Hygiene on maternity units: lessons from a needs assessment in Bangladesh and India

Abstract

BackgroundAs the proportion of deliveries in health institutions increases in low- and middle-income countries, so do the challenges of maintaining standards of hygiene and preventing healthcare-associated infections (HCAIs) in mothers and babies. Adequate water, sanitation, and hygiene (WASH) and infection prevention and control (IPC) in these settings should be seen as integral parts of the broader domain of quality care. Assessment approaches are needed which capture standards for both WASH and IPC, and so inform quality improvement processes.DesignA needs assessment was conducted in seven maternity units in Gujarat, India, and eight in Dhaka Division, Bangladesh in 2014. The WASH & CLEAN study developed and applied a suite of tools – a ‘walkthrough checklist’ which included the collection of swab samples, a facility needs assessment tool and document review, and qualitative interviews with staff and recently delivered women – to establish the state of hygiene as measured by visual cleanliness and the presence of potential pathogens, and individual and contextual determinants or drivers.ResultsNo clear relationship was found between visually assessed cleanliness and the presence of pathogens; findings from qualitative interviews and the facility questionnaire found inadequacies in IPC training for healthcare providers and no formal training at all for ward cleaners. Lack of written policies and protocols, and poor monitoring and supervision also contributed to suboptimal IPC standards.ConclusionsVisual assessment of cleanliness and hygiene is an inadequate marker for ‘safety’ in terms of the presence of potential pathogens and associated risk of infection. Routine environmental screening of high-risk touch sites using simple microbiology could improve detection and control of pathogens. IPC training for both healthcare providers and ward cleaners represents an important opportunity for quality improvement. This should occur in conjunction with broader systems changes, including the establishment of functioning IPC committees, implementing standard policies and protocols, and improving health management information systems to capture information on maternal and newborn HCAIs.

Barriers and opportunities experienced by staff when implementing infection prevention and control guidelines during labour and delivery in healthcare facilities in Nigeria

“…Areas where HCFs were performing well in IPC compliance included provision of usable HWFs in delivery units and visible cleanliness of delivery units and postnatal wards. However, as swab tests were not performed, it cannot be assumed that cleanliness correlates with microbiological safety [15]. Critical areas of concern related to IPC included: lack of provision of single-use towels for hand drying, inadequate availability of cleaning products and equipment, inadequate segregation of waste, inadequate provision of personal protective equipment, inadequate hand hygiene practices, and outdated procedures to reprocess medical equipment.…”

Segurança do paciente na perspectiva de gestantes e puérperas

“…It was identified in a study carried out in maternity hospitals in India, that the training of professionals, the implementation of protocols and the management of information systems are opportunities to improve the service. 19 Other suggestions were considered, such as improving communication among professionals, due to the change of behavior after the change of the medical attendance, listening more attentively to patients, increasing night shift professionals, improving hospitalization and discharge, agility in the diagnosis and testing, reassessment of access to family members and surveillance. It corroborates the perception of pregnant women and puerperae in studies that identified failures in obstetric care, such as lack of communication and shortage of professionals, overloading work.…”

A Linked Community and Health Facility Intervention to Improve Newborn Health in Cambodia: The NICCI Stepped-Wedge Cluster-Randomized Controlled Trial

“…Acceptance of these practices by local populations has been shown to be important in the success of WASH-based interventions [30], and simultaneous community-based antenatal care education on possible danger signs is key in this process. Previous studies on community health worker effectiveness have noted the importance of WASH practices in maternal and neonatal health, especially at the level of the health center [31,32]. However, it is not possible to determine the effect on outcomes of training on knowledge beyond 28 days of delivery without cohort or longitudinal studies.…”