Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Division of Psychiatry, University College London, London W1T 7BN, UK.
Int J Environ Res Public Health. 2021 Apr 21;18(9):4416. doi: 10.3390/ijerph18094416.
Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behavioural change intervention in rural Cambodia, a formative mixed-methods observational study was conducted to investigate the context-specific behaviours and determinants of handwashing among healthcare workers, and maternal and non-maternal caregivers along the early newborn care continuum.
Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and the associated communities were completed and hand hygiene compliance was assessed. Semi-structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional and environmental factors influencing the observed key hand hygiene behaviours.
Hand hygiene opportunities during newborn care were frequent in both settings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance with hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge.
Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.
在全球范围内，感染是导致新生儿死亡的第三大原因。医疗机构内出生的新生儿的主要危险因素是卫生习惯不佳，这些问题同时存在于医疗机构和家庭环境中。目前的改善干预措施仅针对一种环境，并针对有限的照顾者，主要是分娩助手和母亲。为了为柬埔寨农村地区的手部卫生行为改变干预措施提供信息，我们进行了一项形成性混合方法观察性研究，以调查医疗保健工作者以及母婴和非母婴照顾者在整个新生儿护理过程中与具体情况相关的洗手行为及其决定因素。
对为 46 名新生儿提供护理的所有人员的卫生习惯进行了直接观察，并评估了手部卫生的依从性。随后与 35 名助产士和家庭成员进行了半结构化互动访谈，以探讨影响观察到的主要手部卫生行为的相应认知、情感和环境因素。
在这两种环境中（n = 1319），新生儿护理期间经常进行手部卫生操作，主要由母亲、父亲和非亲代照顾者进行。包括助产士在内的所有照顾者对手部卫生协议的遵守情况都不充分（0%）。实践受到缺乏可及的物理基础设施、时间、工作量增加、低感染风险感知、养育相关动机、规范和知识不足的影响。
我们的研究结果表明，在这种情况下，有效的干预措施应该是多模式的，以解决不同的关键行为决定因素，并针对广泛的照顾者。
