Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units
Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units
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DOI：
10.1093/heapol/czx081
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发表时间：
2017-10-01
影响因子：
3.2
通讯作者：
Graham, Wendy J.
中科院分区：
文献类型：
--
作者：
Gon, Giorgia;Ali, Said M.;Graham, Wendy J.
坦桑尼亚联合共和国最近的全国调查显示，设施中出生时的卫生标准很差。随着越来越多的妇女选择住院分娩，改善基本卫生成为减少产后和新生儿败血症的预防性战略的重要组成部分。我们在桑给巴尔的合作研究提供了产科病房卫生状况的深入图景，为采取行动提供参考。2014年，在桑给巴尔设有产科病房的所有37家医院都进行了卫生评估。我们使用了混合方法，包括结构化和半结构化访谈，以及环境微生物学。根据世卫组织的“清洁”框架对数据进行了分析，重点放在预防新生儿和产妇败血症的基本做法上。对于每一个“干净的”，我们探索了以下促进因素：知识、基础设施(包括设备)、人员配备水平和政策。从量化数据中构建了清洁的促成因素的综合指数：干净的手、脐带切割和产后表面。定性工具的结果被用来补充这一信息。只有49%的设施具有使人能够清洁双手的基础设施要求，特别是缺乏持续的自来水供应。只有不到一半(46%)的设施达到了确保“清洁的分娩表面”的“知识”要求；7个设施中有6个的分娩表面对多种潜在病原体检测呈阳性。几乎三分之二的设施满足“清洁绳索”的“基础设施(设备)要求”；然而，一次性绳索夹经常缺货，往往导致使用非无菌布线。这一混合方法以及以世卫组织“清洁”和有利因素为基础的分析框架产生了与地方和部级行动直接相关的实用信息。同样的办法也可用于收集和分析其他情况下产科病房关于预防感染的数据。
Recent national surveys in The United Republic of Tanzania have revealed poor standards of hygiene at birth in facilities. As more women opt for institutional delivery, improving basic hygiene becomes an essential part of preventative strategies for reducing puerperal and newborn sepsis. Our collaborative research in Zanzibar provides an in-depth picture of the state of hygiene on maternity wards to inform action. Hygiene was assessed in 2014 across all 37 facilities with a maternity unit in Zanzibar. We used a mixed methods approach, including structured and semi-structured interviews, and environmental microbiology. Data were analysed according to the WHO 'cleans' framework, focusing on the fundamental practices for prevention of newborn and maternal sepsis. For each 'clean' we explored the following enabling factors: knowledge, infrastructure (including equipment), staffing levels and policies. Composite indices were constructed for the enabling factors of the 'cleans' from the quantitative data: clean hands, cord cutting, and birth surface. Results from the qualitative tools were used to complement this information.Only 49% of facilities had the 'infrastructural' requirements to enable 'clean hands', with the availability of constant running water particularly lacking. Less than half (46%) of facilities met the 'knowledge' requirements for ensuring a 'clean delivery surface'; six out of seven facilities had birthing surfaces that tested positive for multiple potential pathogens. Almost two thirds of facilities met the 'infrastructure (equipment) requirement' for 'clean cord'; however, disposable cord clamps being frequently out of stock, often resulted in the use of non-sterile thread made of fabric. This mixed methods approach, and the analytical framework based on the WHO 'cleans' and the enabling factors, yielded practical information of direct relevance to action at local and ministerial levels. The same approach could be applied to collect and analyse data on infection prevention from maternity units in other contexts.