Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Hand Hygiene during the Early Neonatal Period: A Mixed-methods Observational Study in Healthcare Facilities and Households in Rural Cambodia

Yolisa Nalule
* ORCID logo ,
Helen Buxton
,
Alison Macintyre
,
Por Ir
,
Ponnary Pors
,
Channa Samol
,
Supheap Leang
,
Robert Dreibelbis
Version 1 : Received: 19 March 2021 / Approved: 22 March 2021 / Online: 22 March 2021 (10:37:57 CET)

A peer-reviewed article of this Preprint also exists.

Nalule, Y.; Buxton, H.; Macintyre, A.; Ir, P.; Pors, P.; Samol, C.; Leang, S.; Dreibelbis, R. Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia. Int. J. Environ. Res. Public Health 2021, 18, 4416. Nalule, Y.; Buxton, H.; Macintyre, A.; Ir, P.; Pors, P.; Samol, C.; Leang, S.; Dreibelbis, R. Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia. Int. J. Environ. Res. Public Health 2021, 18, 4416.

DOI: 10.3390/ijerph18094416

Abstract

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both the facility and home environments. Current improvement interventions focus on only one environment and tar-get limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behaviour change intervention in rural Cambodia, a formative mixed-methods research study was conducted to investigate the context specific behaviours and determinants of hand-washing among healthcare workers, maternal and non-maternal caregivers along the early new-born care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and associated communities were completed and hand hygiene compliance assessed in analysis. Semi structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional, and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both set-tings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance to hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusion: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

Keywords

Neonatal infection; hand hygiene; behaviour change; Cambodia; post-natal care; newborn care; formative research; intervention design; health facility; household

Subject

SOCIAL SCIENCES, Accounting

Copyright: 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.

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