Safe and respectful? Birth attendants' hand hygiene compliance and its determinants using nationally representative data from Kenya, Malawi and Nepal.

IF 4.4 2区医学 Q1 INFECTIOUS DISEASES

Antimicrobial Resistance and Infection Control Pub Date : 2025-10-21 DOI:10.1186/s13756-025-01634-2

Lucia Dansero, Giorgia Gon

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Abstract

Background: In low and middle-income countries (LMICs), infections acquired during childbirth contribute significantly to maternal and neonatal mortality. Hand hygiene (HH) is critical in preventing the spread of infections, yet compliance remains inadequate. This study investigates birth attendants' HH compliance during labour, delivery, and postpartum in LMICs, using nationally representative data from Service Provision Assessments (SPAs) in Kenya, Malawi, and Nepal.

Methods: We analysed 1565 observed deliveries across 517 health facilities, resulting in 3919 HH opportunities. The outcomes were hand washing or hand disinfectant use: (1) before any initial examination, (2) before aseptic procedures during labour, (3) after birth. We used descriptive statistics to assess HH compliance and multivariate multilevel mixed-effect logistic regressions to investigate determinants, accounting for facility and individual clustering.

Findings: Hand hygiene compliance varied significantly across countries, with Kenya showing the lowest rates, while Malawi and Nepal had higher compliance levels. Supportive and effective communication towards pregnant women was significantly associated with an increase in HH compliance before the vaginal examination (Kenya - OR: 5.94, 95% CI 1.68-21.0; Malawi - OR: 2.19, 95% CI 1.04-4.65) and before aseptic procedures (Kenya - OR: 4.03, 95% CI 1.81-8.96; Malawi - OR: 4.01, 95% CI 1.69-9.50; Nepal - OR: 2.66, 95% CI 1.30-5.44). HH compliance during aseptic procedures during labour was also associated with recent IPC training in Malawi (OR: 3.48,95%CI 1.44-8.41) and facility infrastructure (OR: 6.14,95%CI 1.07-35.3).

Conclusion: Low hand hygiene compliance during birth, especially before aseptic procedures, can lead to healthcare-associated infections with serious consequences for mothers and newborns. Future research should investigate further the association between effective communication and hand hygiene.

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安全又有礼貌？助产士的手部卫生依从性及其决定因素，使用肯尼亚、马拉维和尼泊尔具有全国代表性的数据。

背景：在低收入和中等收入国家（LMICs），分娩期间获得的感染是孕产妇和新生儿死亡率的重要因素。手部卫生对预防感染传播至关重要，但遵守情况仍然不足。本研究调查了中低收入国家助产士在分娩、分娩和产后的HH依从性，使用了肯尼亚、马拉维和尼泊尔服务提供评估（spa）的全国代表性数据。方法：我们分析了517家卫生机构的1565例观察到的分娩，产生了3919例HH机会。结果是洗手或洗手消毒剂的使用：(1)在任何初步检查之前，(2)在分娩过程中进行无菌操作之前，(3)出生后。我们使用描述性统计来评估HH依从性，并使用多变量多水平混合效应逻辑回归来调查决定因素，考虑设施和个体聚类。调查结果：各国对手部卫生的遵守程度差异很大，肯尼亚的遵守程度最低，而马拉维和尼泊尔的遵守程度较高。在阴道检查前（肯尼亚- OR: 5.94, 95% CI 1.68-21.0；马拉维- OR: 2.19, 95% CI 1.04-4.65）和无菌手术前（肯尼亚- OR: 4.03, 95% CI 1.81-8.96；马拉维- OR: 4.01, 95% CI 1.69-9.50；尼泊尔- OR: 2.66, 95% CI 1.30-5.44），对孕妇的支持和有效沟通与HH依从性的增加显著相关。分娩过程中无菌程序中的卫生合规也与马拉维最近的IPC培训（OR: 3.48,95%CI 1.44-8.41）和设施基础设施（OR: 6.14,95%CI 1.07-35.3）有关。结论：分娩过程中手部卫生依从性低，特别是在无菌程序之前，可导致卫生保健相关感染，对母亲和新生儿造成严重后果。未来的研究应进一步调查有效沟通与手卫生之间的关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

9.70

自引率

3.60%

发文量

140

审稿时长

13 weeks

期刊介绍： Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.