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Int. J. Environ. Res. Public Health 2018, 15(9), 1942; https://doi.org/10.3390/ijerph15091942

“How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections”? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India

1
Department of Community Medicine, R.D. Gardi Medical College, Ujjain 456006, India
2
Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain 456006, India
3
International Centre for Health Research, Ujjain Charitable Trust Hospital and Research Centre, Ujjain 456001, India
4
Department of Public Health Sciences, Global Health, Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, 17177 Stockholm, Sweden
5
Department of Microbiology, R.D. Gardi Medical College, Ujjain 456006, India
6
Department of Pharmacology, R.D. Gardi Medical College, Ujjain 456006, India
7
Department of Pediatrics, R.D. Gardi Medical College, Ujjain 456006, India
8
Department of Women and Children’s Health, International Maternal and Child Health Unit, Uppsala University, 75185 Uppsala, Sweden
9
Indian Initiative for Management of Antibiotic Resistance, Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain 456006, India
These authors contributed equally.
*
Author to whom correspondence should be addressed.
Received: 16 July 2018 / Revised: 1 September 2018 / Accepted: 3 September 2018 / Published: 6 September 2018
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Abstract

Background: Health care-associated infections (HAIs) result in treatment delays as well as failures and financial losses not only to patients but also to the treating hospital and overall health-care delivery system. Due to hospital-acquired infections, there are problems of increase in morbidity and mortality, additional diagnostic and therapeutic interventions and ultimately antimicrobial resistance. Proper understanding among health-care workers about the ill effects of HAIs is very important to address this issue. The present study is a qualitative exploration aimed at understanding various aspects of hospital environmental hygiene and Infection prevention control program, by exploring the staff perception regarding the challenges, facilitators and barriers as well as feasible measures towards improvement in a rural tertiary teaching hospital in central India. Method: A qualitative study was conducted using 10 focus group discussions (FGDs) among five different professional groups, which included hospital administrators, doctors, nurses, environmental cleaning staff, and undergraduate medical students. The FGD guide included the following topics: (1) opinion about the status of cleanliness, (2) concepts and actual practices prevailing of hospital environmental hygiene, (3) Barriers, constraints, and problems in maintaining hospital environmental hygiene, (4) Suggestions for improvements. The data were analyzed manually using the content (thematic) analysis method. Results: Two themes were identified: Theme 1: “Prevailing practices and problems related to hospital surface/object contamination and hospital infection control”. Theme 2: “Measures suggested for improving hospital cleanliness within the existing constraints”. The participants emphasized the influence of resource constraints and needed inputs. They brought up the consequent prevailing practices and problems related, on one hand, to various stakeholders (service consumers, hospital personnel including the management), on the other, to specific infection prevention and control processes. They also suggested various measures for improvement. Conclusions: The study has revealed prevailing practices, problems, and suggested measures related to hospital environmental hygiene, particularly hospital cleanliness and HAI prevention and control processes. These insights and assertions are important for developing future behavioral and structural interventions in resource-limited settings. This study recommends a nationwide reliable HAI surveillance system and a robust infection prevention and control program in each health-care institution. View Full-Text
Keywords: health care-associated infection; hospital environmental hygiene; infection control; patient safety; hospital personnel; qualitative research; India health care-associated infection; hospital environmental hygiene; infection control; patient safety; hospital personnel; qualitative research; India
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Joshi, S.C.; Diwan, V.; Joshi, R.; Sharma, M.; Pathak, A.; Shah, H.; Tamhankar, A.J.; Stålsby Lundborg, C. “How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections”? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India. Int. J. Environ. Res. Public Health 2018, 15, 1942.

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