Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana

Abstract

Healthcare-associated infections (HAIs) remain a serious threat to patient safety worldwide, particularly in low- and middle-income countries. Reducing the burden of HAIs through the observation and enforcement of infection prevention and control (IPC) practices remains a priority. Despite growing emphasis on HAI prevention in low- and middle-income countries, limited evidence is available to improve IPC practices to reduce HAIs. This study examined the perspectives of healthcare providers (HPs) and mothers in the neonatal intensive care unit on HAIs and determined the major barriers and facilitators to promoting standard IPC practices. This study draws on data from an ethnographic study using 38 in-depth interviews, four focus group discussions and participant observation conducted among HPs and mothers in neonatal intensive care units of a secondary- and tertiary-level hospital in Ghana. The qualitative data were analysed using a grounded theory approach, and NVivo 12 to facilitate coding. HPs and mothers demonstrated a modest level of understanding about HAIs. Personal, interpersonal, community, organizational and policy-level factors interacted in complex ways to influence IPC practices. HPs sometimes considered HAI concerns to be secondary in the face of a heavy clinical workload, a lack of structured systems and the quest to protect professional authority. The positive attitudes of some HPs, and peer interactions promoted standard IPC practices. Mothers expressed interest in participation in IPC activities. It however requires systematic efforts by HPs to partner with mothers in IPC. Training and capacity building of HPs, provision of adequate resources and improving communication between HPs and mothers were recommended to improve standard IPC practices. We conclude that there is a need for institutionalizing IPC policies and strengthening strategies that acknowledge and value mothers’ roles as caregivers and partners in IPC. To ensure this, HPs should be better equipped to prioritize communication and collaboration with mothers to reduce the burden of HAIs.

Do Knowledge, Attitudes, and Barrier Perception Affect the Prevention and Control of Healthcare-Associated Infections? A Structural Equation Modelling Approach

“…As for the direct positive link between attitudes and IPC practice, this may lie in the fact that IPC practice was more likely to be driven by subjectively held information. 35 Similarly, Sunkwa-Mills et al 37 demonstrated that positive attitudes of some HCWs promoted standard IPC practice. Previous studies also indicated that believing one’s own behavior can change HCAIs outcomes is essential to achieving sustained behavior change.…”

“…Similarly, previous studies demonstrated that lack of time and excess workload were main barriers hindering adherence to IPC precautions, particularly in busy clinical work environment. 14 , 33 Sunkwa-Mills et al 37 also reported that HCWs sometimes regarded HCAIs concerns as secondary when faced with heavy clinical workload. Lien et al 34 also found that physicians complained that patient overload was a dominant barrier for their IPC compliance.…”

Reduction of Hospital-Acquired Infections Through a Nursing Education Program: A Quality Improvement Project on the Sensitization of Nursing Staff Toward Infection Control in Neonates

“…Hospital-acquired infections (HAIs) remain a concern of utmost importance in neonatal intensive care units (NICUs) [1]. HAIs contribute to a large number of neonatal morbidity and mortality [1,2].…”

A qualitative study of infection prevention and control practices in the maternal units of two Ghanaian hospitals

“…The Ghana Health Service (GHS) and other agencies of the Ministry of Health (MOH) are paying attention to issues of quality service delivery, having put in place some strategies to improve care [9]. Despite efforts by GHS and the MOH to improve the quality of care, there are health system challenges in the implementation of IPC interventions [10][11][12][13]. The COVID-19 pandemic was a further reminder of the risks that healthcare workers face from exposure to HAIs in hospital wards [14].…”