Impact of a low-cost bundle of interventions on infection prevention and control during labour and delivery in rural health centres in Zambia: results from a quasi-experimental study
DOI:
https://doi.org/10.3396/ijic.v19.23183Keywords:
infection control, public health, rural health, hand hygiene, childbirth, peripartum period, ZambiaAbstract
Infection remains an important cause of maternal and newborn morbidity and mortality globally despite evidence that it can be reduced with adherence to infection prevention and control (IPC) practices. The implementation of IPC has been especially challenging in rural health centres. This pilot study used a non-randomised quasi-experimental design to examine the impact of a low-cost intervention bundle at five rural health facilities in Southern Province of Zambia. We used the Infection Control Assessment Tool (ICAT) and surveyed the incharge nurse, observed deliveries and reviewed logbooks to collect pre- and post-intervention data on healthcare worker IPC practices and maternal and newborn outcomes. The intervention bundle included education sessions, provision of alcohol hand rubs (AHRs), short message service (SMS) text messages and poster reminders, and monthly study visits. The overall ICAT score did not significantly increase after the intervention (64.0 vs. 71.8, maximum score 133, P = 0.28). There was a significant increase in the labour and delivery practices module score (12.5 vs. 16.6, maximum score 27, P = 0.04) and a trend towards improvement in the hand hygiene module (9.1 vs. 13.6, maximum score 23, P = 0.08). There were no differences in pre- or post-intervention outcomes amongst the 654 mothers who delivered and the 655 newborns during the study period. In conclusion, a low-cost bundle of interventions did neither overall improve healthcare workers’ IPC practices in rural Zambia nor significantly change the rates of newborn and maternal complications. Identified challenges included inconsistent supplies of AHRs, protective and sterile equipment, as well as heavy workload for healthcare workers, which inhibited preventative behaviours.
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Filippi V, Chou D, Ronsmans C, Graham W, Say L. Chapter 3: Levels and causes of maternal mortality and morbidity. In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, maternal, newborn, and child health: disease control priorities. 3rd ed. Volume 2. Washington, DC: The International Bank for Reconstruction and Development / The World Bank; 2016, 77: 53–54.
Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385(9966): 430–40. doi: 10.1016/S0140-6736(14)61698-6
Blencowe H, Cousens S, Mullany LC, et al. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect. BMC Public Health 2011; 11 (Suppl 3): S11. doi: 10.1186/1471-2458-11-S3-S11
World Health Organization. Recommendations for prevention and treatment of maternal peripartum infections. Geneva: World Health Organization; 2015. Available from: https://www.who.int/publications/i/item/9789241549363 [cited 25 October 2022].
Seward N, Osrin D, Li L, et al. Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia. PLoS Med 2012; 9(2): e1001180. doi: 10.1371/journal.pmed.1001180
Buxton H, Flynn E, Oluyinka O, et al. Hygiene during childbirth: An observational study to understand infection risk in healthcare facilities in Kogi and Ebonyi states, Nigeria. Int J Environ Res Public Health 2019; 16(7): 1301. doi: 10.3390/ijerph16071301
Sharma G, Powell-Jackson T, Haldar K, Bradley J, Filippi V. Quality of routine essential care during childbirth: clinical observations of uncomplicated births in Uttar Pradesh, India. Bull World Health Organ 2017; 95(6): 419–29. doi: 10.2471/BLT.16.179291
Pincock T, Bernstein P, Warthman S, Holst E. Bundling hand hygiene interventions and measurement to decrease health care-associated infections. Am J Infect Control 2012; 40(4 Suppl 1): S18–27. doi: 10.1016/j.ajic.2012.02.008
Saito H, Inoue K, Ditai J, et al. Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda (‘WardGel’ study). Antimicrob Resist Infect Control 2017; 6(1): 129. doi: 10.1186/s13756-017-0287-8
Mwananyanda L, Pierre C, Mwansa J, et al. Preventing bloodstream infections and death in Zambian neonates: impact of a low-cost infection control bundle. Clin Infect 2019; 69(8): 1360–7. doi: 10.1093/cid/ciy1114
Guo A, Bowling JM, Bartram J, Kayser G. Water, sanitation, and hygiene in rural health-care facilities: a cross-sectional study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Am J Trop Med Hyg 2017; 97(4): 1033–42. doi: 10.4269/ajtmh.17-0208
Soofi S, Cousens S, Imdad A, Bhutto N, Ali N, Bhutta ZA. Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Lancet 2012; 379(9820): 1029–36. doi: 10.1016/S0140-6736(11)61877-1
Darmstadt GL, Hassan M, Balsara ZP, Winch PJ, Gipson R, Santosham M. Impact of clean delivery-kit use on newborn umbilical cord and maternal puerperal infections in Egypt. J Health Popul Nutr 2009; 27(6): 746–54. doi: 10.3329/jhpn.v27i6.4326
Central Statistical Office (CSO) [Zambia], Ministry of Health (MOH) [Zambia], and ICF International. Zambia Demographic and Health Survey 2013–14. Rockville, MD: Central Statistical Office, Ministry of Health, and ICF International; 2014. Available from: https://www.dhsprogram.com/pubs/pdf/fr304/fr304.pdf [cited 25 October 2022].
Owens L, Semrau K, Mbewe R, et al. The state of routine and emergency obstetric and neonatal care in Southern Province, Zambia. Int J Gynaecol Obstet 2015; 128(1): 53–7. doi: 10.1016/j.ijgo.2014.07.028
Strengthening Pharmaceutical Systems. Infection control assessment tool. 2nd ed. Arlington, VA: Management Sciences for Health; 2009. Available from: https://pdf.usaid.gov/pdf_docs/PNADK023.pdf [cited 25 October 2022].
Huskins C, Ross-Degnan D, Goldmann D. Improving infection control in developing countries: the infection control assessment tool. BMC Proc 2011; 5: O18. doi: 10.1186/1753-6561-5-S6-O18
World Health Organization. Guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. Geneva: World Health Organization; 2009. 21.4, ‘My five moments for hand hygiene’. Available from: https://www.who.int/publications/i/item/9789241597906 [cited 25 October 2022].
Tietjen L, McIntosh N. Chapter 25: Preventing maternal and newborn infections. In: Bossemeyer D, ed. Infection prevention guidelines for healthcare facilities with limited resources. Baltimore, MD: JHPIEGO; 2003, 287–301.
World Health Organization. Guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. Geneva: World Health Organization; 2009. 12, WHO-recommended handrub formulations. Available from: https://www.who.int/publications/i/item/9789241597906 [cited 25 October 2022].
Pittet D, Allegranzi B, Boyce J; World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30(7): 611–22. doi: 10.1086/600379
Harris C, Patel H, Corn O, Harris U, Munyagwa M, Greenough A. Infection control and treatment guidelines and neonatal mortality in a rural hospital in Uganda. Paediatr Int Child Health 2019; 39(2): 124–7. doi: 10.1080/20469047.2018.1528757
Gould DJ, Moralejo D, Drey N, Chudleigh JH, Taljaard M. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2017; 9(9): CD005186. doi: 10.1002/14651858.CD005186.pub4
World Health Organization. Guide to implementation: a guide to the implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. Geneva: World Health Organization; 2009. Available from: http://www.who.int/gpsc/5may/Guide_to_Implementation.pdf [cited 25 October 2022].
Henry EG, Ngoma T, Kaiser JL, et al. Evaluating implementation effectiveness and sustainability of a maternity waiting homes intervention to improve access to safe delivery in rural Zambia: a mixed-methods protocol. BMC Health Serv Res 2020; 20(1): 191. doi: 10.1186/s12913-020-4989-x
Mobbs NA, Ditai J, Abeso J, et al. In search of a primary outcome for community-based newborn infection trials in Eastern Uganda: a nested cohort study within the BabyGel pilot trial. Pilot Feasibility Stud 2019; 5(1): 43. doi: 10.1186/s40814-019-0428-3
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