What are the threats from antimicrobial resistance for maternity units in low- and middle- income countries?

Graham, Wendy; Morrison, Emma; Dancer, S.J.; Afsana, Kaosar; Aulakh, Alex; Campbell, Oona M. R.; Cross, Suzanne; Ellis, Ryan J.; Enkubahiri, Siyoum; Fekad, Bazezew; Gon, Giorgia; Idoko, Patrick; Moore, Jolene; Saxena, Deepak; Velleman, Yael; Woodd, Susannah

doi:10.3402/gha.v9.33381

Cited by 21 publications

(23 citation statements)

References 18 publications

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“…Factors predisposing to high risks of puerperal infections include non-compliance with SPIC, unhygienic births by unskilled birth attendants, multiple vaginal examinations, prolonged labour and premature rapture of foetal membranes home [1]. Other factors also include the flora of the delivery room, and the types of antibiotics used, [9].…”

Section: Standard Precautions Of Infection Control (Spic) Protocols Rmentioning

confidence: 99%

Factors Associated with Compliance with Infection Control Guidelines in the Management of Labour by Healthcare Workers at Mulago Hospital, Uganda

Komuhangi¹,

Kevin²,

Felex³

et al. 2019

OJN

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Globally, infections acquired during childbirth contribute to one tenth of the maternal deaths annually [1] [2]. Factors predisposing to high risks of puerperal infections include non-compliance with Standard Precautions of Infection Control (SPIC), unhygienic births by unskilled birth attendants, multiple vaginal examinations, prolonged labour and premature rapture of membranes [1]. The main purpose of this study was to determine factors associated with compliance to standard precautions of infection control the management of labour by healthcare workers in Mulago Hospital to generate information, which may be used in infection control and prevention practices. A cross-sectional study utilizing a quantitative approach was conducted among 115 healthcare workers. Consecutive sampling was done to include respondents in the study. Data were collected by direct observation and researcher administered questionnaires. Data were coded and entered into the computer using SPSS version 20 with programmed quality control checks. Descriptive data analyses, frequencies, cross tabulations and logistic regression analysis were the major statistical methods used. 103 healthcare workers were involved in the study, where 74% were females. Overall compliance was at 52%, although it varied across domains. The majority of the healthcare workers (95.1%) did not comply with hand hygiene. Being a male was associated with low compliance scores a cross most domains. One of the hospital factors which was significantly associated with compliance to hand hygiene was having had an in-service training with p = 0.008 and p = 0.012 at multivariate analysis. Overall compliance to standard precautions of infection control was

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Section: Standard Precautions Of Infection Control (Spic) Protocols Rmentioning

confidence: 99%

Factors Associated with Compliance with Infection Control Guidelines in the Management of Labour by Healthcare Workers at Mulago Hospital, Uganda

Komuhangi¹,

Kevin²,

Felex³

et al. 2019

OJN

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“…Similarly in Zanzibar, Tanzania maternity beds of surveyed facilities were found to be highly contaminated, with multiple organisms also found on mops and cleaning cloths [12]. This poor state of hygiene has also been suggested to contribute to the overuse of antibiotics in LMICs [6].…”

Section: Introductionmentioning

confidence: 99%

“…The increased risk to mothers and newborns of iatrogenic infections are well known [5]. Despite this, primary prevention of infections through water, sanitation and hygiene (WASH) and infection prevention and control (IPC) is often lacking [6].…”

Section: Introductionmentioning

confidence: 99%

An invisible workforce: the neglected role of cleaners in patient safety on maternity units

Cross¹,

Gon

Morrison³

et al. 2019

Global Health Action

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Hospital cleaning has been shown to impact on rates of healthcare-associated infections (HCAIs) and good environmental hygiene is critical to quality care, yet those tasked with the role of ensuring a safe and clean environment often go unrecognised as members of the healthcare workforce. Sepsis is a leading cause of maternal and newborn death, a significant proportion of these cases are estimated to be due to HCAIs. Deliveries in health institutions have now reached 75% globally, and in low and middle income countries the corresponding increased pressure on facilities has impacted both quality of care provided and quality of the birth environment in terms of infection prevention and control (IPC) and HCAIs. The paper discusses the neglected role of health facility cleaners, providing evidence from the literature and from needs assessments conducted by The Soapbox Collaborative and partners in Bangladesh, India, The Gambia and Zanzibar. While not the primary focus of the assessments, common themes emerged consistently pointing to institutional neglect of cleaning and cleaners. The paper argues that low status within facilities, wider societal marginalisation, lack of training, and poor pay and working conditions contribute to the lack of prioritisation placed on health facility environmental hygiene. With increased international attention focused towards health facility water, sanitation and hygiene and a growing focus on IPC, now is the time to address the neglect of this frontline healthcare workforce. We propose that provision of and improved training can enable the recognition of the valuable role cleaning staff play, as well as equipping these staff with the tools required to perform their job to the highest standard. In addition to training, wider systems changes are necessary to establish improvements in environmental hygiene and the role of cleaning staff, including addressing resource availability, supportive supervision, and an increased emphasis on preventative healthcare.

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“…Systematic investigation into clean birthing practices in LMIC has to-date been concentrated on umbilical cord care [17,18] hygiene among traditional birth attendants [19]. More recently, there has been increased attention to the availability and quality of water, sanitation, and hygiene (WASH) infrastructure in health care facilities [20][21][22]. These are fundamental in facilitating hygienic birth and postnatal care, and are essential for the delivery of most infection prevention control procedures and quality of care more generally [23].…”

Section: Introductionmentioning

confidence: 99%

Determinants of Clean Birthing Practices in Low- and Middle-Income Countries: a Scoping Review

Mills

Flynn

Cumming

et al. 2020

Preprint

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Background Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare workers or mothers during the perinatal period in LMIC. Methods We reviewed literature published between January 2000 and February 2018 providing information on behaviour change interventions, behaviours or behavioural determinants during the perinatal period in LMIC. Following a multi-stage screening process, we extracted key data manually from studies. We mapped identified determinants according to the COM-B behavioural framework, which posits that behaviour is shaped by three categories of determinants – capability, opportunity and motivation. Results 78 studies were included: 47 observational studies and 31 studies evaluating an intervention. 51% had a household or community focus, 28% had a healthcare facility focus and 21% focused on both. We identified 31 determinants of clean birthing practices. Determinants related to clean birthing practices as a generalised set of behaviours featured in 50 studies; determinants related specifically to one or more of six predefined behaviours – commonly referred to as “the six cleans” – featured in 31 studies. Determinants of hand hygiene (n=13) and clean cord care (n=11) were most commonly reported. Reported determinants across all studies clustered around psychological capability (knowledge) and physical opportunity (access to resources). However, greater heterogeneity in reported behavioural determinants was found across studies investigating specific clean birthing practices compared to those studying clean birthing as a generalised set of behaviours. Conclusions Efforts to combine clean birthing practices into a single suite of behaviours – such as the “six cleans”– may simplify policy and advocacy efforts. However, each clean practice has a unique set of determinants and understanding what drives or hinders the adoption of these individual practices is critical to designing more effective interventions to improve hygiene behaviours and neonatal and maternal health outcomes in LMIC. Current understanding in this regard remains limited. More theory-grounded formative research is required to understand motivators and social influences across different contexts.

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What are the threats from antimicrobial resistance for maternity units in low- and middle- income countries?

Cited by 21 publications

References 18 publications

Factors Associated with Compliance with Infection Control Guidelines in the Management of Labour by Healthcare Workers at Mulago Hospital, Uganda

Factors Associated with Compliance with Infection Control Guidelines in the Management of Labour by Healthcare Workers at Mulago Hospital, Uganda

An invisible workforce: the neglected role of cleaners in patient safety on maternity units

Determinants of Clean Birthing Practices in Low- and Middle-Income Countries: a Scoping Review

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