Interviews Of Health Care Workers Research Articles

Determinants of hand hygiene compliance among healthcare workers in intensive care units: a qualitative study

BackgroundPracticing hand hygiene is a cost-effective method to decrease the occurrence of Healthcare-Associated Infections (HAIs). However, despite their simplicity, adhering to hand hygiene methods among healthcare workers (HCWs) can be highly challenging. We aim to examine the factors influencing hand hygiene compliance as perceived by HCWs working in the intensive care units (ICUs) at several major hospitals in Riyadh, Saudi Arabia.MethodThis qualitative study was conducted by adopting a content analysis to examine the interviews of HCWs who are currently working in the ICUs of various major hospitals located in the capital city of Riyadh, Saudi Arabia.ResultsWe interviewed 49 HCWs working in ICUs, with an average age of 38 and 8 years of experience. The HCWs comprised doctors (n = 12), anesthesiologists (n = 6), and nurses (n = 31). There were 34 females and 15 males among the participants. Our analysis revealed several factors that impact hand hygiene compliance, including individual, work/environment, team, task, patient, organizational, and management concerns. Several obstacles and possibilities for enhancement have been identified.ConclusionThe results of this study would enhance our comprehension of hand hygiene practices and serve as a foundation for creating future strategies and assessment methods to enhance compliance with hand hygiene protocols in ICUs.

Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study.

The urine Determine LAM test has the potential to identify tuberculosis (TB) and reduce early mortality among people living with HIV. However, implementation of the test in practice has been slow. We aimed to understand how a Determine LAM intervention was received and worked in a Ghanaian in-hospital context. Nested in a Determine LAM intervention study, we conducted a two-phase explanatory sequential mixed methods study at three hospitals in Ghana between January 2021 and January 2022. We performed a quantitative survey with 81 healthcare workers (HCWs), four qualitative focus-group discussions with 18 HCWs, and 15 in-depth HCW interviews. Integration was performed at the methods and analysis level. Descriptive analysis, qualitative directed content analysis, and mixed methods joint display were used. The gap in access to TB testing when relying on sputum GeneXpert MTB/Rif alone was explained by difficulties in obtaining sputum samples and an in-hospital system that relies on relatives. The Determine LAM test procedure was experienced as easy, and most eligible patients received a test. HCWs expressed that immediate access to Determine LAM tests empowered them in rapid diagnosis. The HCW survey confirmed that bedside was the most common place for Determine LAM testing, but qualitative interviews with nurses revealed concerns about patient confidentiality when performing and disclosing the test results at the bedside. Less than half of Determine LAM-positive patients were initiated on TB treatment, and qualitative data identified a weak link in the communication of the Determine LAM results. Moreover, HCWs were reluctant to initiate Determine LAM-positive patients on TB treatment due to test specificity concerns. The Determine LAM intervention did not have an impact on the time to TB treatment as expected, but patients were, in general, initiated on TB treatment rapidly. We further identified a barrier to accessing TB treatment during weekends and that treatment by tradition is administrated early in the morning. The Determine LAM testing was feasible and empowered HCWs in the management of HIV-associated TB. Important gaps in routine care and Determine LAM-enhanced TB care were often explained by the context. These findings may inform in-hospital quality improvement work and scale-up of Determine LAM in similar settings.

COVID-19 Vaccine Hesitancy and Its Causes among Elderly Family Members of Health-care Workers

Abstract Introduction: Vaccination has proven to be an effective preventive measure against COVID-19. The main hindrance for COVID-19 vaccination is vaccine hesitancy. Attitude of health-care workers (HCWs) toward vaccination is vital to promote vaccination and reduce vaccine hesitancy. HCWs are expected to promote COVID-19 vaccination and educate their family members for vaccination. Thus, it is important to know the reasons for vaccine hesitancy among elderly family members of HCWs so that these barriers can be overcome by proper measures. Methodology: This was a single-center cross-sectional study conducted by questionnaire-based interviews of HCWs pertaining to the COVID-19 vaccination details of their elderly household members. Questions with Likert scale-type responses were used to discern the reasons for vaccine hesitancy. Results: Among the study group, 38% were found to have high vaccine hesitancy. Low educational status (P = 0.0001), rural area of residence (P = 0.001), and female gender (P = 0.028) as well as the occupation of the HCW respondent (P = 0.011) were found to be significantly associated with high vaccine hesitancy. Fear of unknown side effects (52.6%), difficulties with vaccination slot booking (48.4%), belief of low risk for contracting COVID-19 disease, fear of the vaccine side effects, fear of vaccine itself causing COVID-19 illness, and mistrust against the vaccine manufacturers were the most common reasons for vaccine hesitancy. Conclusion: High vaccine hesitancy was found among elderly individuals with lower education status, female gender, and residence in rural areas. Fear of side effects of vaccine and contracting COVID-19 from the vaccine, logistical and technical difficulties, belief of low disease risk, and mistrust against the vaccine manufacturers were the most common reasons for vaccine hesitancy.

CHARACTERISTICS OF ILLNESS AMONG HEALTHCARE EMPLOYEES

The aim of the work is to characterize and assess the state of health of health care workers and to find out which diseases are most common among health care workers and which list of diseases requires treatment on the basis of social health insurance.
 Materials and methods. In the course of the research, 550 health care workers were interviewed and surveyed regarding the feasibility of implementing social insurance for health care workers in the city of Kyiv and medical and preventive institutions in the Kyiv region. Evaluating the classification of commercial and social insurance in Ukraine, the authors noted that 9% of them do not support any type of insurance at all, 5% support commercial insurance, and 85% support social insurance, 1% refrained from answering.
 The results. As of January 1, 2022, the number of insured persons in the Social Insurance Fund of Ukraine was 4,236,285, of which: legal entities – 2,548,964, individuals – 1,714,321, voluntarily insured persons – 52. In 2021, the fund's income amounted to UAH 17,753.1 million, or 99.3% of the plan, including insurance contributions of policyholders and insured persons – UAH 16,858.8 million, which is 99.2% of the plan [1].
 The article provides a thorough characterization of statistical information, which includes the processing of the primary documents "Occupational Disease Record Card (Occupational Injury)", compiled for all cases of occupational diseases first detected and registered in Ukraine for the specified years; conducted questionnaires and interviews of health care workers (employees of health care institutions in the city of Kyiv and Kyiv, Khmelnytskyi, Odesa, Cherkasy, and Sumy regions).
 The number of appeals for qualified specialized medical care and issuance of disability certificates was studied. The formation of occupational diseases of health care workers was also determined and their statistical information was provided.
 Conclusions. For the high-quality functioning of the health care sector and the reduction of mortality among medical workers, it is necessary to implement the proposed model of social insurance for health care workers. It is this kind of insurance that will ensure the proper life of health care workers, preserve and restore their working capacity, reduce the rate of deaths among them with a low financial loss for them and their family members.

A qualitative study on the perception of infection prevention and control measures among healthcare workers without patient contact during the SARS-CoV-2 pandemic

We conducted a qualitative interview-based study to examine the perception of infection prevention and control (IPC) measures implemented during the COVID-19 pandemic among healthcare workers (HCWs) without patient contact in a tertiary academic care center. We compared these findings to those derived from interviews of HCWs with patient contact from the same institution using the same study design. The following main four themes were identified: (1) As for HCWs with patient contact, transparent communication strongly contributes to employees’ sense of security. (2) Information on personal protective equipment (PPE) usage needs to be stratified according to different educational backgrounds and professions. (3) Consistency of IPC measures was positively perceived yet a desire for constant reminders to counteract the fatigue effect played a more significant role for HCWs without patient contact. (4) As compared to HCWs with patient contact, HCWs without patient contact preferred uniform digital training resources rather than more face-to-face training. This study shows that the needs of HCWs with and without patient contact differ and need to be considered in pandemic management.

Determinants of COVID-19 Vaccination Intention among Health Care Workers in France: A Qualitative Study.

COVID-19 vaccines are one of the best tools to limit the spread of the virus. However, vaccine hesitancy is increasing worldwide, and France is one of the most hesitant countries. From the beginning of the COVID-19 vaccination campaign, health care workers (HCW) have been prioritized in the vaccination strategy but were also hesitant. This study was conducted to identify and understand the determinants of COVID-19 vaccination intention in the French context, with a view to promoting HCW vaccination. A qualitative study using individual semi-structured interviews of HCWs was carried out at the beginning of the vaccination campaign (January to April 2021) in a French university hospital. Interviews indicated that the vaccination intention of HCWs was influenced by confidence in the proposed vaccines, past experience with vaccines and disease, the opinions and vaccination status of others, and media handling of information related to COVID-19 vaccination. Improving HCW vaccination intention regarding COVID-19 vaccines could be achieved through the dissemination of clear, reassuring, scientific information. Information should be disseminated by HCWs and vaccination experts and adapted to local contexts. To improve the level of confidence and vaccination uptake through a compliance effect, it would be useful to promote positive COVID-19 vaccination experiences and increased rates of immunization.

Health care workers’ perspectives on care for patients with injection drug use associated infective endocarditis (IDU-IE)

BackgroundDespite high morbidity and mortality, patients with injection drug use associated infective endocarditis (IDU-IE) lack standardized care, and experience prolonged hospitalization and variable substance use disorder (SUD) management.Our study’s objective was to elicit perspectives of health care workers (HCWs) who deliver care to this population by understanding their perceived patient, provider, and system-level resources and barriers.MethodsThis qualitative study included interviews of HCWs providing care to patients with IDU-IE from January 2017 to December 2019 at a single Midwest academic center. Based on electronic medical record queries to determine high and low rates of referral to SUD treatment, HCWs were selected using stratified random sampling followed by convenience sampling of non-physician HCWs and a patient. Study participants were recruited via email and verbal consent was obtained. The final sample included 11 hospitalists, 3 specialists (including 2 cardiovascular surgery providers), 3 case managers, 2 social workers, 1 nurse, and 1 patient. Qualitative semi-structured interviews explored challenges and resources related to caring for this population. Qualitative Data Analysis (QDA) Minor Lite was used for thematic data using an inductive approach.ResultsThree major thematic categories emerged relative to patient-level barriers (e.g., pain control, difficult patient interactions, social determinants of health), provider-level barriers (e.g., inequity, expectations for recovery, varying levels of hope, communication style, prescribing medication for SUD), and system-level barriers (e.g., repeat surgery, placement, resources for SUD and mental health). The need to address underlying SUD was a prominent theme.ConclusionPractical steps we can take to improve treatment for this population include training and coaching HCWs on a more person-centered approach to communication and transparent decision-making around pain management, surgery decisions, and expectations for SUD treatment.

Barriers to physical distancing among healthcare workers on an academic hospital unit during the coronavirus disease 2019 (COVID-19) pandemic.

Physical distancing among healthcare workers (HCWs) is an essential strategy in preventing HCW-to-HCWs transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2). To understand barriers to physical distancing among HCWs on an inpatient unit and identify strategies for improvement. Qualitative study including observations and semistructured interviews conducted over 3 months. A non-COVID-19 adult general medical unit in an academic tertiary-care hospital. HCWs based on the unit. We performed a qualitative study in which we (1) observed HCW activities and proximity to each other on the unit during weekday shifts July-October 2020 and (2) conducted semi-structured interviews of HCWs to understand their experiences with and perspectives of physical distancing in the hospital. Qualitative data were coded based on a human-factors engineering model. We completed 25 hours of observations and 20 HCW interviews. High-risk interactions often occurred during handoffs of care at shift changes and patient rounds, when HCWs gathered regularly in close proximity for at least 15 minutes. Identified barriers included spacing and availability of computers, the need to communicate confidential patient information, and the desire to maintain relationships at work. Physical distancing can be improved in hospitals by restructuring computer workstations, work rooms, and break rooms; applying visible cognitive aids; adapting shift times; and supporting rounds and meetings with virtual conferencing. Additional strategies to promote staff adherence to physical distancing include rewarding positive behaviors, having peer leaders model physical distancing, and encouraging additional safe avenues for social connection at a safe distance.

Coronavirus Disease 2019 (COVID-19) Infections Among Healthcare Workers, Los Angeles County, February-May 2020.

Across the world, healthcare workers (HCW) are at a greater risk of infection by the novel coronavirus 2019 (COVID-19) due to the nature of their work. The Los Angeles County Department of Public Health (LAC DPH) set out to understand the impact of COVID-19 on healthcare facilities and HCWs by tracking and analyzing data from case-patient interviews of HCWs. As of May 31st, over three months into the pandemic, nearly 5,500 positive HCWs were reported to LAC DPH, representing 9.6% of all cases. Cases reported working in 27 different setting types, including outpatient medical offices, correctional facilities, emergency medical services, etc., with the highest proportion from long-term care facilities (46.6%) and hospitals (27.7%). Case-patients included both clinical and non-clinical roles, with nearly half (49.4%) of positive HCWs being nurses. Over two-thirds of HCWs (68.6%) worked at some point during their infectious period and nearly half (47.9%) reported a known exposure to a positive patient and/or co-worker within their facility. Overall, compared to all LAC cases, HCWs reported lower rates of hospitalization (5.3% vs. 12.2%) and death (0.7% vs. 4.3%) from COVID-19. There are many factors that increase HCWs risk of infection, including high risk work environment, limited supply of personal protective equipment, and even pressure to help and work during a pandemic. In response to these data, LAC DPH created resources and provided guidance for healthcare facilities to best protect their patients and staff during the COVID-19 pandemic.

Ethiopian Health Care Workers' Insights into and Responses to Intimate Partner Violence in Pregnancy-A Qualitative Study.

Violence against women is a global pandemic, with the potential to spread through generations. Intimate partner violence has impacts on women’s sexual, reproductive, and psycho-social health. It can occur during pregnancy and adversely affect the health of both mother and child. Health care workers involved in antenatal care can have a unique role in identifying intimate partner violence and in intervening, preventing, and mitigating its consequences. In this study, the objective was to explore Ethiopian health care workers’ insights of and responses to intimate partner violence in pregnancy. Using an exploratory design, this qualitative study includes ten semi-structured interviews of health care workers representing different antenatal care centers in Jimma, Ethiopia. The content analyses of translated interview notes were conducted with Atlas.ti7 software, (Atlas.ti Scientific Software Development Gmbh, Berlin). The health care workers shared their insights of the consequences of intimate partner violence during pregnancy in addition to their experience with and responses to the victims. There was a limited understanding of the extent of the adverse impacts of intimate partner violence on pregnancy outcomes, as well as the potential long-term health implications. The informants described how they only gave medical treatment for obstetric complications or visible trauma during pregnancy. There was no formal referral to or linkages with other resources. Women’s empowerment and systemic changes in the health care, including training and capacity building, clear guidelines addressing management of intimate partner violence in pregnancy, and inclusion of intimate partner violence screening tools in the Ethiopian antenatal care chart/card, were recommended by the informants. The adverse impacts of intimate partner violence on pregnancy outcomes were poorly understood by the Ethiopian health care workers in this study. They offered limited assistance to the victims and recommended changes in the routine antenatal care (ANC) and health care systems. They identified various policy initiatives focusing on women’s empowerment to reduce intimate partner violence and its complications especially during pregnancy.

A cluster of nosocomial Lassa fever cases in a tertiary health facility in Nigeria: Description and lessons learned, 2018

BackgroundLassa fever is an acute viral haemorrhagic disease endemic in Nigeria. The 2018 Lassa fever outbreak in Nigeria was unprecedented, with 8% of all cases occurring among healthcare workers (HCWs). A disproportionately high number of these infections occurred in HCWs working in a tertiary health facility in Nigeria. This paper describes the cluster of Lassa fever infections among HCWs in a treatment centre and the lessons learnt. MethodsWe analysed clinical, epidemiological and laboratory data from surveillance and laboratory records kept during the 2018 outbreak. Interviews were conducted with surviving HCWs using a questionnaire developed specifically for the investigation of Lassa fever infections in HCWs. Descriptive analysis of the data was performed in Microsoft excel. ResultsThe index case was a 15-year-old male who presented at the health facility with fever and uncontrolled nasopharyngeal bleeding, following a recent uvulectomy by a traditional healer. Overall, 16 HCWs were affected (15 confirmed and 1 probable) with five deaths (CFR-31.6%). Of the 15 confirmed cases, five (33.3%) were asymptomatic. Nine HCWs were direct contacts of the index case; the remaining six HCWs had no direct contact with the index case. HCW interviews identified a low index of suspicion for Lassa fever leading to inadequate infection prevention and control (IPC) practices as possible contributing factors to nosocomial transmission. ConclusionMaintaining a high index of suspicion for Lassa fever in all patients, especially in endemic areas, is essential in adhering to adequate IPC practices in health facilities in order to prevent nosocomial transmission of Lassa fever among HCWs. There is a need to continually train and sensitise HCWs on strict adherence to IPC measures while providing care, irrespective of a patient’s provisional diagnosis.

Human immunodeficiency virus infection disclosure status to infected school aged children and associated factors in bale zone, Southeast Ethiopia: cross sectional study

BackgroundHuman immunodeficiency virus (HIV) positive status disclosure is an essential component of Pediatric care and long term disease management. Children have a right to know their HIV diagnosis result. However, Pediatric HIV disclosure is complex and varies in different communities. This study aimed to assess the prevalence of HIV-positive status disclosure to infected children and associated factors among caregivers of infected children.MethodologyA facility based mixed methods research design study was conducted in Bale Zone of South East Ethiopia. Randomly selected caregivers of HIV-positive children were interviewed using structured questionnaires for quantitative study and 17 in-depth interviews of health care workers and caregivers were conducted for qualitative data. Content analysis was done for qualitative data and logistic regression analysis was used to see the association between different variables and HIV-positive disclosure status. Odds ratio with 95% CI was computed to determine the presence and strength of the associated factors.ResultsA total of 200 caregivers of school aged (6–14 years) children participated in the study. Only 57 (28.5%) of the care givers disclosed HIV-positive status to the child for whom they were caring. The main reason for disclosure delay was due to fear of negative consequences, perception on maturity of the child, and fear of social rejection and stigma. Having social support [AOR = 2.7, 95% CI: (1.1–6.4)], caring for a child between 10 and 14 years with HIV [AOR = 6.5, 95% CI: (2.1–20.2)], a child diagnosed with HIV at age > 5 years [AOR = 2.8, 95% CI: (1.1–7.1)], and children on antiretroviral therapy (ART) with follow-up for > 5 years [AOR = 4.7, 95% CI: (1.8–11.2)] had significant association with HIV- positive status disclosure to infected children.ConclusionThe frequency of HIV infection disclosure to infected children was very low in our cohort. Having social support, having an older child with HIV, a long period of ART follow-up and HIV diagnosis after age of five years were positively associated with HIV-positive status disclosure to infected children. Giving age appropriate counselling to children, social support to the caregivers and working on related factors are very important to improve the observed low disclosure status.

\u201cIf I had known, I would have applied\u201d: poor communication, job dissatisfaction, and attrition of rural health workers in Sierra Leone

BackgroundSierra Leone’s health outcomes rank among the worst in the world. A major challenge is the shortage of primary healthcare workers (HCWs) in rural areas due to especially high rates of attrition. This study was undertaken to determine the drivers of job dissatisfaction and poor retention among Sierra Leone’s rural HCWs.MethodsInterviews were conducted with 58 rural and 32 urban primary HCWs in Sierra Leone’s public health sector, complemented by key informant discussions and review of national policy documents. HCW interviews included (1) semi-structured discussion, (2) questionnaire, (3) card sort about HCW priorities, and (4) free-listing of most pressing challenges and needs. Sampling for HCW interviews was stratified purposive, emphasizing rural HCWs.ResultsAmong 90 HCWs interviewed, 67% were dissatisfied with their jobs (71% rural vs 52% urban) and 61% intended to leave their post (75% rural vs 38% urban). While working and living conditions and remuneration were significant factors, a major reason for rural HCW disenchantment was their inability to access worker rights, benefits, and advancement opportunities. This was caused by HCWs’ lack of knowledge about human resource (HR) policies and procedures, as well as ambiguity in many policies and inequitable implementation. HCWs reported feeling neglected and marginalized and perceived a lack of transparency. These issues can be attributed to the absence of systems for regular two-way communication between the Ministry of Health and HCWs; lack of official national documents with up-to-date, clear HR policies and procedures for HCWs; pay statements that do not provide a breakdown of financial allowances and withholdings; and lack of HCW induction.ConclusionsHCWs in Sierra Leone lacked accurate information about entitlements, policies, and procedures, and this was a driver of rural HCW job dissatisfaction and attrition. System-oriented, low-cost initiatives can address these underlying structural causes in Sierra Leone. These issues likely apply to other countries facing HCW retention challenges and should be considered in development of global HCW retention strategies.

Correlates of observing and willingness to report stigma towards HIV clients by (TB) health workers in Africa.

Health care facilities in Kenya, Tanzania and Namibia. To study the factors associated with the observation of and willingness to report stigmatising behaviour towards persons living with the human immunodeficiency virus (HIV) among health care workers (HCWs). Mixed-effect logistic regression analyses of 9516 HCW interviews, including those of 4062 (43%) TB workers carried out as part of the Service Provision Assessments (SPAs) between 2006 and 2010. Discrimination (i.e., enacted stigma) was observed by respectively 1042 (60%), 384 (40%) and 907 (69%) TB workers in Kenya, Namibia and Tanzania, similar to the trend observed among all HCWs. Observations of discrimination were clustered at facility level in Kenya, and mapping of facility-level discrimination suggested geographic clustering. HCWs were more likely to observe discrimination in facilities without regular supportive supervision (adjusted OR [aOR] 2.33, 95%CI 1.09-4.96). No HCW characteristics were found to predict intention to report. Training in patients' rights and in confidentiality predisposed HCWs to recognise discrimination (aOR 2.51, 95%CI 1.19-5.28) and the willingness to report it (aOR 2.23, 95%CI 1.11-4.47). Exposure to training in TB infection control (IC) was associated with greater willingness to report discrimination (aOR 2.13, 95%CI 1.03-4.39). Supervision and exposure to training in patient's rights and confidentiality improved HCWs' understanding and advocacy of dignified and respectful TB-HIV care. All HCWs are equally likely to be allies, agents of change and amplifiers of an anti-stigma message, and broad engagement is required. Innovative approaches to reduce discrimination-while ensuring proper IC-should be explored.

Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care

Health care workers (HCWs) are recommended to wear nonsterile clinical gloves (NSCG) for direct contact with blood and body fluids. However, there is evidence of extensive inappropriate NSCG use. A mixed-methods study comprising observation of NSCG use in 2 acute hospitals and semistructured HCW interviews. Qualitative data were categorized using thematic analysis. Findings were mapped to the Systems Engineering Initiative for Patient Safety model and used to develop a strategy for improving NSCG use. Two hundred seventy-eight procedures performed in 178 episodes of care involved the use of NSCG. NSCG were inappropriate for 59% of procedures (165 out of 278). Risk of cross-contamination occurred in 49% (87 out of 178) episodes. Twenty-six HCWs were interviewed; emotion and socialization were key factors influencing decisions to use NSCG. Data from observation and thematic analysis were mapped to 6 interacting components of the Systems Engineering Initiative for Patient Safety work system. Interventions targeting each component informed quality improvement strategies CONCLUSIONS: Despite intense promotion of hand hygiene as the key measure to protect patients from health care-associated infection, NSCG dominate routine clinical practice and potential cross-contamination occurs in 50% of care episodes. Such practice is associated with significant environmental and financial costs and adversely affects patient safety. The application of human factors and ergonomics to the complex drivers of inappropriate NSCG behavior may be more effective than conventional approaches of education and policy in achieving the goal of preventing health care-associated infection and improving patient safety.

Primary Health Care Facilities in Sub-Saharan Africa Found to Provide Poor Basic Maternal Care

The quality of basic maternity care in primary care facilities--where a substantial proportion of deliveries in many low-income countries take place--is much lower than that in secondary care facilities, according to an analysis of data from five Sub-Saharan African countries. (1) In both types of facilities, greater delivery volumes were associated with higher scores on an index of quality of care. However, primary care facilities--even those with the highest delivery volume--had lower quality-of-care scores than secondary care facilities, and frequently lacked even such basic elements of infrastructure as electricity. Efforts to reduce maternal mortality in developing countries often have focused on increasing the proportion of births that take place in facilities; however, improving the quality of obstetric care has received less attention from policymakers and researchers. Because studies from high-income countries have found that maternal outcomes tend to be worse at facilities with lower delivery caseloads, the authors of the current study examined the relationship between delivery volume and quality of care in five low- and middle-income Sub-Saharan African countries (Kenya, Namibia, Rwanda, Tanzania and Uganda). All five had maternal mortality rates far higher than the Sustainable Development Goal target of 70 deaths per 100,000 live births; Namibia, the only middle-income country in the group, had by far the lowest maternal mortality rate (130 per 100,000, compared with 320-410 per 100,000 in the other countries) and the highest proportion of deliveries in facilities (87% vs. 50-69%). The analysis used data from service provision assessment surveys conducted between 2006 and 2010 as part of the Demographic and Health Survey program. The surveys collected information on facility characteristics and services through standardized questionnaires and through structured interviews of health care workers; for each country, the sample of facilities either was nationally representative or included nearly all facilities in the health system. Analyses examined secondary care facilities--those with the capacity to perform caesarean deliveries--separately from primary care facilities. The researchers used a categorical variable for annual delivery volume, although to account for differences in capacity the category thresholds were smaller for primary facilities (from [less than or equal to]52 to >500) than for secondary facilities (from [less than or equal to]500 to >4,000). Assessing quality of care was trickier; although maternal mortality is often used as an indicator of quality, this approach can be misleading unless analyses adjust for the greater severity of cases typically treated by higher-level facilities. Because severity data were unavailable, the researchers created a 12-item index of quality of maternal care that indicated the number of basic care elements provided at each facility. Items ranged from simple structural indicators (e.g., the availability of electricity and safe water) to process indicators that assessed whether the facility had the capacity to perform certain procedures (e.g., to remove retained products of conception) or had performed specified procedures in the past three months (e.g., manual removal of placenta). For each facility, the number of items was converted to a score ranging from 0 to 1. Covariates used in the analyses included sector (public vs. private), capacity to provide antiretroviral therapy (ART) and number of staff per bed. In addition to providing descriptive statistics, the researchers created scatter plots to visualize the relationship between delivery volume and quality of care, and conducted logistic regression analyses to adjust for covariates and country fixed effects. The analytic sample consisted of 1,715 facilities that performed deliveries and provided data on delivery volume. …

Human activities and microbial geographies. An anthropological approach to the risk of infections in West African hospitals

In hospital care, management of the risk of infection represents a crucial issue. Nevertheless, this question remains a neglected area in anthropological research, especially in African countries. To shed new light on this question, we conducted an anthropological investigation in the infectious disease department of a hospital in Niger. Daily observation of the work of the hospital staff for a total period of 6 months was spread out over 2008 and 2009. During our prolonged stay, we also collected 64 in-depth interviews of health care workers and attendants in the department. This study method made it possible to describe many of the practices and discourses related to the issues of medical and personal care and hospital hygiene and to compare the practices observed to standard principles for preventing hospital-acquired infections. Our ethnographic attention to the behavior of the actors showed the absence of formal spatial segmentations between different activities. The care provided by the untrained relatives serving as personal attendants introduced territorial enclaves governed by home hygiene standards into the interior of technical spaces. At the same time, privatizing equipment and space for their diverse activities, the medical staff disrupted technical chains and generated the recurrent crossing of microbial geographies. These results allow us to offer two principal guidelines for improving the quality of care and the management of risks of infection in hospitals in West Africa: (1) the essential role of the attendants in the care provided to hospital inpatients must be officially taken into account, especially by including them in the organization of medical hygiene procedures; (2) the different overlapping technical activities and social activities in the work space must be limited by their geographic and architectural segmentation.

Clinical glove use: healthcare workers' actions and perceptions

The incorrect use of clinical gloves and the failure to change them between procedures increases the risk of cross-transmission. Much attention has been focused on compliance with hand hygiene. To investigate the use of gloves, their potential for cross-contamination, and factors that influence the decision of healthcare workers (HCWs) to wear them. The use of gloves was observed in six wards in a single UK hospital trust. Risk of cross-contamination was defined as a violation of a 'moment of hand hygiene' during the glove-use episode. Twenty-five HCWs from the wards included in the observational audit were interviewed to identify the drivers for glove use. A total of 163 glove-use episodes were observed over a period of 13 h. Glove use was inappropriate in 69 out of 163 (42%) episodes, with gloves commonly used inappropriately for low-risk procedures (34/37; 92%). In 60 out of 163 (37%) episodes of glove use there was a risk of cross-contamination, most (48%) being associated with failure to remove gloves or with performing hand hygiene after use. HCW interviews indicated that the decision to wear gloves was influenced by both socialization and emotion. Key emotions were disgust and fear. Assumptions that patients preferred gloves to be used, confusion about when to wear them, and social norms and peer pressure were also important influences. Glove use is associated with risk of cross-contamination and should be more explicitly integrated into hand hygiene policy. An understanding of the drivers of glove-use behaviour is required to design interventions to reduce misuse and overuse.

Hospital-wide survey of the use of central venous catheters

There are few data on indications for central venous catheter (CVC) use. We conducted an observational, hospital-wide prospective cohort study to quantify the indications for catheter placement over dwell time and to investigate agreement between healthcare workers (HCWs) on CVC use. Catheter use was observed by on-site visits, HCW interviews, and screening of patient charts. A total of 378 CVCs were inserted in 292 patients, accounting for 2704 catheter-days. Of these, 93% CVCs were multilumen catheters and 70% were placed in the intensive care unit (ICU). Median dwell time (interquartile range) was 5 (2-9) days overall, and 4 (2-7) and 8 (3-15) in the ICU and non-ICU settings, respectively. The mean number of specified indications for CVC use per day was 1.7 (1.9 for ICU and 1.5 for non-ICU; P<0.001). The most frequent reason (49%) for catheter use was prolonged (>7 days) antibiotic therapy followed by parenteral nutrition (22.3%). A total of 130 catheter-days (4.8%) were unnecessary with a higher proportion in non-ICU settings (6.6%). In 94% of cases, there was agreement among HCWs on indications for CVC use. However, 35 on-site visits (8.3%) in non-ICU settings revealed that neither the nurse nor the treating physician knew why the catheter was in place. ICU catheters have a short dwell time but are utilised more often, whereas catheters in non-ICU settings show a reverse characteristic. Prevention measures targeting catheter care are more likely to be successful in non-ICU settings.

Cultural Appropriate Rehabilitation Within the Environmental Context of a Third World Country

Lydia L. Christesen, United States of America Purpose: The purpose of this ethnographic study was to discover whether the therapeutic approaches frequently utilized by western trained therapists would be appropriate for children and their families in developing countries. The study was designed around the tenets of the Transcultural Nursing Research Model. Methods: The study was a qualitative ethnographic research study. The study consisted of four semistructured family interviews of children with hand burns and or Cerebral Palsy coupled with observations of their children in therapy, plus four semi-structured interviews of health care workers at a hospital in Zambia and Kenya. The author chose the ethnographic transcultural nursing method for her study because it required the collecting of data by a naturalistic and emic mode in order to arrive at a therapeutic approach that would be consistent with the culture. Participants were asked to sign a consent form. An interpreter was provided prior to participating in the study. The transcultural nursing technique involved four essential phases; phase one: observation and active listening; phase two: observation with minimal participation; phase three: semi-structured open-ended questions developed by the researcher with in the context of the transcultural nursing sunrise model, and phase four: reflection and reconfirmation of the study to recheck the findings with two general informants who are health care workers at the hospital. Results: Results of the ethnographic study indicated that factors such as religion, economy, technology and social structure play a significant part in the design of an appropriate cultural therapy program for those in a developing country. Conclusions: Utilization of the transcultural nursing model for developing an appropriate therapy program allowed the therapist to develop a treatment plan that provides the ability to preserve, maintain, accommodate, negotiate, and then repattern or restructure the individuals therapeutic needs according to his/her cultural worldview. Relevance: The study provides a complimentary approach to adapting hand therapy protocols when working in a developing country where limitations of resources and cultural differences could impact the therapists goal of optimum hand function for the client.