Understanding infection prevention behaviour in maternity wards: A mixed-methods analysis of hand hygiene in Zanzibar. (March 2021)

• Record Type: Journal Article
• Authors: de Barra, Mícheál; Gon, Giorgia; Woodd, Susannah; Graham, Wendy J.; de Bruin, Marijn; Kahabuka, Catherine; Williams, A. Jess; Konate, Khadidja; Ali, Said M.; Said, Rukaiya; Penn-Kekana, Loveday
• Is Part Of: Social science & medicine. Volume 272(2021)
• Publication Date: 2021-03
• Subjects: Risk of hospital-acquired infection -- Hospital hygiene -- Infection prevention and control -- Health care professionals -- Qualitative approach; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2020.113543
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Rationale: 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. Objective: To understand variations between facilities and between people in hygiene behaviour and to explore potential intervention targets in four labour wards in Zanzibar. Methods: 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. Results: 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. Conclusions: 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. Highlights: 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.