scholarly journals A qualitative study of barriers and facilitators to adequate environmental health conditions and infection control for healthcare workers in Malawi

2022 ◽  
Author(s):  
Raymond Tu ◽  
Hayley Elling ◽  
Nikki Behnke ◽  
Jennifer Mmodzi Tseka ◽  
Holystone Kafanikhale ◽  
...  
Keyword(s):  
Environmental Health ◽  
Healthcare Workers ◽  
Barriers And Facilitators ◽  
Infection Prevention And Control ◽  
Structured Interviews ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Management Procedures ◽  
Water Provision ◽  
Healthcare Associated

Abstract The burden of healthcare-associated infections (HAIs) is greater in low- and middle-income countries than in high-income countries. Inadequate environmental health (EH) conditions and work systems contribute to HAIs in countries like Malawi. We collected qualitative data from 48 semi-structured interviews with healthcare workers (HCWs) from 45 healthcare facilities (HCFs) across Malawi and conducted a thematic analysis. The facilitators of infection prevention and control (IPC) practices in HCFs included disinfection practices, patient education, and waste management procedures. HCWs reported barriers such as lack of IPC training, bottlenecks in maintenance and repair, hand hygiene infrastructure, water provision, and personal protective equipment. This is one of the most comprehensive assessments to date of IPC practices and environmental conditions in Malawian HCFs in relation to HCWs. A comprehensive understanding of barriers and facilitators to IPC practices will help decision-makers craft better interventions and policies to support HCWs to protect themselves and their patients.

scholarly journals Risk Factors for Occupational Transmission of Tuberculosis among Healthcare Workers in Zambia

2020 ◽  
pp. 59-65
Author(s):  
Namaunga Kasumu Chisompola ◽  
Kapambwe Mwape Kamanga ◽  
Pipina Vlahakis Matafwali
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Healthcare Workers ◽  
Critical Role ◽  
Nosocomial Transmission ◽  
Infection Prevention And Control ◽  
Original Research ◽  
Healthcare Facilities ◽  
Prolonged Contact ◽  
And Control

Healthcare workers (HCWs) play a critical role in the management and control of nosocomial transmission of tuberculosis (TB). At the same time, working in TB healthcare facilities such as hospital wards, diagnostic and treatment facilities increases the risk of acquiring TB due to occupational exposure in HCWs. The risk is further heightened in high TB prevalence populations, such as Zambia, as HCWs are exposed both occupationally and in the community. This review aims to provide a better understanding of the risk factors associated with occupational transmission of TB in HCWs in Zambia, by synthesising available data on TB in HCWs in Zambia and the surrounding region. A search of peer reviewed original research on the transmission of TB among HCWs in Zambia was conducted in PubMed and Google Scholar. Studies were eligible for inclusion in the analysis if they described TB amongst HCWs in Zambia, risk factors for TB in HCWs, and nosocomial transmission of TB in Zambia and the surrounding region. The prevalence of TB in HCWs has been demonstrated to be higher than that of the general population. Transmission of TB in healthcare facilities is driven by several factors centred on the lack of adherence to TB infection prevention and control (IPC) practices. Nosocomial transmission of TB in HCWs is further driven by the HIV epidemic and the rise in lifestyle diseases such as diabetes mellitus. However, there is very scarce data on the association of diabetes mellitus and TB among HCWs in Zambia. Prolonged contact with TB patients on wards has been demonstrated to play a vital role in occupational transmission of TB amongst nurses in Zambia. To curb the transmission of TB in HCWs several measures will require implementation such as; administrative support, IPC training and annual TB and HIV screening for all HCWs.

scholarly journals Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N’zérékoré Prefecture, Guinea: a cross-sectional study

2020 ◽  
Author(s):  
Manuel Raab ◽  
Lisa M. Pfadenhauer ◽  
Tamba Jacques Millimouno ◽  
Michael Hoelscher ◽  
Guenter Froeschl
Keyword(s):  
Healthcare Workers ◽  
Good Knowledge ◽  
Infection Prevention And Control ◽  
Public Healthcare ◽  
Case Detection ◽  
Rural Healthcare ◽  
Healthcare Facilities ◽  
Attitudes And Practices ◽  
Knowledge Attitudes And Practices ◽  
Suspect Case

Abstract Introduction: The 2013-2016 Ebola epidemic in West Africa began in Guinea’s Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas. Methods: In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N’zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys. Results: The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF. Conclusions: Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N’zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training.

scholarly journals Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing

2020 ◽  
Vol 17 (6) ◽  
pp. 2075 ◽  
Author(s):  
Darcy M. Anderson ◽  
Ryan Cronk ◽  
Lucy Best ◽  
Mark Radin ◽  
Hayley Schram ◽  
...  
Keyword(s):  
Data Collection ◽  
Health Services ◽  
Environmental Health ◽  
Quality Data ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Good Practices ◽  
Middle Income Countries ◽  
Step Model ◽  
Adequate Provision

Environmental health services (EHS) in healthcare facilities (HCFs) are critical for safe care provision, yet their availability in low- and middle-income countries is low. A poor understanding of costs hinders progress towards adequate provision. Methods are inconsistent and poorly documented in costing literature, suggesting opportunities to improve evidence. The goal of this research was to develop a model to guide budgeting for EHS in HCFs. Based on 47 studies selected through a systematic review, we identified discrete budgeting steps, developed codes to define each step, and ordered steps into a model. We identified good practices based on a review of additional selected guidelines for costing EHS and HCFs. Our model comprises ten steps in three phases: planning, data collection, and synthesis. Costing-stakeholders define the costing purpose, relevant EHS, and cost scope; assess the EHS delivery context; develop a costing plan; and identify data sources (planning). Stakeholders then execute their costing plan and evaluate the data quality (data collection). Finally, stakeholders calculate costs and disseminate findings (synthesis). We present three hypothetical costing examples and discuss good practices, including using costing frameworks, selecting appropriate indicators to measure the quantity and quality of EHS, and iterating planning and data collection to select appropriate costing approaches and identify data gaps.

scholarly journals 1208. Preventing Transmission of Bloodborne Viruses from-Infected Healthcare Workers to Patients in Canadian Healthcare Settings: A National Guideline

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S434-S434 ◽  
Author(s):  
Toju Ogunremi ◽  
Katherine Defalco ◽  
B Lynn Johnston ◽  
Isabelle Boucoiran ◽  
Maureen Cividino ◽  
...  
Keyword(s):  
Viral Load ◽  
Healthcare Workers ◽  
Infection Prevention And Control ◽  
Post Exposure Prophylaxis ◽  
Minimal Risk ◽  
Expert Review ◽  
Healthcare Settings ◽  
Exposure Prophylaxis ◽  
Healthcare Associated ◽  
Bloodborne Viruses

Abstract Background Infectious agents, such as bloodborne viruses (BBVs), can potentially be transmitted from healthcare workers (HCWs) to patients. In an effort to reduce this risk to patients, this guideline, which provides a framework for policies on the management of HCWs infected with BBVs in Canada, was developed. Methods A total of six systematic reviews (1995–2016) were conducted to inform the risk of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) from infected HCWs to patients and the infectivity of each virus related to source serum viral load. Three environmental scans were conducted to inform sections on disclosure of HCW’s serologic status, Expert Review Panels, and lookback investigations. Government partners and key stakeholder organizations were consulted and a Task Group provided technical expertise. Results The risk of HCW-to-patient BBV transmission is negligible, except during exposure-prone procedures where there is a risk of HCW injury and possible exposure of a patient’s open tissues to the HCW’s blood. Transmission rates were lowest with HIV and highest with HBV (Table 1). Rates varied with several factors including source viral load, nature of potential exposure, infection prevention and control breaches, susceptibility of exposed patient, and use of post-exposure prophylaxis where relevant. The extent of reporting bias for exposure incidents where transmission did not occur is unknown. Current antiviral therapy informed guideline recommendations, with viral load thresholds provided to assist treating physician, Expert Review Panels and regulatory authorities in determining a HCW’s fitness for practice. Conclusion Routine Practices (or Standard Precautions) are critical to prevent HCW-to-patient transmission of infections; including BBVs. Recommendations provided in this guideline aim to further reduce the already minimal risk of HCW-to-patient transmission. The guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations directly impacting clinical practice related to preventing and controlling healthcare-associated infections. Disclosures All authors: No reported disclosures.

scholarly journals Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Lesley T. Bhebhe ◽  
Cornel Van Rooyen ◽  
Wilhelm J. Steinberg
Keyword(s):  
Infection Control ◽  
Prevention And Control ◽  
Healthcare Workers ◽  
Infection Prevention ◽  
Significant Proportion ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Attitudes And Practices ◽  
Healthcare Associated ◽  
And Control

Background: Healthcare-associated tuberculosis (TB) has become a major occupational hazard for healthcare workers (HCWs). HCWs are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Whenever there is a possibility of exposure, implementation of infection prevention and control (IPC) practices is critical.Objective: Following a high incidence of TB among HCWs at Maluti Adventist Hospital in Lesotho, a study was carried out to assess the knowledge, attitudes and practices of HCWs regarding healthcare-associated TB infection and infection controls.Methods: This was a cross-sectional study performed in June 2011; it involved HCWs at Maluti Adventist Hospital who were involved with patients and/or sputum. Stratified sampling of 140 HCWs was performed, of whom, 129 (92.0%) took part. A self-administered, semi-structured questionnaire was used.Results: Most respondents (89.2%) had appropriate knowledge of transmission, diagnosis and prevention of TB; however, only 22.0% of the respondents knew the appropriate method of sputum collection. All of the respondents (100.0%) were motivated and willing to implement IPC measures. A significant proportion of participants (36.4%) reported poor infection control practices, with the majority of inappropriate practices being the administrative infection controls (> 80.0%). Only 38.8% of the participants reported to be using the appropriate N-95 respirator.Conclusion: Poor infection control practices regarding occupational TB exposure were demonstrated, the worst being the first-line administrative infection controls. Critical knowledge gaps were identified; however, there was encouraging willingness by HCWs to adapt to recommended infection control measures. Healthcare workers are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Implementation of infection prevention and control practices is critical whenever there is a possibility of exposure.

scholarly journals Serologic Evaluation of Healthcare Workers Caring for COVID-19 Patients in the Republic of Korea

2020 ◽  
Vol 11 ◽  
Author(s):  
Jae-Hoon Ko ◽  
Ji Yeon Lee ◽  
Hyun Ah Kim ◽  
Seung-Ji Kang ◽  
Jin Yang Baek ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Workers ◽  
High Sensitivity ◽  
Screening Strategy ◽  
Infection Prevention And Control ◽  
Respiratory Syndrome Virus ◽  
Enzyme Linked Immunosorbent Assay ◽  
Neutralizing Activity ◽  
The Republic ◽  
Healthcare Associated

The safety of healthcare workers (HCWs) against severe acute respiratory syndrome virus 2 (SARS-CoV-2) transmission is an important aspect of managing the coronavirus disease 2019 (COVID-19) pandemic. In the South Korea, highly stringent infection prevention and control (IPC) guidelines are implemented, and reports of healthcare-associated SARS-CoV-2 transmission among HCWs are limited. However, subclinical infections may have been missed by the current symptom-based screening strategy. To evaluate the risk of undetected SARS-CoV-2 transmissions from COVID-19 patients to HCWs, we conducted a multicenter seroprevalence study after the first surge of the COVID-19 outbreak. A total of 432 HCWs were evaluated, comprising 309 HCWs designated to laboratory-confirmed COVID-19 patient care and 123 non-designated HCWs. Designated HCWs wore personal protective equipment including an N95 respirator, eye protection, hooded overalls, shoe covers, and inner and outer gloves. Use of a powered air-purifying respirator was recommended for aerosol-generating procedures or long-duration care activities. A high-sensitivity (99.1%) fluorescence immunoassay immunoglobulin G (IgG) kit was used as the initial screening test, and two enzyme-linked immunosorbent assay kits for total and IgG antibodies were used to confirm the test results. A microneutralization test was additionally performed to evaluate the neutralizing activity of positive specimens. Among the evaluated HCWs, none of the non-designated HCWs had a positive result, while one of the HCWs designated for COVID-19 patient care (1/309, 0.3%) was seropositive for SARS-CoV-2 with confirmed neutralizing activity (1:40). This finding suggests that subclinical seroconversion may occur among HCWs caring for COVID-19 patients, although the risk is low under strict IPC guidance.

scholarly journals Safe Healthcare Facilities: A Systematic Review on the Costs of Establishing and Maintaining Environmental Health in Facilities in Low- and Middle-Income Countries

2021 ◽  
Vol 18 (2) ◽  
pp. 817
Author(s):  
Darcy M. Anderson ◽  
Ryan Cronk ◽  
Donald Fejfar ◽  
Emily Pak ◽  
Michelle Cawley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Waste Management ◽  
Vector Control ◽  
Environmental Health ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
Low And Middle Income

A hygienic environment is essential to provide quality patient care and prevent healthcare-acquired infections. Understanding costs is important to budget for service delivery, but costs evidence for environmental health services (EHS) in healthcare facilities (HCFs) is lacking. We present the first systematic review to evaluate the costs of establishing, operating, and maintaining EHS in HCFs in low- and middle-income countries (LMICs). We systematically searched for studies costing water, sanitation, hygiene, cleaning, waste management, personal protective equipment, vector control, laundry, and lighting in LMICs. Our search yielded 36 studies that reported costs for 51 EHS. There were 3 studies that reported costs for water, 3 for sanitation, 4 for hygiene, 13 for waste management, 16 for cleaning, 2 for personal protective equipment, 10 for laundry, and none for lighting or vector control. Quality of evidence was low. Reported costs were rarely representative of the total costs of EHS provision. Unit costs were infrequently reported. This review identifies opportunities to improve costing research through efforts to categorize and disaggregate EHS costs, greater dissemination of existing unpublished data, improvements to indicators to monitor EHS demand and quality necessary to contextualize costs, and development of frameworks to define EHS needs and essential inputs to guide future costing.

scholarly journals Impact of mhealth messages and environmental cues on hand hygiene practice among healthcare workers in the greater Kampala metropolitan area, Uganda: study protocol for a cluster randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard K. Mugambe ◽  
Jane Sembuche Mselle ◽  
Tonny Ssekamatte ◽  
Moses Ntanda ◽  
John Bosco Isunju ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Randomized Trial ◽  
Metropolitan Area ◽  
Healthcare Workers ◽  
Cluster Randomized Trial ◽  
Barriers And Facilitators ◽  
Infection Prevention And Control ◽  
Environmental Cues ◽  
Cluster Randomized ◽  
The Impact

Abstract Background Hand hygiene (HH) among healthcare workers (HCWs) is critical for infection prevention and control (IPC) in healthcare facilities (HCFs). Nonetheless, it remains a challenge in HCFs, largely due to lack of high-impact and efficacious interventions. Environmental cues and mobile phone health messaging (mhealth) have the potential to improve HH compliance among HCWs, however, these remain under-studied. Our study will determine the impact of mhealth hygiene messages and environmental cues on HH practice among HCWs in the Greater Kampala Metropolitan Area (GKMA). Methods The study is a cluster-randomized trial, which will be guided by the behaviour centred design model and theory for behaviour change. During the formative phase, we shall conduct 30 key informants’ interviews and 30 semi-structured interviews to explore the barriers and facilitators to HCWs’ HH practice. Besides, observations of HH facilities in 100 HCFs will be conducted. Findings from the formative phase will guide the intervention design during a stakeholders’ insight workshop. The intervention will be implemented for a period of 4 months in 30 HCFs, with a sample of 450 HCWs who work in maternity and children’s wards. HCFs in the control arm will receive innovatively designed HH facilities and supplies. HCWs in the intervention arm, in addition to the HH facilities and supplies, will receive environmental cues and mhealth messages. The main outcome will be the proportion of utilized HH opportunities out of the 9000 HH opportunities to be observed. The secondary outcome will be E. coli concentration levels in 100mls of hand rinsates from HCWs, an indicator of recent fecal contamination and HH failure. We shall run multivariable logistic regression under the generalized estimating equations (GEE) framework to account for the dependence of HH on the intervention. Discussion The study will provide critical findings on barriers and facilitators to HH practice among HCWs, and the impact of environmental cues and mhealth messages on HCWs’ HH practice. Trial registration ISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.

scholarly journals A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical units in Québec

2021 ◽  
Author(s):  
Eric Tchouaket ◽  
Stephanie Robins ◽  
Sandra Boivin ◽  
Drissa Sia ◽  
Kelley Kilpatrick ◽  
...  
Keyword(s):  
Best Practices ◽  
Prevention And Control ◽  
Healthcare Workers ◽  
Infection Prevention ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Median Cost ◽  
Healthcare Associated ◽  
The Cost ◽  
And Control

Abstract Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions are keystones of infection prevention and control (IPC). Systematic reviews of IPC economic evaluations report the lack of rigorous empirical evidence demonstrating the cost-benefit of IPC program in general, and point to the lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials required (e.g. masks, cloths, disinfectants) for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars. Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 19.6 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21.4 cents per action, while cleaning of small equipment (N = 85) was 25.3 cents per action. Additional precautions median cost was $4.13 per action. The donning or removing or personal protective equipment (N = 720) cost was 75.9 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27.2 cents per action. Conclusion The costs of clinical best practices were low, from 20 cents to $4.13 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.

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