Background
-
Management systems (health information data, protocols)
-
Clean practices (hand washing, antisepsis, asepsis, surgical procedures)
-
Clean equipment (gloves, gowns and instruments)
-
Clean environment (surfaces, washing facilities)
-
Diagnostics and treatment (blood products, antibiotics)
Methods
District and health facility selection
Facility type | FRU* | Primary health centres | Private | Public (urban) | Tertiary | Private non profit | Total |
---|---|---|---|---|---|---|---|
Ahmedabad | 2 | 2 | 1 | 3 | 1 | 1 | 10 |
Surendranagar | 2 | 2 | 1 | 1 | 1 | 3 | 10 |
Total | 4 | 4 | 2 | 4 | 2 | 4 | 20 |
Data collection
Analysis
Results
% (N = 20) | |
---|---|
A standard procedure exists | 70 |
Type of information available
| |
Book and chart showing infection rates | 5 |
Chart only | 15 |
Written procedure available | 5 |
Verbal procedure reported | 45 |
Management/procedural activities conducted
| |
Infection control committee (monthly meetings held) | 15 |
Case(s) of hospital acquired infection recorded | 5 |
Audit or maternal death review | 10 |
Any staff member attended training in infection control in last year | 25 |
Details of clean practices or asepsis
| |
All staff routinely wash hands before procedures. | 95 |
Soap available at all times for hand-washing. | 95 |
Staff vigorously rub hands together with antiseptic or soap and water before any aseptic procedure such as a vaginal examination during labour. | 75 |
Sterile gloves | 80 |
Patients are advised for prevention of infection | 95 |
Diagnosis and treatment
| |
Blood culture can be taken in facility | 25 |
Staff aware of common organisms found in blood/pus/fluid culture reports | 20 |
Antibiotics available in facilities for organisms found | 95 |
% (N = 20) | |
---|---|
Wall posters and charts relevant to infection control | 35 |
Thermometer available on the ward | 65 |
Patients charts with temperature recorded regularly | 45 |
Soap (or any other antiseptic) available | 90 |
Antibiotics seen | 90 |
Management and procedural activities
Clean practices and asepsis
Items available | Labor room,% (N = 20) | Operation theatre, % (N = 18) |
---|---|---|
24-hour running water | 95 | 100 |
Wash basin with elbow or knee tap | 65 | 61 |
Soap | 90 | 80 |
Antiseptics for skin preparation | 95 | 94 |
Sterile (unused) gloves | 0 | 89 |
Surgical gloves: reused | 85 | 71 |
Sterile linen packs | 65 | 66 |
Sterile delivery packs | 50 | 0 |
Disposable delivery kit ("Mamta kit") | 40 | 0 |
Clean equipment and supplies
Clean environment
Diagnosis and treatment
Experience of recent cases of puerperal sepsis
Discussion
Conclusion
-
Given the lack of information, underreporting of puerperal sepsis and other infectious complications relating to childbirth is likely. Record keeping, analysis and feedback of data needs to be improved. Criteria for diagnosis of puerperal sepsis should be uniformly laid down and communicated. Notification of puerperal sepsis should be encouraged.
-
Protocols for infection control measures should be prepared, standardised and adapted to local situations. The protocols should include assessment of the evidence for procedures like fumigation, reuse of items, maintaining cleanliness of the environment (especially in labour rooms) and rational use of antibiotics, adapted to resource constrained settings.
-
Training to upgrade minimum skills for infection prevention should be started at pre-service level and extend to continuous training at service for staff. This should be based on assessments of staff needs. The means to create motivation and accountability at individual level should be explored.
-
Community based research should be carried out to estimate the burden of infection in postnatal mothers. Factors associated with occurrence of infection should be documented. This needs assessment can provide the basis for such work.
-
There should be active hospital infection control committees set up, combined with maternal death reviews, audits, training and feedback on infection rates. State level officers could be included in such activities to ensure integration of these activities within the health system as a whole. Their role should also be to ensure the link-up between increasing utilization (for example, through incentives) and improving the quality of care that women receive once they reach health facilities.