A qualitative study of infection prevention and control practices in the maternal units of two Ghanaian hospitals

Abstract

Abstract Healthcare-associated infections (HAIs) remain a common challenge in healthcare delivery, with a significant burden in low- and middle-income countries. Preventing HAIs has gained enormous attention from policy makers and providers of healthcare services in resource-limited settings including Ghana. Despite policies to position health facilities to enforce infection prevention and control (IPC) measures as a means for improving patient experience of care and preventing HAIs, evidence points to poor IPC practices in hospitals in Ghana. In this study we explore the experiences of healthcare providers and post-natal women, and assess facilitators and barriers to IPC practice in two hospitals in Ghana. Methods: The study used a qualitative approach involving semi-structured interviews, focus group discussions, and observations from January 2019 to June 2019. Interviews were recorded and transcribed verbatim for thematic analysis. The data sets were uploaded into the qualitative software NVivo 12 to facilitate coding and analysis. Observation notes were incorporated into the data analysis. Findings: Healthcare providers’ responsibility to care for patients and establish professional identity, influenced their approach to care. Hygiene behaviour and IPC compliance were driven by the desire to care for and protect oneself from infections. Other IPC facilitators include leadership commitment and support, training and education for IPC. Postnatal women were informed about IPC during antenatal care visits, and their practices were also shaped by their background and their communities. IPC barriers include the poor documentation or ‘invisibility’ of HAIs, low prioritization of IPC tasks, lack of clear IPC goals, inadequate deference to guidelines, and communication-related challenges. The results of this study demonstrate the need for a comprehensive understanding of the individual and collective perceptions of HAIs, and what constitutes ‘care’, to drive hygiene behaviour to improve IPC in hospital wards. Hospital managers need to position themselves as key drivers of IPC and develop clear goals and define roles to stimulate IPC while engaging postnatal mothers and communities.