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The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals
BACKGROUND: Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an ed...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789081/ https://www.ncbi.nlm.nih.gov/pubmed/33413647 http://dx.doi.org/10.1186/s13756-020-00866-8 |
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author | Gon, Giorgia Kabanywanyi, Abdunoor M. Blinkhoff, Petri Cousens, Simon Dancer, Stephanie J. Graham, Wendy J. Hokororo, Joseph Manzi, Fatuma Marchant, Tanya Mkoka, Dickson Morrison, Emma Mswata, Sarah Oza, Shefali Penn-Kekana, Loveday Sedekia, Yovitha Virgo, Sandra Woodd, Susannah Aiken, Alexander M. |
author_facet | Gon, Giorgia Kabanywanyi, Abdunoor M. Blinkhoff, Petri Cousens, Simon Dancer, Stephanie J. Graham, Wendy J. Hokororo, Joseph Manzi, Fatuma Marchant, Tanya Mkoka, Dickson Morrison, Emma Mswata, Sarah Oza, Shefali Penn-Kekana, Loveday Sedekia, Yovitha Virgo, Sandra Woodd, Susannah Aiken, Alexander M. |
author_sort | Gon, Giorgia |
collection | PubMed |
description | BACKGROUND: Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. METHODS: This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. RESULTS: Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. CONCLUSIONS: The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design. |
format | Online Article Text |
id | pubmed-7789081 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-77890812021-01-08 The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals Gon, Giorgia Kabanywanyi, Abdunoor M. Blinkhoff, Petri Cousens, Simon Dancer, Stephanie J. Graham, Wendy J. Hokororo, Joseph Manzi, Fatuma Marchant, Tanya Mkoka, Dickson Morrison, Emma Mswata, Sarah Oza, Shefali Penn-Kekana, Loveday Sedekia, Yovitha Virgo, Sandra Woodd, Susannah Aiken, Alexander M. Antimicrob Resist Infect Control Research BACKGROUND: Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. METHODS: This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. RESULTS: Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. CONCLUSIONS: The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design. BioMed Central 2021-01-07 /pmc/articles/PMC7789081/ /pubmed/33413647 http://dx.doi.org/10.1186/s13756-020-00866-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Gon, Giorgia Kabanywanyi, Abdunoor M. Blinkhoff, Petri Cousens, Simon Dancer, Stephanie J. Graham, Wendy J. Hokororo, Joseph Manzi, Fatuma Marchant, Tanya Mkoka, Dickson Morrison, Emma Mswata, Sarah Oza, Shefali Penn-Kekana, Loveday Sedekia, Yovitha Virgo, Sandra Woodd, Susannah Aiken, Alexander M. The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals |
title | The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals |
title_full | The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals |
title_fullStr | The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals |
title_full_unstemmed | The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals |
title_short | The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals |
title_sort | clean pilot study: evaluation of an environmental hygiene intervention bundle in three tanzanian hospitals |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789081/ https://www.ncbi.nlm.nih.gov/pubmed/33413647 http://dx.doi.org/10.1186/s13756-020-00866-8 |
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