Application of tools to monitor environmental conditions, identify exposures, and inform decision-making to improve infection prevention and control practices in Malawian maternity wards
Application of tools to monitor environmental conditions, identify exposures, and inform decision-making to improve infection prevention and control practices in Malawian maternity wards
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DOI：
10.1007/s10661-020-8089-5
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发表时间：
2020-01-22
影响因子：
3
通讯作者：
Bartram, Jamie
中科院分区：
文献类型：
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作者：
Oza, Hemali Harish;Fisher, Michael Benjamin;Bartram, Jamie
卫生保健获得性感染（HAI）导致孕产妇和新生儿发病率和死亡率，特别是在低收入和中等收入国家（LMIC）。缺乏环境卫生（EH）条件和医疗机构（HCF）的感染预防和控制（IPC）实践有助于HAI的传播，但在低资源环境中很少进行或报告污染源的微生物采样。本研究的目的是评估高血压条件和IPC的做法在马拉维HCF和评估如何高血压的缺陷有助于病原体暴露和HAI，并提供建议，告知改善高血压条件使用混合方法的方法。在马拉维的三个地区，对政府经营的HCF中的31个产科病房进行了调查。在对EH条件和IPC实践进行结构化观察的同时，还对水源和设施表面进行了微生物检测。结果表明，IPC的做法和微生物污染之间的显着关联。在没有为感染的母亲和新生儿提供单独病房以及在医疗服务期间没有为患者使用床单的设施中，更有可能有表面污染的分娩台（相对风险= 2.23; 1.49，3.34）。E.在7个（23%）HCF的水样中检测到大肠杆菌。我们的研究结果表明，马拉维产科病房可以减少微生物污染，并可能减少HAI的发生，通过改善EH条件和IPC的做法。HCF工作人员可以使用本研究中使用的简单、低成本的EH监测方法，将EH条件的微生物监测和低资源环境中HCF的IPC实践结合起来。
Healthcare-acquired infections (HAIs) contribute to maternal and neonatal morbidity and mortality, especially in low- and middle-income countries (LMICs). Deficient environmental health (EH) conditions and infection prevention and control (IPC) practices in healthcare facilities (HCFs) contribute to the spread of HAIs, but microbial sampling of sources of contamination is rarely conducted nor reported in low-resource settings. The purpose of this study was to assess EH conditions and IPC practices in Malawian HCFs and evaluate how EH deficiencies contribute to pathogen exposures and HAIs, and to provide recommendations to inform improvements in EH conditions using a mixed-methods approach. Thirty-one maternity wards in government-run HCFs were surveyed in the three regions of Malawi. Questionnaires were administered in parallel with structured observations of EH conditions and IPC practices and microbial testing of water sources and facility surfaces. Results indicated significant associations between IPC practices and microbial contamination. Facilities where separate wards were not available for mothers and newborns with infections and where linens were not used for patients during healthcare services were more likely to have delivery tables with surface contamination (relative risk = 2.23; 1.49, 3.34). E. coli was detected in water samples from seven (23%) HCFs. Our results suggest that Malawian maternity wards could reduce microbial contamination, and potentially reduce the occurrence of HAIs, by improving EH conditions and IPC practices. HCF staff can use the simple, low-cost EH monitoring methods used in this study to incorporate microbial monitoring of EH conditions and IPC practices in HCFs in low-resource settings.