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

研究背景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，那里也有很高的医院获得性感染负担，暴露在不卫生的做法和环境中进一步对母亲和新生儿构成重大风险。发生在这些环境中的人类免疫缺陷病毒通常是由抗生素耐药细菌引起的，其传播是几个因素的结果，包括水、卫生和卫生(洗涤)不足、感染控制不佳、清洁不足和过度拥挤的病房。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的患者-妇女和新生儿的影响。具体目标是：1.建立冈比亚两家医院产科和新生儿病房环境污染的基线测量，包括此类测量的两周变化；2.专门为小岛屿发展中国家的新生儿制定一套切合实际的清洁培训包，重点放在撒哈拉以南非洲地区3。在冈比亚的两家大型医院试行这一一揽子培训干预措施，并衡量对环境清洁度的潜在影响。4.建立一个由研究人员和包括区域产妇--新生儿感染网络和感染控制非洲网络在内的研究人员和相关的清洁/新生婴儿方案利益攸关方组成的网络，并建立合作，以支持西非今后在多个区域新生儿单位进行同样的清洁干预措施的试验，将西非和英国的学术伙伴聚集在一起。潜在的应用和好处清洁和卫生的卫生保健设施可以帮助建立对卫生服务的信任，并鼓励母亲寻求产前护理并在设施内分娩，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元素。我们的研究结果也将为世界卫生决议产生的新的全球行动计划提供新的证据，IPC和AMR。我们将利用从这项前期工作中获得的经验教训，召集一个研究人员网络，为未来非洲试验这种清洁培训方案干预多个新生儿病房的感染结果奠定基础。

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.