“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
Abstract
:1. Background
2. Material and Methods
3. Results
“Mostly our patients they are from rural area. We are dealing with a large number of rural patients”.(Administrators FGD 8)
“Mostly the filth spreads from the latrines and bathrooms. People are responsible for this they scatter the filth. And such a case that we go on cleaning and the filth always remains we clean daily but filth always remains there in spite of so much cleaning. Since floors have the filth, as people walk they spread the filth wherever they go.”(Cleaning Staff FGD 6)
“What is happening in the TB Ward? When a chest tube is put in place for removal of fluid then the fluid is drained out in any kind of a container. The relatives or visitors of the patients would accidentally spill the fluid all around on the ground. The floor is thus soiled. Staff shortage is there and sweepers are not available. Hence problem arises who would clean it?”(Nursing Administrators FGD 10)
“Mop is really very dirty and the water is seldom changed. Then the storage of the mop is another issue. She would store that mop in one of the toilets. And that toilet is no longer usable, there is nothing like a broom closet.”(Doctors FGD 9)
“Can....can you imagine flies in the O.T. sitting on the wound of the patients? What is that? Can you talk about that flies I don’t know about your OT I have seen umpteen times the flies have been sitting while operating, on either on the trolley operating trolley or on the wound.”(Doctors FGD 9)
“Come to our dressing room and you will know. The tray, on which the dressing material has been presented to you, has not been sterilized for generations. [On] the same tray the new [autoclaved] material from the drum is poured on.”(Doctors FGD 9)
“The doctors are often using the same instruments, used on one patient and they are frequently used on other patients without sterilizing. In fact, this is the major cause of infection, from patient to patient. If the patients is from well [to do] background then doctor get conscious about his cleanliness but not when the rural and poor patients are coming.”(Medical Students FGD 5)
“Toilets are not cleaned properly there are so many relatives are coming, bed occupancy also more, shortage of staff is there, water shortage is also there and all; like gloves, mask, caps that we are also not getting, means, we have to just wait for the items. So these all thing are there.”(Nursing Administrators FGD 10)
“After all who has to clean when a patient spits or vomits on the floor? It is we; we have to do it with our bare hands. Today I cleaned the vomitus of a patient with bare hands before I came here. I collected that entire nasty thing in my palm with the other hand and in both the hands, like this (depicts through action too). Like this, like this I filled the vomitus in my flexed palm.”(Cleaning staff FGD7)
“How can the patients remain safe, if we are not safe and protected from the infections?”(Nurses FGD3)
“We would like to send the swabs from the [points] where the nurses sit one thing and from each ward especially from the post-operative ward and postnatal ward.”(Doctors FGD 9)
“Fumigationshould be done with proper norms, at proper intervals.”(Nursing Administrators FGD 10)
4. Discussion
5. Methodological Considerations
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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No. | Male | Female | Age Range (in Years) | |
---|---|---|---|---|
Hospital Administrators | 15 | 8 | 7 | 22–68 |
Doctors | 15 | 11 | 4 | 26–63 |
Nursing Staff | 14 | 0 | 14 | 20–34 |
Cleaning Staff | 17 | 8 | 9 | 18–48 |
Undergraduate medical students | 14 | 9 | 5 | 20–23 |
Total | 75 | 36 | 39 | 18–68 |
Subtheme | Categories | Codes |
---|---|---|
1.1. Related to the beneficiaries (service consumers) | Surface contamination by the beneficiaries | defecation on washroom floors/spitting and littering anywhere/waste disposal through windows |
Beneficiary background | rural background/illiteracy/diehard habits | |
Visitor overcrowding | tradition of overcrowding/sociocultural aspects/some doctors to justify | |
1.2. Related to hospital personnel and organizational work culture | Surface contamination by the staff | staff contributes significantly/spillage of blood and body fluids on the floors |
Poor ward hygiene | infrequent cleaning/linen and laundry/mattresses/blankets/pillows/pillow covers/inadequate patient care/lacunae in ward management | |
Staff factors in visitor overcrowding | inadequate emphasis/treatment witness needed/need of some attenders/neglect of control by the security staff | |
Infection transmission in OT * | flies in the OT/infection from ward to OT/seniors’ noncompliance in the OT | |
Infection Transmission in other critical zones | infectious and immune compromised patients clumped together/casualty ward/ labor ward/ ICU ** | |
1.3. Practices and problems related to the specific infection prevention and control processes | Sterilization of instruments | use of unsterilized instruments for poor and rural patients/use of unsterilized dressing trays and other similar lacunae/improper sterilization/re-use of unsterilized instruments |
Disinfection | dearth of disinfectants/dearth of antiseptics/excessive dilution/lacunae in procedures | |
HAI-Surveillance | poor HAI surveillance/guideline ignorance/reporting problems | |
Resource management issues | inculcation/competence and attitude related issues/lack of a proper system and infrastructure/pros and cons of the prevailing centralized system/poor maintenance of scarcely available facilities/lack of rules and regulations/poor clarity about rules/poor implementation of the rules/poor hygiene and sanitation/powerless hospital infection control committee/nominal security and control systems/lack of a team spirit/problems related to the management of cleaning staff | |
1.4. Influence of resource constraints | Water shortage | restricted water supply/wastage of scarce water/toilets stinking due to water shortage |
Material shortage | scarcity of PPE #/availability of gloves and masks/ limited supply of antiseptics and disinfectants | |
Staff shortage | staff shortage and high workload/duty roster lacunae and other deployment discrepancies/multitasking | |
Restricted Access Issues | access to toilets/access to blankets |
Subtheme | Categories | Codes |
---|---|---|
2.1. Behavioral and structural interventions to address the prevailing practices and problems | Educational measures | awareness/inculcation/training/other avenues of improving competence/combination of educational measures with other interventions |
Motivational measures | rise in salary/other material incentives/certificates/competition and awards/positive-reinforcement/improving attitude | |
Team development | Technical capability combined with leadership/team development | |
Monitoring and Supervision | rules for everyone/implementation of rule/rounds/surprise-rounds/reinforcement-alternatives | |
Security system and assistance | improving security system/visitor-overcrowding-management/patient-assistance/beneficiary-education-motivation | |
Teaching of nursing care and ward care | improving nursing-care-teaching/improving bed-making/using the opportunity of bed-making/ ward-hygiene-teaching/personal-hygiene-care in wards | |
Resource management and maintenance | adequate strength of staff/recruitment of ICO, ICN etc./provision of clean bed-linen/provision of blankets/provision of adequate number of washrooms and toilets/provision of water, mops, antiseptics and disinfectants/provisions of PPE for the staff and the visitors/standard precautions/universal precautions/hepatitis B immunization/barrier protection/availability of gloves and masks | |
2.2. Measures suggested for improving the specific hospital infection control processes | Improving surveillance | routine swabbing/delivery of reports/methods of surveillance/frequency and sites of surveillance/audit |
Improving isolation and ventilation | ventilation improvement priorities/isolation-improvisation/isolation-monitoring | |
Improving decontamination | better methods for decontamination/proper decontamination/fumigation/need for data on disinfectant use |
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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. https://doi.org/10.3390/ijerph15091942
Joshi SC, Diwan V, Joshi R, Sharma M, Pathak A, Shah H, Tamhankar AJ, 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. International Journal of Environmental Research and Public Health. 2018; 15(9):1942. https://doi.org/10.3390/ijerph15091942
Chicago/Turabian StyleJoshi, Sudhir Chandra, Vishal Diwan, Rita Joshi, Megha Sharma, Ashish Pathak, Harshada Shah, Ashok J. Tamhankar, and Cecilia Stålsby Lundborg. 2018. "“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" International Journal of Environmental Research and Public Health 15, no. 9: 1942. https://doi.org/10.3390/ijerph15091942