Assessment of terminal cleaning in pediatric isolation rooms: Options for low-resource settings

Dramowski, Angela; Whitelaw, Andrew; Cotton, Mark F.

doi:10.1016/j.ajic.2016.05.026

Cited by 10 publications

(12 citation statements)

References 35 publications

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“…Another key finding was the poor knowledge and training and practice of health orderlies in cleaning the birth surface—from the walkthrough exercise we found that six of the seven maternity units swabbed had beds with S. aureus , representing a lack of effective or frequent cleaning. A very recent study in paediatric wards with poor cleaning practices in South Africa also found S. aureus on their surfaces ( Dramowski et al 2016 ). A study from India which includes the maternity unit environment, found that 10% of patient care equipment was contaminated with some kind of pathogen ( Dadhich et al 2014 ).…”

Section: Discussionmentioning

confidence: 99%

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Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units

Gon

Ali

Towriss

et al. 2017

Health Policy and Planning

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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.

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Section: Discussionmentioning

confidence: 99%

“…Overall cleaning in healthcare facilities is a poorly monitored and an under-researched area in spite of being vital to effective IPC and the reduction of healthcare associated infection. Simple solutions like fluorescent gel and UV markers can promote local engagement and training of cleaners ( Dramowski et al 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units

Gon

Ali

Towriss

et al. 2017

Health Policy and Planning

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“…[20][21][22] Despite widespread implementation in high-income settings, few SA healthcare facilities have guidelines on environmental cleaning and even fewer perform routine assessment of cleaning adequacy. [23] A study comparing methods for evaluation of paediatric isolation room terminal cleaning, identified fluorescent markers as an inexpensive option for cleaning assessment, which also allows for provision of immediate visual feedback to cleaning personnel. [23] Other important topics include: staffing norms for IP and paediatric staff; management of patient isolation facilities; hand hygiene and personal protective equipment; HAI surveillance and reporting; outbreak investigation recommendations and reporting; antimicrobial usage and restriction; and staff vaccination.…”

Section: Hai Prevention Policies and Guidelinesmentioning

confidence: 99%

A framework for preventing healthcare-associated infection in neonates and children in South Africa

2017

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Healthcare-associated infection (HAI) is a frequent and serious complication affecting 4 -8% of hospitalised children and neonates in high-income countries. The burden of HAI in South African (SA) paediatric and neonatal wards is substantial but underappreciated, owing to a lack of HAI surveillance and reporting. Maternal and child health and infection prevention are priority areas for healthcare quality improvement in the National Core Standards programme. Despite increasing recognition in SA, infection prevention efforts targeting hospitalised children and neonates are hampered by health system, institutional and individual patient factors. To ensure safe healthcare delivery to children, a co-ordinated HAI prevention strategy should promote development of infection prevention norms and policies, education, patient safety advocacy, healthcare infrastructure, surveillance and research. We present a framework for SA to develop and expand HAI prevention in hospitalised neonates and children.

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“…The financial burden of HAI includes direct costs to the hospital for prolonged stay and readmission, as well as costs to the community and the patients themselves 6 . Many global initiatives have addressed these higher rates of HAI and SSI in developing countries with programs such as continuous quality improvement efforts, 7 , 8 antimicrobial stewardship, 9 use of checklists, 10 and infection prevention guidelines for facilities with limited resources 11 . Multiple tools have been developed for the assessment of infection control (IC) by the World Health Organization 12 and the US Agency for International Development has created the Infection Control Assessment Tool (ICAT) 13 .…”

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confidence: 99%

Gap Analysis of Infection Control Practices in Low- and Middle-Income Countries

Weinshel

Dramowski

Hajdu

et al. 2015

Infect. Control Hosp. Epidemiol.

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Assessment of terminal cleaning in pediatric isolation rooms: Options for low-resource settings

Cited by 10 publications

References 35 publications

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

A framework for preventing healthcare-associated infection in neonates and children in South Africa

Gap Analysis of Infection Control Practices in Low- and Middle-Income Countries

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