Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

Abstract

Background Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first six hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. Results Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. Conclusions In this setting, hand hygiene practices during post-natal care and the first six hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

A Multi-Modal Intervention To Improve Hand Hygiene in The Health Care Facility and Home Environment During The Peri-Natal Period in Kampong Chhnang, Cambodia: A Controlled Before-And-After Feasibility Study

“…One facility from each setting was assigned to receive the intervention. The referral hospital with the Hand hygiene compliance of birth attendants and caregivers along this care continuum remains low (13)(14)(15)(16). A recent systematic review of facility-based birth attendants' hand hygiene compliance in LMIC estimated compliance ranging from 1-38% (13).…”

“…A recent systematic review of facility-based birth attendants' hand hygiene compliance in LMIC estimated compliance ranging from 1-38% (13). Observational studies of facility-based births in LMIC have identi ed multiple risks of infection to mothers and newborns due to inadequate hand hygiene practices during post-natal care in the facility through to the return to the household (14)(15)(16)(17)(18)(19).…”

“…Postnatal care in the critical days following facility-based birth remains under investigated (11,12). The role and engagement of paternal and non-parental caregivers in LMIC in the provision of care across both environments has been documented (15,19,24,25,28,29), however hand hygiene improvement strategies commonly only target birth attendants and mothers' practices, leaving other important caregiver groups' practices unaddressed (20). There is a need for contextualised hand hygiene strategies that can span both the HCF and the home and effectively target hand hygiene practices of the multiple caregivers that lie along this pathway.…”

A controlled before-and-after study of a multi-modal intervention to improve hand hygiene during the peri-natal period in Cambodia

“…Observational studies of facility-based births in LMIC have identified multiple risks of infection to mothers and newborns due to inadequate hand hygiene practices during post-natal care in the facility through to the return to the household 14 – 19 . While global estimates are not available, both qualitative and quantitative studies suggest that hand hygiene compliance specific to newborn care is very low in low-resource settings—as low as 1% in Nigeria among healthcare workers and family members and 2.3–9.1% among mothers in Bangladesh 15 , 20 – 23 .…”

“…Postnatal care in the critical days following facility-based birth remains under investigated 11 , 12 . The role and engagement of paternal and non-parental caregivers in LMIC in the provision of care across both environments has been documented 8 , 15 , 19 , 20 , 29 , 30 , however hand hygiene improvement strategies commonly only target birth attendants and mothers’ practices, leaving other important caregiver groups’ practices unaddressed 24 . There is a need for contextualised hand hygiene strategies that can span both the HCF and the home and effectively target hand hygiene practices of the multiple caregivers that lie along this pathway.…”