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 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 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 Hygiene During Childbirth: An Observational Study to Understand Infection Risk in Healthcare Facilities in Kogi and Ebonyi States, Nigeria

2019 ◽  
Vol 16 (7) ◽  
pp. 1301 ◽  
Author(s):  
Helen Buxton ◽  
Erin Flynn ◽  
Olutunde Oluyinka ◽  
Oliver Cumming ◽  
Joanna Esteves Mills ◽  
...  
Keyword(s):  
Observational Study ◽  
Hand Hygiene ◽  
Health Care Providers ◽  
Infection Risk ◽  
Care Providers ◽  
Prevention Strategies ◽  
Aseptic Technique ◽  
Healthcare Facilities ◽  
Significant Difference ◽  
Hygiene Compliance

Background: Infections acquired during labour and delivery are a significant cause of maternal and child morbidity and mortality. Adherence to hand hygiene protocols is a critical component of infection prevention strategies, but few studies have closely examined the hand hygiene of health care providers with sufficient detail to understand infection risks and prioritize prevention strategies. Methods: This observational study was conducted in six healthcare facilities in Nigeria. In each, five women were observed from the onset of labour through to delivery of the placenta. Hand hygiene infection risk was estimated for all procedures requiring aseptic technique compared against adherence to proper hand hygiene protocol and potential recontamination events. Results: Hands were washed with soap and sterile gloves applied with no observed recontamination before only 3% of all observed procedures requiring aseptic technique. There was no significant difference in hygiene compliance between midwives and doctors nor facilities or states. Adherence to proper hygiene protocol was observed more in morning compared to afternoon and night shifts. Conclusions: This study highlights that hand hygiene remains a barrier to delivering high-quality and safe care in health facilities. Improving hygiene practices during labour and delivery will require strategies that extend beyond infrastructure provision.

scholarly journals COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices

2021 ◽  
Vol 111 ◽  
pp. 27-34 ◽  
Author(s):  
F. Huang ◽  
M. Armando ◽  
S. Dufau ◽  
O. Florea ◽  
P. Brouqui ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Behavioural Change ◽  
Hygiene Practices

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 Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study

2020 ◽  
Vol 25 (5) ◽  
pp. 177-186
Author(s):  
Aaron Asibi Abuosi ◽  
Samuel Kaba Akoriyea ◽  
Gloria Ntow-Kummi ◽  
Joseph Akanuwe ◽  
Patience Aseweh Abor ◽  
...  
Keyword(s):  
Health Care ◽  
Observational Study ◽  
Hand Hygiene ◽  
Outcome Measures ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Hand Washing ◽  
Job Aids ◽  
The Mean ◽  
Hygiene Compliance

Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.

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