Abstract
BackgroundInfants in the neonatal intensive care unit (NICU) are particularly susceptible to healthcare-associated infections (HAIs). NICUs in low- and middle income countries face additional challenges to HAI prevention. There is a need to better understand the role of the implementation context surrounding infection prevention interventions in low- and middle income countries.AimThe aim of this study was to identify NICU healthcare worker perceptions of an intervention to reduce bloodstream infections in a large Zambian NICU.MethodsSemi-structured interviews were conducted with NICU staff during a prospective cohort study examining the impact of an infection prevention bundle on bloodstream infections. Interviews were analyzed using an integrated approach, combining inductive theme generation with an application of the Consolidated Framework for Implementation Research (CFIR).ResultsInterviews were conducted with 17 NICU staff (5 physicians and 12 nurses). Respondents believed the bundle elements were easy to use, well-designed and facilitated improved performance. Four organizational characteristics that facilitated HAI transmission were identified – (1) lack of NICU admission protocols; (2) physical crowding; (3) understaffing; and (4) equipment shortages. Respondents suggested that NICU resource constraints reflected a societal ethos that devalued the medical care of infants. Despite the challenges, respondents were highly motivated to prevent HAIs and believed this was an achievable goal. They enthusiastically welcomed the bundle but expressed serious concern about sustainability following the study.ConclusionsBy eliciting healthcare worker perceptions about the context surrounding an infection prevention intervention, our study identified key organizational and societal factors to inform implementation strategies to achieve sustained improvement.
Highlights
Infants in the neonatal intensive care unit (NICU) are susceptible to healthcare-associated infections (HAIs)
Respondents suggested that NICU resource constraints reflected a societal ethos that devalued the medical care of infants
Doctors and nurses expressed enthusiasm for chlorhexidine gluconate (CHG) bathing, especially because it was widely noted that prior to the study, regular bathing was not otherwise occurring: Considering that most babies are not bathed in water and soap when they come here unless they are very, very dirty and we do have the time, the study has been helpful in reducing the amount of bacteria that’s on their skin and that reduce the amount of bacteria going around as you handle other babies. [Nurse 8]
Summary
Infants in the neonatal intensive care unit (NICU) are susceptible to healthcare-associated infections (HAIs). There is a need to better understand the role of the implementation context surrounding infection prevention interventions in low- and middle income countries. Infection prevention initiatives in low and middle income countries are becoming more prevalent through partnerships with high-income countries While these partnerships can provide much-needed resources, they face challenges and often succumb to implementation pitfalls such as differing partner interests, priorities, ownership, commitment, coordination and communication [6, 8, 9]. There is a critical need to understand how the implementation context influences the success of infection prevention interventions that leverage international partnerships [10]. This inquiry can maximize intervention effectiveness, promote sustainability and minimize pitfalls that arise when interventions are misaligned with the systems in which they are implemented [11, 12]
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