Rasmussen Lærke Vinberg, Sengoka Enna, Maro Eusebius, Kisigo Godfrey, Rasch Vibeke, Sørensen Bjarke Lund
Faculty of Health Sciences, University of Southern Denmark.
Kilimanjaro Christian Medical Centre, Tanzania.
East Afr Health Res J. 2021;5(1):36-43. doi: 10.24248/eahrj.v5i1.649. Epub 2021 Jun 11.
Healthcare associated infections is a global burden and is one of the main causes of maternal and neonatal morbidity and mortality during the time of labour when admitted to the hospital. Healthcare workers' hands are in most cases the vehicle for transmission of microorganisms from patient to patient. Good hand hygiene practices at the bedside are a simple way of reducing healthcare associated infections. The objective was to assess the impact of a criterion-based audit on infection prevention performance and knowledge during vaginal delivery at a hospital in Tanzania. The quantitative findings were discussed with staff to identify barriers and solutions to quality improvement.
A mixed-method uncontrolled, before and after intervention study by criterion-based audit was performed at the labour ward at Kilimanjaro Christian Medical Centre. Criteria for best practice were established together with key staff based on national and international guidelines. Sixty clean procedures during vaginal birth were observed and assessed by a structured checklist based on the audit criteria. Baseline findings were discussed with staff and an intervention performed including a short training and preparation of alcohol-based hand rub. Hereafter another 60 clean procedures were observed, and performance compared to the care before the intervention. Furthermore, a knowledge test was performed before and after the intervention.
Hand washing increased significantly after a procedure from 46.7% to 80% (RR=1.71 95% CI; 1.27 to 2.31), the use of alcohol-based hand rub before a procedure from 1.7% to 33.3% <), and the use of alcohol-based hand rub after procedure from 0% to 30% <). After the intervention the mean score for the knowledge test increased insignificantly from 59.3% to 65.3%, (mean difference = 6.1%, 95% CI; -4.69 to 16.88).
The criterion-based audit process identified substandard care for infection prevention at the labour ward. An intervention of discussing baseline findings and a short training session and introducing alcohol-based hand rub resulted in improvements on infection prevention performance.
医疗保健相关感染是一项全球性负担，是产妇和新生儿在住院分娩期间发病和死亡的主要原因之一。在大多数情况下，医护人员的手是微生物在患者之间传播的媒介。在床边实施良好的手部卫生措施是减少医疗保健相关感染的一种简单方法。目的是评估基于标准的审核对坦桑尼亚一家医院阴道分娩期间感染预防绩效和知识的影响。与工作人员讨论了定量研究结果，以确定质量改进的障碍和解决方案。
在乞力马扎罗基督教医疗中心的产房进行了一项基于标准审核的混合方法非对照干预前后研究。根据国家和国际指南，与关键工作人员共同制定了最佳实践标准。通过基于审核标准的结构化检查表，对阴道分娩期间的60项清洁程序进行了观察和评估。与工作人员讨论了基线研究结果，并实施了一项干预措施，包括短期培训和准备含酒精的手消毒剂。此后，又观察了60项清洁程序，并将其绩效与干预前的护理情况进行了比较。此外，在干预前后进行了知识测试。
一项操作后洗手的比例从46.7%显著增加到80%（相对危险度=1.71，95%置信区间：1.27至2.31），操作前使用含酒精手消毒剂的比例从1.7%增加到33.3%，操作后使用含酒精手消毒剂的比例从0%增加到30%。干预后，知识测试的平均得分从59.3%小幅增加到65.3%（平均差异=6.1%，95%置信区间：-4.69至16.88）。
基于标准的审核过程发现产房在感染预防方面存在不合格护理情况。通过讨论基线研究结果、进行短期培训以及引入含酒精的手消毒剂的干预措施，在感染预防绩效方面取得了改进。
