Understanding infection prevention behaviour in maternity wards: A mixed-methods analysis of hand hygiene in Zanzibar.
Understanding infection prevention behaviour in maternity wards: A mixed-methods analysis of hand hygiene in Zanzibar.
复制标题
了解产科病房的感染预防行为：桑给巴尔手部卫生的混合方法分析。
DOI：
10.1016/j.socscimed.2020.113543
复制
发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Penn-Kekana L
中科院分区：
文献类型：
--
作者：
de Barra M;Gon G;Woodd S;Graham WJ;de Bruin M;Kahabuka C;Williams AJ;Konate K;Ali SM;Said R;Penn-Kekana L
虽然越来越多地鼓励中低收入国家的妇女在设施中分娩，但母亲和新生儿的医疗保健相关感染仍然很常见。感染的一个重要原因是手部卫生不良。有必要了解环境，行为和组织因素如何影响卫生实践。了解设施之间和人之间的卫生行为的变化，并探讨潜在的干预目标，在桑给巴尔的四个劳动病房。实地考察，包括观察交货情况和设施的日常运作情况。对助产士、护理员、管理人员和母亲进行了33次半结构化访谈，共计46小时以上。由两位作者阅读转录的访谈和观察记录并进行编码。根据现有研究制定和分析了专题。在这两个大容量设施中，手部卫生的物理先决条件得到了更定期的满足，肥皂、水、手套几乎总是可用的。然而，在所有设施中，手部卫生似乎受到人体工程学不良的影响，例如水龙头、手套或分娩床之间的物理距离。经常观察到良好的手部卫生后戴手套的手再次污染，助产士将这种模式归因于高和不可预测的工作量和设备短缺。访谈和焦点小组表明，助产士通常了解何时以及为什么应该实施手部卫生，并且他们知道同事中洗手率较低。在性能较差的设施，管理人员不太倾向于访问病房，更有可能认为手卫生超出了他们的影响。观察和访谈表明，改善产房的人体工程学设计，包括方便使用水槽、肥皂、洗手液、手巾和手套，可能是减少手部卫生不良造成的感染负担的低成本方法。我们在桑给巴尔进行了一项关于清洁生产实践的混合方法研究。我们采访了34名工作人员，观察了15次分娩，并在四个设施中度过了15天。虽然手套、肥皂和洗手液经常出现，但它们很少方便。助产士意识到，管理层没有优先考虑同事的卫生状况。改善人体工程学和规范的变化可能有助于改善感染控制。
Although women in low- and middle-income countries are increasingly encouraged to give birth at facilities, healthcare-associated infection of both the mother and newborn remain common. An important cause of infection is poor hand hygiene. There is a need to understand how environmental, behavioural, and organisational factors influence hygiene practice. To understand variations between facilities and between people in hygiene behaviour and to explore potential intervention targets in four labour wards in Zanzibar. Site visits including observation of deliveries and of day-to-day workings of the facilities. Thirty-three semi-structured interviews, totalling more than 46 hours, with birth attendants, orderlies, managerial staff and mothers. Transcribed interviews and observation notes were read and coded by two authors. Themes were developed and analysed in light of existing research. The physical preconditions for hand hygiene were met more regularly in the two highvolume facilities, where soap, water, gloves were almost always available. However, in all of the facilities, hand hygiene appeared impeded by poor ergonomics, like, for example, physical distance between water taps, gloves, or delivery beds. Recontamination of gloved hands following good hand hygiene was commonly observed, a pattern that the birth attendants attributed to high and unpredictable workload and equipment shortages. Interviews and focus groups suggested that birth attendants typically understood when and why hand hygiene should be implemented, and that they were aware of low handwashing rates among co-workers. In poorer performing facilities, managers were less inclined to visit wards and more likely to perceive hand hygiene as beyond their influence. Observations and interviews suggest improvements in the ergonomic design of delivery rooms, including convenient availability of sinks, soap, hand gel, hand towels and gloves, may be a low-cost way to reduce the infection burden from poor hand hygiene. We ran a mixed-methods study on clean birth practices in Zanzibar. We interviewed 34 staff, observed 15 births, and spent 15 days in four facilities. While gloves, soap, and handgel are often present, they are rarely convenient. Midwives realise hygiene is low among colleagues not prioritised by management. Improved ergonomics and norm change may help improve infection control.
登录
查看更多内容
DOI：
10.3390/ijerph120302392
发表时间：
2015-02-23
影响因子：
--
作者：
Bazzano AN;Oberhelman RA;Potts KS;Gordon A;Var C
通讯作者：
Var C
影响因子：
3.2
作者：
Gon, Giorgia;Ali, Said M.;Graham, Wendy J.
通讯作者：
Graham, Wendy J.
影响因子：
168.9
作者：
Kassebaum, N. J.;Bertozzi-Villa, A.;Coggeshall, M. S.
通讯作者：
Coggeshall, M. S.
影响因子：
9.8
作者：
Aunger R;Curtis V
通讯作者：
Curtis V
影响因子：
3.7
作者：
Deyneko, Alexander;Cordeiro, Fernanda;Longtin, Yves
通讯作者：
Longtin, Yves