Reducing infection risks in maternity and neonatal wards through improved environmental hygiene: an exploratory study in The Gambia.

感染是孕产妇和新生儿死亡的主要原因，特别是在撒哈拉以南非洲，那里也有医院获得性感染（HAI）的高负担，暴露于不卫生的做法和环境进一步对母亲和新生儿构成重大风险。在这些环境中发生的HAI通常是由耐药性细菌引起的，其传播是几个因素的结果，包括水、环境卫生和个人卫生（WASH）不足，感染控制不良，清洁不充分，目的和目标我们的研究旨在探索环境清洁包的作用及其对非洲医院中一些最脆弱患者的影响-具体目标是：1.确定冈比亚两家医院妇产科和新生儿病房环境污染的基线测量值，包括这类测量值的两周变化情况;2.为中低收入国家的新生儿专门制定一套适合具体情况的清洁培训教材，重点是撒哈拉以南非洲3。在冈比亚的两家大医院试行这一培训包干预措施，并衡量对环境清洁的潜在影响。4.建立一个研究人员和相关WASH/IPC利益攸关方网络，包括区域母婴感染网络和感染控制非洲网络，并建立合作，以支持未来在西非多个区域新生儿单位进行相同清洁干预试验，将西非和英国的学术合作伙伴聚集在一起。潜在的应用和好处清洁卫生的医疗保健设施可以帮助建立对卫生服务的信任，鼓励母亲寻求产前护理，并在设施中而不是在家中分娩-这是降低孕产妇和新生儿死亡率战略的两个重要要素。我们的研究结果还将为根据关于讲卫生运动的世界卫生决议制定的新的全球行动计划提供新的证据，IPC和AMRWe将利用从这项初步工作中获得的知识，召集一个研究人员网络，为未来在非洲试验这种清洁培训包干预多个新生儿病房的感染结果建立案例。

Context of the researchInfection is a leading cause of maternal and newborn deaths, particularly in sub-Saharan Africa where there is also a high burden of hospital-acquired infections (HAIs), and where exposure to unhygienic practices and environment further poses a substantial risk to mothers and newborns. The HAIs occurring in these settings are often caused by antibiotic-resistant bacteria, whose transmission is the result of several factors including inadequate water, sanitation and hygiene (WASH), poor infection control, inadequate cleaning, and overcrowding wards.Aims and objectivesOur research aims to explore the role of an environmental cleaning package and its effect on some of the most vulnerable patients in African hospitals - women and newborns.The specific objectives are:1. To establish baseline measurements of environmental contamination in the maternity and neonatal units in two hospitals in The Gambia, including two-weekly variability in such measures;2. To develop a contextually appropriate cleaning training package specifically for newborn units in LMICs, with a focus on sub-Saharan Africa3. To pilot this training package intervention in two large hospitals in The Gambia and measure potential impact on environmental cleanliness. 4. To establish a network of researchers and relevant WASH/IPC stakeholders, including the regional Maternal-Newborn Infection network and Infection Control Africa Network (ICAN), and build collaborations to support a future West African trial of the same cleaning intervention across multiple regional neonatal units, bringing together academic partners in West Africa and the UK.Potential applications and benefitsClean and hygienic health care facilities can help establish trust in health services and encourage mothers to seek prenatal care and deliver in facilities rather than at home - two important elements of the strategy to reduce maternal and newborn mortality.The findings from our study will also contribute new evidence for the new global action plan arising from the World Health Resolution on WASH, IPC and AMRWe will use the learning derived from this preliminary work to convene a network of researchers to build the case for a future African trial of this cleaning training package intervention against an infectious outcome across multiple neonatal units.