keywords: HAI, healthcare-associated infection; HC, healthcare; Healthcare-associated infection; IC, infection control; IPC, infection prevention and control; IQR, interquartile range; Infection prevention and control; KAP survey; KAP, knowledge attitudes and practice; NS, not significant; Nosocomial infection; PPE, personal protective equipment; Paediatrics; TBP, transmission-based precautions; TCH, Tygerberg Children's Hospital