Dataset Information

Current practices and evaluation of barriers and facilitators to surgical site infection prevention measures in Jimma, Ethiopia.

ABSTRACT:

Objective

Surgical site infections (SSIs) greatly burden healthcare systems around the world, particularly in low- and middle-income countries. We sought to employ the Systems Engineering Initiative for Patient Safety (SEIPS) model to better characterize SSI prevention practices and factors affecting adherence to prevention guidelines at Jimma University Medical Center (JUMC).

Design

Our cross-sectional study consisted of semistructured interviews designed to elicit perceptions of and barriers and facilitators to SSI prevention among surgical staff and observations of current preoperative, perioperative, and postoperative SSI prevention practices in surgical cases. Interviews were recorded, manually transcribed, and thematically coded within the SEIPS framework. Trained observers recorded compliance with the World Health Organization's SSI prevention recommendations.

Setting

A tertiary-care hospital in Jimma, Ethiopia.

Participants

Surgical nurses, surgeons, and anesthetists at JUMC.

Results

Within 16 individual and group interviews, participants cited multiple barriers to SSI prevention including shortages of water and antiseptic materials, lack of clear SSI guidelines and training, minimal Infection Prevention Control (IPC) interaction with surgical staff, and poor SSI tracking. Observations from nineteen surgical cases revealed high compliance with antibiotic prophylaxis (94.7%), hand scrubbing (100%), sterile gloves and instrument use (100%), incision site sterilization (100%), and use of surgical safety checklist (94.7%) but lower compliance with preoperative bathing (26.3%), MRSA screening (0%), and pre- and postoperative glucose (0%, 10.5%) and temperature (57.9%, 47.3%) monitoring.

Conclusions

Utilizing the SEIPS model helped identify institution-specific barriers and facilitators that can inform targeted interventions to increase compliance with currently underperformed SSI prevention practices at JUMC.

SUBMITTER: Berman LR

PROVIDER: S-EPMC9495540 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Current practices and evaluation of barriers and facilitators to surgical site infection prevention measures in Jimma, Ethiopia.

Berman Leigh R LR Lang Andrew A Gelana Beshea B Starke Samuel S Siraj Dawd D Yilma Daniel D Shirley Daniel D

Antimicrobial stewardship & healthcare epidemiology : ASHE 20211117 1

<h4>Objective</h4>Surgical site infections (SSIs) greatly burden healthcare systems around the world, particularly in low- and middle-income countries. We sought to employ the Systems Engineering Initiative for Patient Safety (SEIPS) model to better characterize SSI prevention practices and factors affecting adherence to prevention guidelines at Jimma University Medical Center (JUMC).<h4>Design</h4>Our cross-sectional study consisted of semistructured interviews designed to elicit perceptions of ...[more]

PMID: 36168452

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Project description:BackgroundAdherence to infection prevention and control (IPC) standards and guidelines by healthcare workers is essential for reducing the spread of healthcare-associated infections (HAIs). However, IPC practices among healthcare workers in low- and middle-income countries (LMICs), including Ethiopia, are generally inadequate. This research aims to identify the barriers to and facilitators of IPC practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital (TASH) in Ethiopia.MethodsWe employed a rapid ethnographic assessment (REA) approach for this study, using focus group discussions (FGDs), in-depth interviews (IDIs), and observations to collect data. Participants were selected from the Pediatrics and Child Health Department of TASH, and data collection took place in March and April 2022. Two FGDs and eight IDIs were conducted in the participants' workplace within the department. Unstructured guides were used to facilitate the FGDs and IDIs. Nvivo version 10 software was used for data organization and analysis. The data were coded deductively through thematic analysis to identify similar ideas and concepts, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultA total of 23 healthcare workers participated, with 15 in FGDs and 8 in IDIs. The study identified several barriers to IPC practices, including nonadherence to IPC practice protocols, lack of pre-employment training, space constraints, insufficient maintenance and repair of equipment, limited management engagement and support, shortage of resources and budget, incidents of needle stick injuries and infections, high workloads for healthcare workers, shortages of personal protective equipment and water supply, and inadequate waste management. We also identified some facilitators, including the existence of an IPC team and committee, a health education schedule for patients and visitors, morning sessions for healthcare providers, and the presence of television screens in waiting areas. By addressing the identified barriers and leveraging the facilitators, department heads, IPC team leaders, and decision-makers can develop targeted strategies and interventions to improve infection control, reduce the spread of HAIs, and ultimately enhance the quality of healthcare services.ConclusionThis study explored several barriers that contribute to inappropriate and suboptimal IPC practices in the study area. These barriers create significant challenges for healthcare workers and hindering their ability to effectively implement IPC practices. The findings highlight the complex and multifaceted nature of the problems, which not only affect the current working environment but also compromise the overall quality of care. The hospital administrator should address these critical issues to improving IPC practices and ensuring a safer healthcare environment.

Project description:BackgroundSurgical site infections are one of the leading health care-associated infections in developing countries. Despite improvements in surgical technique and the use of best infection prevention strategies, surgical site infections remained the major cause of hospital acquired infections. Therefore, this study aimed to determine incidence, risk factors, and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia.MethodsA hospital based prospective cohort study design was employed to follow adult patients admitted to general surgery ward, orthopaedic ward and gynaecologic/obstetrics ward of Jimma Medical Centre, from April 20 to August 20, 2019. All patients were followed daily before, during and after operation for 30 days to determine the incidence of surgical site infection and other outcomes. Data was entered using EpiData version 4.2 and analyzed using statistical software package for social science version 20.0. To identify the independent predictors of outcome, multiple stepwise backward cox regression analysis was done. Statistical significance was considered at p-value <0.05.ResultsOf total of 251 participants included to the study, about 126 (50.2%) of them were females. The mean ± SD age of patients was 38 ± 16.30 years. Considerable number of patients 53(21.1%) developed surgical site infections. American Society of Anaesthesiologists score ≥3 [ Adjusted Hazard Ratio (AHR) = 2.26; 95%CI = (1.03-4.93)], postoperative antibiotic prescription [AHR = 3.2; 95%CI = (1.71-6.01)], contaminated-wound [AHR = 7.9; 95%CI = (4.3-14.60)], emergency surgery [AHR = 2.8; 95% CI = (1.16-6.80)], duration of operation ≥ 2 h [AHR = 4; 95% CI = (2.17-7.50)] and comorbidity [AHR = 2.52; 95%CI = (1.28-4.94)] were independent predictors for surgical site infections. Twenty nine (11.6%) patients returned to operation room. The result of the multivariate cox regression analysis showed that SSI [AHR (95% CI) = 7(3.16-15.72)], and incision site [AHR (95% CI) = 2.5(1.14-5.42)] had statistically significant association with re-operation.ConclusionThe incidence of surgical site infection was high in the study setting. There were significant numbers of contributing factors for the occurrence of surgical site infections. Although no mortality observed during the study period, significant number of patients re-operated. Large multicenter study is urgently needed to confirm the outcome of this study.

Project description:BackgroundThis research aims to determine the incidence of calf morbidity, mortality and its potential predisposing factors in the first six months of life. Morbidity and mortality of dairy calves are persistent problems for dairy farmers worldwide. For effective control and prevention programs on calf health, it is imperative to estimate the extent of calf morbidity and mortality, and associated risk factors. Although few studies have investigated the epidemiology of calf morbidity and mortality in Ethiopia, comprehensive information is scarce in this area.MethodsData were collected through a cross-sectional survey and longitudinal follow-up on purposively selected dairy farms. A longitudinal study was conducted on 235 calves from birth to 6 months of age. Survival analysis methods using the Kaplan-Meier (K-M) method, and mixed effect Cox proportional hazard regression were employed to compute the life-to-event data on morbidity and mortality.ResultsFrom the 235 calves studied, 53 morbidity and 15 mortality events were recorded. This gives an overall morbidity and mortality incidence rate of 55 per 100-calf 6-months at risk (risk rate of 42.07%) and 14 per 100-calf 6-months at risk (risk rate of 12.97%), respectively. Diarrhea (13.84%) followed by pneumonia (8.97%) were the most common diseases that occurred in calves, respectively. Similarly, diarrhea (33.3%) and pneumonia (26.7%) were the leading causes of death. Dam parity (p < 0.001) and pen cleaning (p < 0.001) were significant predictors of calf morbidity. Dam parity (p = 0.007), calving status (p = 0.005), pen cleaning (p = 0.04), and floor type (p = 0.001) of houses were significantly associated with mortality. The hazard of diarrhea was significantly associated with sex (p = 0.003), first colostrum feeding time (p = 0.028), pen cleaning (p = 0.010), and breeding method (p = 0.013).ConclusionThe rates of morbidity and mortality reported in the study were higher than the economically acceptable, also affecting the welfare of the animals. The risk factors found need due attention in the management practices of dairy calves in Ethiopia.

Project description:Despite the high prevalence of adolescent food insecurity in Ethiopia, there is no study which documented its association with suboptimal dietary practices. The objective of this study is to determine the association between adolescent food insecurity and dietary practices. We used data on 2084 adolescents in the age group of 13-17 years involved in the first round survey of the five year longitudinal family study in Southwest Ethiopia. Adolescents were selected using residence stratified random sampling methods. Food insecurity was measured using scales validated in developing countries. Dietary practices were measured using dietary diversity score, food variety score and frequency of consuming animal source food. Multivariable regression models were used to compare dietary behaviors by food security status after controlling for socio-demographic and economic covariates. Food insecure adolescents had low dietary diversity score (P<0.001), low mean food variety score (P<0.001) and low frequency of consuming animal source foods (P<0.001). After adjusting for other variables in a multivariable logistic regression model, adolescent food insecurity (P<0.001) and rural residence (P<0.001) were negatively associated with the likelihood of having a diversified diet (P<0.001) and frequency of consuming animal source foods, while a high household income tertile was positively associated. Similarly, multivariable linear regression model showed that adolescent food insecurity was negatively associated with food variety score, while residence in semi-urban areas (P<0.001), in urban areas (P<0.001) and high household income tertile (P = 0.013) were positively associated. Girls were less likely to have diversified diet (P = 0.001) compared with boys. Our findings suggest that food insecurity has negative consequence on optimal dietary intake of adolescents. Food security interventions should look into ways of targeting adolescents to mitigate these dietary consequences and provide alternative strategies to improve dietary quality of adolescents in Southwest Ethiopia.

Dataset Information

Current practices and evaluation of barriers and facilitators to surgical site infection prevention measures in Jimma, Ethiopia.

Objective

Design

Setting

Participants

Results

Conclusions

Publications

Current practices and evaluation of barriers and facilitators to surgical site infection prevention measures in Jimma, Ethiopia.

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