Hygiene During Childbirth: An Observational Study to Understand Infection Risk in Healthcare Facilities in Kogi and Ebonyi States, Nigeria

Abstract

Background: Infections acquired during labour and delivery are a significant cause of maternal and child morbidity and mortality. Adherence to hand hygiene protocols is a critical component of infection prevention strategies, but few studies have closely examined the hand hygiene of health care providers with sufficient detail to understand infection risks and prioritize prevention strategies. Methods: This observational study was conducted in six healthcare facilities in Nigeria. In each, five women were observed from the onset of labour through to delivery of the placenta. Hand hygiene infection risk was estimated for all procedures requiring aseptic technique compared against adherence to proper hand hygiene protocol and potential recontamination events. Results: Hands were washed with soap and sterile gloves applied with no observed recontamination before only 3% of all observed procedures requiring aseptic technique. There was no significant difference in hygiene compliance between midwives and doctors nor facilities or states. Adherence to proper hygiene protocol was observed more in morning compared to afternoon and night shifts. Conclusions: This study highlights that hand hygiene remains a barrier to delivering high-quality and safe care in health facilities. Improving hygiene practices during labour and delivery will require strategies that extend beyond infrastructure provision.

Barriers and opportunities experienced by staff when implementing infection prevention and control guidelines during labour and delivery in healthcare facilities in Nigeria

“…Global guidelines on glove use in HCFs [16,20] note that donning and removing gloves can result in contamination when not coupled with handwashing with soap. Previously reported observational findings from these HCFs [11] found very low rates of handwashing with soap or rubbing with alcohol-based gel prior to donning gloves, suggesting that this critical step is often missed.…”

“…Following clinical training, on-site support also focused on the full range of maternal and newborn services, including components of IPC ( Figure 1). The assessment of IPC practices reported here was embedded within a larger observational study of hygiene practices [11].…”

Reducing hand recontamination of healthcare workers during COVID-19

“…3 Similar findings come from obstetric wards in Nigeria and Ghana. 4,5 Recontamination is not only a problem in low-income settings. A US study demonstrated microbiological recontamination of hands at the point of care despite high levels of self-reported hand hygiene compliance.…”

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

“…Data reported here focus on the post-natal care ward, facility discharge, and the home environment. Findings related to IPC standards and infrastructure and practices during labour and delivery have been reported elsewhere (27,28).…”

“…While all participating facilities received interventions aimed at improving the quality and utilisation of maternal and neonatal healthcare services, focus on hygiene was very limited. Further details of the MCSP quality of care improvement programme and facility selection are described in previous publications (27,28). In both Kogi and Ebonyi states, we sampled one facility at each of three levels: one primary HCF, a secondary HCF, and a tertiary HCF.…”