Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings: a qualitative study.
Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings: a qualitative study.
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DOI：
10.1186/s13031-021-00428-8
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发表时间：
2021-12-20
影响因子：
3.6
通讯作者：
Graham W
中科院分区：
文献类型：
--
作者：
Lowe H;Woodd S;Lange IL;Janjanin S;Barnet J;Graham W
医疗保健相关感染(HAI)是全球医疗保健服务中最常见的不良后果。在受冲突影响的环境中，禽流感，特别是手术部位感染很普遍。有效的感染预防和控制(IPC)对于结束可避免的甲型HAIs至关重要，是安全、有效、高质量卫生服务提供的组成部分。然而，武装冲突和普遍的暴力可能会通过劳动力短缺、供应链中断以及对卫生设施和工作人员的袭击而对卫生保健的质量产生负面影响。为了在这些环境中改进IPC，有必要了解当地经历的具体障碍和促进者。2020年1月和2月，我们在八个受冲突影响的国家(中非共和国、南苏丹、刚果民主共和国、马里、尼日利亚、黎巴嫩、也门和阿富汗)对红十字国际委员会的医院工作人员进行了半结构化访谈。我们探讨了IPC的障碍和促进者，以及冲突对医院及其IPC计划的直接影响。对数据进行了主题分析。我们发现，医院基础设施不足、资源和劳动力短缺、员工教育、在职IPC培训和监督不足以及大量访客是医院IPC的障碍，与其他资源有限的环境中看到的障碍类似。高患者人数、供应链中断、高感染率和对医疗基础设施的攻击，这些都是冲突的直接结果，加剧了现有的挑战，并给医院及其IPC方案带来了额外的负担。我们还找到了在资源有限的情况下改进IPC的地方战略的例子，包括部门IPC冠军和带插图的在职培训指导方针。这项研究中包括的医院展示了它们如何在资源和资金有限的情况下克服某些挑战。这些战略提供了跨背景学习和知识交流的机会，特别是在当前全球冠状病毒大流行的情况下。这些调查结果在今天越来越具有现实意义，因为它们证明了在这些情况下IPC方案的脆弱性。需要更多地研究如何调整IPC方案，以使它们在不稳定的环境中能够可行和可持续。
Healthcare associated infections (HAIs) are the most frequent adverse outcome in healthcare delivery worldwide. In conflict-affected settings HAIs, in particular surgical site infections, are prevalent. Effective infection prevention and control (IPC) is crucial to ending avoidable HAIs and an integral part of safe, effective, high quality health service delivery. However, armed conflict and widespread violence can negatively affect the quality of health care through workforce shortages, supply chain disruptions and attacks on health facilities and staff. To improve IPC in these settings it is necessary to understand the specific barriers and facilitators experienced locally. In January and February of 2020, we conducted semi-structured interviews with hospital staff working for the International Committee of the Red Cross across eight conflict-affected countries (Central African Republic, South Sudan, Democratic Republic of the Congo, Mali, Nigeria, Lebanon, Yemen and Afghanistan). We explored barriers and facilitators to IPC, as well as the direct impact of conflict on the hospital and its’ IPC programme. Data was analysed thematically. We found that inadequate hospital infrastructure, resource and workforce shortages, education of staff, inadequate in-service IPC training and supervision and large visitor numbers are barriers to IPC in hospitals in this study, similar to barriers seen in other resource-limited settings. High patient numbers, supply chain disruptions, high infection rates and attacks on healthcare infrastructures, all as a direct result of conflict, exacerbated existing challenges and imposed an additional burden on hospitals and their IPC programmes. We also found examples of local strategies for improving IPC in the face of limited resources, including departmental IPC champions and illustrated guidelines for in-service training. Hospitals included in this study demonstrated how they overcame certain challenges in the face of limited resources and funding. These strategies present opportunities for learning and knowledge exchange across contexts, particularly in the face of the current global coronavirus pandemic. The findings are increasingly relevant today as they provide evidence of the fragility of IPC programmes in these settings. More research is required on tailoring IPC programmes so that they can be feasible and sustainable in unstable settings.
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