Ratnayake Ruwan, Ho Lara S, Ansumana Rashid, Brown Hannah, Borchert Matthias, Miller Laura, Kratz Thomas, McMahon Shannon A, Sahr Foday
Health Unit, International Rescue Committee, New York, New York, USA.
Health Unit, International Rescue Committee, Washington, District of Columbia, USA.
BMJ Glob Health. 2016 Dec 2;1(4):e000103. doi: 10.1136/bmjgh-2016-000103. eCollection 2016.
Accomplishing infection prevention and control (IPC) in health facilities in Sub-Saharan Africa is challenging. Owing to poor IPC, healthcare workers (HCWs) were frequently infected during Sierra Leone's Ebola epidemic. In late 2014, IPC was rapidly and nationally scaled up. We carried out workshops in sampled facilities to further improve adherence to IPC. We investigated HCW experiences and observed practice gaps, before and after the workshops.
We conducted an uncontrolled, before and after, mixed-methods study in eight health facilities in Bo and Kenema Districts during December 2014 and January 2015. Quantitative methods administered to HCWs at baseline and follow-up included a survey on attitudes and self-efficacy towards IPC, and structured observations of behaviours. The intervention involved a workshop for HCWs to develop improvement plans for their facility. We analysed the changes between rounds in survey responses and behaviours. We used interviews to explore attitudes and self-efficacy throughout the study period.
HCWs described IPC as 'life-saving' and personal protective equipment (PPE) as uncomfortable for providers and frightening for patients. At baseline, self-efficacy was high (median=4/strongly agree). Responses reflecting unfavourable attitudes were low for glove use (median=1/strongly disagree, IQR, 1-2) and PPE use with ill family members (median=1, IQR, 1-2), and mixed for PPE use with ill HCWs (median=2/disagree, IQR, 1-4). Observations demonstrated consistent glove reuse and poor HCW handwashing. The maintenance of distance (RR 1.09, 95% CI 1.02 to 1.16) and patient handwashing (RR 1.19, 95% CI 1.3 to 1.25) improved to >90%.
We found favourable attitudes towards IPC and gaps in practice. Risk perceptions of HCWs and tendencies to ration PPE where chronic supply chain issues normally lead to PPE stock-outs may affect practice. As Sierra Leone's Ebola Recovery Strategy aims to make all facilities IPC compliant, socio-behavioural improvements and a secure supply chain are essential.
在撒哈拉以南非洲的医疗机构中实现感染预防与控制（IPC）具有挑战性。由于感染预防与控制措施不力，在塞拉利昂埃博拉疫情期间医护人员频繁被感染。2014年末，感染预防与控制措施在全国迅速扩大规模。我们在抽样的医疗机构中举办了研讨会，以进一步提高对感染预防与控制措施的依从性。我们调查了医护人员的经历，并观察了研讨会前后的实际操作差距。
2014年12月至2015年1月期间，我们在博城和凯内马区的八家医疗机构中开展了一项非对照的前后混合方法研究。在基线和随访时对医护人员采用的定量方法包括关于对感染预防与控制的态度和自我效能的调查，以及对行为的结构化观察。干预措施包括为医护人员举办一次研讨会，以制定其所在医疗机构的改进计划。我们分析了各轮调查回复和行为之间的变化。我们通过访谈来探究整个研究期间的态度和自我效能。
医护人员将感染预防与控制描述为“挽救生命的”，并认为个人防护装备（PPE）对医护人员来说不舒服，对患者来说令人恐惧。在基线时，自我效能较高（中位数=4/强烈同意）。对于手套使用（中位数=1/强烈不同意，四分位距，1 - 2）和与患病家庭成员一起使用个人防护装备（中位数=1，四分位距，1 - 2），反映不利态度的回复较低，而对于与患病医护人员一起使用个人防护装备（中位数=2/不同意，四分位距，1 - 4），回复则好坏参半。观察结果表明存在一致的手套重复使用情况以及医护人员洗手不佳的问题。保持距离（相对危险度1.09，95%置信区间1.02至1.16）和患者洗手（相对危险度1.19，95%置信区间1.3至1.25）改善至>90%。
我们发现对感染预防与控制有积极态度，但在实际操作中存在差距。医护人员的风险认知以及在长期供应链问题通常导致个人防护装备缺货的情况下节约使用个人防护装备的倾向可能会影响实际操作。由于塞拉利昂的埃博拉恢复战略旨在使所有医疗机构符合感染预防与控制要求，社会行为的改善和安全的供应链至关重要。
