Understanding the drivers of poor infection prevention control (IPC) practices in Kenyan health facilities: An interdisciplinary study.

Improving IPC practices in health facilities is a major concern for the global health community. This paper combines insights from rapid ethnographic research and epidemiological measures of IPC adherence undertaken in four health facilities of different sizes in western Kenya between November 2022 and January 2023. At the time of our research, the Covid-19 pandemic was a WHO-defined Public Health Emergency of International Concern, although the pandemic was subsiding, and there was an ongoing Ebola outbreak across the border in Uganda. Our findings evidence serious issues with adherence to standard IPC guidelines and the urgent need for reform of IPC practices. If the practices we observed are widespread beyond the study setting, we believe there is an urgent need to develop new interventions to improve adherence to IPC guidelines, with better follow-up to ensure interventions have long-term impact. The ethnographic material we present offers insights into the following IPC-related practices: (1) Hand hygiene (HH) and glove use; (2) Use of objects/material items; (3) Cleaning; (4) Waste disposal. When interrogated alongside epidemiological findings, our data offer preliminary evidence for understanding some of the social drivers for poor IPC adherence and the ways risky practice is embedded in organisational processes and personal perceptions of risk. We highlight the need to consider the social context of IPC behaviours in order to develop interventions which can deliver sustained change. Specific recommendations include better training and resources for cleaning and casual staff, and for a shift in emphasis in IPC interventions from health worker education towards modes of influencing sustained behaviour change.