scholarly journals Hand Hygiene during the Early Neonatal Period: A Mixed-methods Observational Study in Healthcare Facilities and Households in Rural Cambodia

2021 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Alison Macintyre ◽  
Por Ir ◽  
Ponnary Pors ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hand Hygiene ◽  
Mixed Methods Research ◽  
Newborn Care ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Hygiene Behaviour ◽  
Wide Range ◽  
Hygiene Compliance ◽  
Context Specific

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both the facility and home environments. Current improvement interventions focus on only one environment and tar-get limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behaviour change intervention in rural Cambodia, a formative mixed-methods research study was conducted to investigate the context specific behaviours and determinants of hand-washing among healthcare workers, maternal and non-maternal caregivers along the early new-born care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and associated communities were completed and hand hygiene compliance assessed in analysis. Semi structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional, and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both set-tings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance to hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusion: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

scholarly journals Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia

2021 ◽  
Vol 18 (9) ◽  
pp. 4416
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Alison Macintyre ◽  
Por Ir ◽  
Ponnary Pors ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Observational Study ◽  
Hand Hygiene ◽  
Behavioural Change ◽  
Newborn Care ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Wide Range ◽  
Hygiene Compliance ◽  
Context Specific

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behavioural change intervention in rural Cambodia, a formative mixed-methods observational study was conducted to investigate the context-specific behaviours and determinants of handwashing among healthcare workers, and maternal and non-maternal caregivers along the early newborn care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and the associated communities were completed and hand hygiene compliance was assessed. Semi-structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both settings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance with hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusions: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

scholarly journals Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

2020 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Erin Flynn ◽  
Olutunde Oluyinka ◽  
Stephen Sara ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Maternal Caregivers ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Post Natal Care ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn ◽  
Natal Care

Abstract Background Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first six hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. Results Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. Conclusions In this setting, hand hygiene practices during post-natal care and the first six hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

scholarly journals Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Por Ir ◽  
Supheap Leang ◽  
Alison Macintyre ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Night Shift ◽  
Formative Research ◽  
Health Care Facilities ◽  
Environmental Drivers ◽  
Birth Attendants ◽  
Hygiene Practices ◽  
Hygiene Compliance

Abstract Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility –based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants. Methods This formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours. Results Birth attendants’ compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants’ qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives’ hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception. Conclusion The resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants’ hand hygiene compliance in our study settings.

scholarly journals Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Erin Flynn ◽  
Olutunde Oluyinka ◽  
Stephen Sara ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Maternal Caregivers ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Post Natal Care ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn ◽  
Natal Care

Abstract Background Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. Results Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. Conclusions In this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

scholarly journals Hygiene Along the Continuum of Care in the Early Post-Natal Period: An Observational Study in Nigeria

2020 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Erin Flynn ◽  
Olutunde Oluyinka ◽  
Stephen Sara ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Limited Attention ◽  
Maternal Caregivers ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Increased Risk ◽  
Post Natal Care ◽  
Natal Care

Abstract Background: Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods: This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first six hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge.Results: Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn.Conclusions: In this setting, hand hygiene practices during post-natal care and the first six hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

scholarly journals Hand Hygiene During Facility-Based Childbirth in Cambodia: A Theory-Driven, Mixed-Methods Observational Study

2021 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Por Ir ◽  
Supheap Leang ◽  
Alison Macintyre ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Night Shift ◽  
Formative Research ◽  
Health Care Facilities ◽  
Environmental Drivers ◽  
Birth Attendants ◽  
Hygiene Practices ◽  
Hygiene Compliance

Abstract Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility –based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants. Methods This formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours. Results Birth attendants’ compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants’ qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives’ hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception. Conclusion The resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants’ hand hygiene compliance in our study settings.

scholarly journals Pathways to clean hands: highlights of successful hand hygiene implementation strategies in Europe

2010 ◽  
Vol 15 (18) ◽  
Author(s):  
A P Magiorakos ◽  
E Leens ◽  
V Drouvot ◽  
L May-Michelangeli ◽  
C Reichardt ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Implementation Strategies ◽  
World Health ◽  
Surveillance Systems ◽  
The European Union ◽  
Hygiene Practices ◽  
Governmental Support ◽  
Hygiene Compliance ◽  
Health Organization ◽  
Healthcare Associated

Hand hygiene is the most effective way to stop the spread of microorganisms and to prevent healthcare-associated infections (HAI). The World Health Organization launched the First Global Patient Safety Challenge - Clean Care is Safer Care - in 2005 with the goal to prevent HAI globally. This year, on 5 May, the WHO’s initiative SAVE LIVES: Clean Your Hands, which focuses on increasing awareness of and improving compliance with hand hygiene practices, celebrated its second global day. In this article, four Member States of the European Union describe strategies that were implemented as part of their national hand hygiene campaigns and were found to be noteworthy. The strategies were: governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol-based hand rub consumption, ensuring seamless coordination of processes between health regions in countries with regionalised healthcare systems, implementing the WHO's My Five Moments for Hand Hygiene, and auditing of hand hygiene compliance.

scholarly journals Behavior and perceptions of hand hygiene practices among dental students

2016 ◽  
Vol 64 (4) ◽  
pp. 434-441 ◽  
Author(s):  
Eliana Dantas da COSTA ◽  
Glaucia Maria Bovi AMBROSANO ◽  
Camila PINELLI
Keyword(s):  
Hand Hygiene ◽  
Undergraduate Students ◽  
Dental Students ◽  
Educational Strategies ◽  
Structured Interviews ◽  
Hygiene Practices ◽  
Adequate Knowledge ◽  
School Of Dentistry ◽  
Hygiene Compliance ◽  
Voice Recorder

ABSTRACT Objective: To investigate behavior and perception of hand hygiene practices among undergraduate students in a School of Dentistry. Methods: The study adopted a qualitative technique called Collective Subject Discourse (CSD). The sample comprised students enrolled in a Public School of Dentistry, in Sao Paulo State, Brazil (n=54). Semi-structured interviews were recorded in a digital voice recorder. Data analysis was carried out by means of a quali-quantitative approach with the help of Qualiquantisoft(r) software. Results: Students showed adequate knowledge regarding guidelines about hand hygiene practices. However, they considered their procedure gloves as an effective way to avoid crossed-infection, and mentioned inadequate infrastructure of sinks and sometimes lack of consumables undermined their adherence to hand hygiene practices. They reported health professionals and professors at the Institution as being reckless with handwashing, especially before donning gloves or after removal. Students reported the school properly guided them in relation to teaching hand hygiene practices, but they stated they were careless with the recommendations. Students were very concerned if they would hypothetically be treated by professionals who did not wash their hands. Conclusion: This study identified some of the hand hygiene compliance failures among dental students. Educational strategies by means of an increase in motivation to perform hand hygiene properly, and by adjusting professor's practices in front of the students would be crucial to improve adherence. Additionally, the improvement on the infrastructure in this institution by means of new washbasins and more available consumables would benefit hand hygiene adherence.

scholarly journals Taking a critical stance towards mixed methods research: A cross-disciplinary qualitative secondary analysis of researchers’ views

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0252014
Author(s):  
Sergi Fàbregues ◽  
Elsa Lucia Escalante-Barrios ◽  
José Francisco Molina-Azorin ◽  
Quan Nha Hong ◽  
Joan Miquel Verd
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Research ◽  
Empirical Studies ◽  
Secondary Analysis ◽  
National Sample ◽  
Research Approach ◽  
Structured Interviews ◽  
Theoretical Perspectives ◽  
Wide Range ◽  
Thoughtful Criticism

Recent growth and institutionalization in the field of mixed methods research has provided fertile ground for a wide range of thoughtful criticism of how this research approach has been developed and conceptualized by some members of the mixed methods community. This criticism reflects the increasing maturity of the field as well as the different theoretical perspectives and methodological practices of researchers in different disciplines. While debates addressing these criticisms are likely to lead to valuable insights, no empirical studies have been carried out to date that have investigated researchers’ critical views on the development and conceptualization of mixed methods research. This study examines the criticisms of the mixed methods field raised by a cross-national sample of researchers in education, nursing, psychology, and sociology. We carried out a secondary analysis of semi-structured interviews with 42 researchers and identified 11 different criticisms, which we classified in four domains: essence of mixed methods, philosophy, procedures, and politics. The criticisms related to the procedures domain were equally distributed among the four disciplines, while those related to the essence, philosophy and politics domains were more common among sociologists. Based on our findings, we argue that the divergence of views on foundational issues in this field reflects researchers’ affiliation to different communities of practice, each having its own principles, values, and interests. We suggest that a greater awareness of this divergence of perspectives could help researchers establish effective collaboration and anticipate potential challenges when working with researchers having different methodological approaches.

Conducting Mixed Methods Research: Using Dialectical Pluralism and Social Psychological Strategies

2020 ◽  
pp. 835-874
Author(s):  
Susan A. Tucker ◽  
R. Burke Johnson ◽  
Anthony J. Onwuegbuzie ◽  
Marjorie L. Icenogle
Keyword(s):  
Mixed Methods ◽  
Group Dynamics ◽  
Mixed Methods Research ◽  
Implementation Strategies ◽  
Group Processes ◽  
Process Theory ◽  
Social Psychological ◽  
Counseling Group ◽  
Workplace Justice ◽  
Wide Range

Dialectical pluralism is both a philosophical process theory and grounded approach for producing syntheses from differences, working toward mutually beneficial solutions, and, through group processes, produces procedural/process justice in mixed methods research and evaluation. Ontologically, dialectical pluralism views reality as plural and changing. Epistemologically, it follows a dialectical, dialogical, hermeneutical approach that includes listening, interacting, and learning from the Other. After explaining how the philosophical process theory of dialectical pluralism provides a process for positively and systematically engaging with differences, we draw on concepts and findings from social psychological literatures such as positive psychology, conflict management, negotiation, small group psychology, group counseling, group dynamics, political diplomacy, deliberative democracy, and workplace justice to show how dialectical pluralism enables learning from differences and produces effective collaboration across paradigms. Implementation strategies are identified for integrating DP into mixed methods research and evaluation (MMR/E). We conclude with a brief vision for MMR/E driven by the philosophy of DP that we hope will be attractive to a wide range of practitioners working across different contexts and topics.

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