Practices and barriers to healthcare worker compliance with guidelines preventing nosocomial infections among severely acutely malnourished children at a national referral hospital nutrition unit in Uganda

Abstract

Globally, malnutrition is a rapidly growing public health concern that is associated with high costs of healthcare and increased mortality. Undernutrition is associated with an overwhelming percentage of child deaths aged 5 years and below. The stakes are even higher when it comes to Severely acutely malnourished children. The condition is further complicated by nosocomial infection attacks hence increasing the risk of death. Nosocomial infections are common occurrence in facilities in Sub-Saharan Africa like Uganda and prevention measures and guidelines have been put in place for them. Nonetheless, nosocomial infections continue to be a difficulty in the management of severe acute malnutrition. There remains scanty information on the practices and barriers to the prevention of Nosocomial Infections among severely acutely malnourished children in Ugandan nutrition rehabilitation units. While there are standard recommendations on practices, the prevalence of nosocomial infections remains a concern. This study, therefore, looked into which practices are employed in the nutrition unit. How well and consistently the practices are carried out since poor execution and lapse in behaviour create a gap that hinders the success of nosocomial infection control. For this study 18 eligible healthcare workers employed by the nutrition unit were recruited to participate in this study as respondents since they interact with patients daily and are custodians of patients’ health. Informed consent was obtained from all participants before responding to any questions on the interview protocol. Additional information was obtained by observation with the guidance of an observation checklist. Document analysis of the IMAM and MIYCAN guidelines was carried out and the findings added to those of interviews and observation. Interview data and document analysis data were analyzed using the interactive model of data analysis. While observation data were analyzed using attached numeric scores that are interpreted on a Likert scale. The themes developed that informed the results and implications of the study were proper use of personal protective equipment, proper hygiene, health education, presence of environmental cues and routine surveillance were the practices mentioned. The themes under predisposing factors were skills gap, and poor knowledge while themes under barriers to a nosocomial-free hospital stay were limited financial and human resources as well as infrastructural setup. Results of the study indicate that despite some prevention practices being known, they are neither practised well nor consistently in the cases were they are well done and therefore are not effective. There is a lot of room for improvement. Practices such as cohorting patients according to arrival, giving systemic antibiotics to all patients and an active surveillance system are important prevention practices that were not mentioned and respondents. Recommendations following the finding of the study are for caretakers to heed advice and guidance offered during health education and to ask for help when needed to bridge the knowledge and skills gap. Healthcare workers carry out routine health education for patients and caretakers while on the ward and acquaint themselves with the guidelines used by the nutrition unit. Hospital authorities to avail appropriate environmental cues, ensure reliable access to supplies used in infection prevention, and offer training and retaining of health care workers on Infection prevent Control measures. To carry out IPC audits and put in place surveillance systems to monitor occurrence, actions taken and the prevalence of NIs. For future research, interventions and investigations of IPC behaviour change with a focus on consistence is ideal. Planning interventions in key areas such as hand washing and health education. Future surveillance studies through laboratory investigations to find out the prevalence of NIs among SAM children in nutrition units around Uganda.