Infection Control in Labor and Delivery Room, Learning from the Small Hospital Based Project-Juniper Publishers
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Background: It has been estimated
that around 36% of the neonatal deaths occur due to infection in the
lower and middle income countries. Infection control is a more
substantial area of concern, particularly in Labor and delivery room.
Multiple factors can cause infection in the labor room, therefore it is
important to assess various factors of maternal and neonatal infection.
Hence we explored multiple factors through this project and developed
the action plan to address those factors effectively.
Methods: During our Leadership and
Management course, we conducted a project in Labor room pertaining to a
prevalent issue. The whole process from identification of the issue to
the resolution was supposed to be in the light of leadership and
management concepts. After a thorough analysis and discussion, an action
plan was formulated considering the resources, audience, facilities and
time required for implementation and evaluation. Every step was
mentioned in the action plan for identification of issue till the
evaluation of the project.
Findings: Factors of infection were
grouped under six broad headings including staff, environment,
practices, equipment, factors related to patient and others. These were
diagrammatically represented through “Fishbone” Diagram
Conclusion: Infection is a common
issue in the hospital setting and we tried to assess the factors of
infection in the labor room. We identified multiple factors of infection
and tried to address those factors by developing a simple action plan.
We found that infection can be controlled by taking very simple
precautionary measures without incurring a lot of cost.
Keywords: Labor room; Infection; Factors; Action planIntroduction
Mothers and neonates are vulnerable to get infections
from the surrounding environment of the Hospital [1]. The chances of
infection increases, if the precautions are not taken appropriately,
especially by nursing staff who is the prime person, responsible for
taking care of neonates in the Hospital. Infection control is a more
substantial area of concern in Labor and delivery room because these
neonates do not adapt to their surroundings immediately after they come
out of the womb of mothers. In addition to this, mothers might be
exposed to infection due to multiple examinations by health care
providers during the process of labor [2]. Moreover, in lower middle
income countries, neonatal deaths are due to infections acquired at home
or in the hospital and around 36% of the neonatal deaths occur due to
infection [3-5]. Healthcare professionals always aim to preserve the
maternal and newborn health, but sometimes little negligence can put
their
health at risk which should not be overlooked. Multiple factors can
cause infection in the labor room, therefore it is important to assess
various factors of maternal and neonatal infection. Hence we explored
multiple factors through this project and developed the action plan to
address those factors effectively.
Overview of the project
During our Leadership and Management course, we had
to carry out a project in Labor room pertaining to a prevalent issue.
The whole process from identification of the issue of the resolution was
supposed to be in the light of leadership and management concepts [6].
Amongst multiple issues that were encountered in Labor room, we selected
“infection control” as an issue for our project. We carried out a
systematic process to collect data by using questionnaire
andobservations. A questionnaire was developed after doing literature
search. The target audience was the nursing staff in the labor room.
Through this questionnaire
and observation, it was identified that several factors could cause
infection. These factors and their cause and effect relationships
were grouped under six broad headings including staff,
environment, practices, equipment, factors related to patient
and others [7,8]. For example, staff related factors included lack
of awareness and sensitization about the causes of infection.
Similarly with respect to equipment in the labor room, warmers
were not found to be disinfected properly according to the hospital
infection control policy. Likewise patient related factors included
increased age, high parity and history of additional co-morbids.
This was diagrammatically represented through “Fishbone”
Diagram (Figure 1). Fishbone method was selected because it is
the most comprehensive way of analyzing complex problems and
identifying its causes and effects. It is a type of method which sort
out ideas into useful categories and also help to identify the root
causes of any problem [9].
Development of action plan
After a thorough analysis and discussion, an action plan was
formulated considering the resources, audience, facilities and
time required for implementation and evaluation. Every step was
mentioned in the action plan for identification of issue till the
evaluation of the project. A multimodal Interventional approach
was planned, including visual and verbal reminders, educational
initiatives like educational and motivational sessions for staff
through videos. Moreover, action plan also included reviewing
different policies with staff and providing pamphlets to each
staff highlighting common and important preventive measures
to control the infection. These interventions would cater the
principle of staff development by building the capacity of staff and
by improving their knowledge regarding infection control. It is
known fact that in the hospital premises, the chances of infection
are always possible; therefore precautionary measures should
be taken to avoid the sudden rise in infection [10]. Moreover,
problem solving principle can be used to resolve this issue, which
is a rational-logical thought process, helping to resolve problems
successfully using several incidents of decision making [11,12].
For problem solving process, different approaches were identified
through brainstorming and literature review of the possible
solutions by involving various experts. Furthermore, multiple
people can share their ideas and opinions therefore sometimes
there could be conflict between different team members, which
need to be resolved through the principal of conflict management
[13].
Implementation of action plan
We implemented the action plan in the labor room on
the
basis of different management principles. All interventions
were done as planned and mentioned in the action plan, except
a few modifications. We showed the videos of hand washing and
suctioning techniques to the nursing staff. Moreover, we also tried
to negotiate with the management and administrative staff to
change the suctioning bottles after every 24 hours, as mentioned in
the infection control policy. We also reviewed different skills with
staff, for example IV (Intravenous) canulation, suctioning, Foleys
catheterization and infection control policy. In addition to this, the
session also consisted of suctioning skill demonstration, which was
performed by student nurse with particular emphasis on infection
control. Apart from this, we also reinforced the management staff
that they should not allow the attendants to enter the labor room
with dirty shoes. The whole session was successful, which was
reflected by the staff’s increased participation during the session and
positive feedback from the staff at the end of the session.
Additionally, we provided pamphlets of infection control. We also
gave a brief presentation to reinforce and motivate nursing staff
regarding infection prevention practices. However, due to time
limitation, we could not cater all the staff, therefore we provided
the presentation to receptor so that she could circulate that
presentation among staff for their reference. In addition to this,
we also pasted the flyers on the notice board to remind the staff
whenever needed. Finally, evaluation of nursing staff was done to
assess their learning through sessions.
Challenges of the project
Challenges are unavoidable in any project and one should
take those challenges as an opportunity to move forward. The
implementation of the proposed action plan was itself a challenge
as it required human, financial and time resources. The second
most important challenge was the budget, as this project was not
funded therefore we had to manage the resources cost effectively
within our limited budget. For instance, we recycled the used
sheets to make the flash cards, instead of buying the new ones.
Another challenge was to gather the staff at a time during the clinic
hours for showing them videos and presentation. To overcome
this issue, we intervened several times in small groups and it
entirely depended on the availability of staff and sometimes we
had to utilize shift changing times and break times of the staff as
well. Apart from this, we encountered another great challenge of
arranging multimedia. Moreover, we had to carry out this project
during clinical hours, but we had to utilize our theory hours to
meet with a preceptor to discuss the progress of the project.
Our evaluation comprised of ongoing monitoring along with
formative feedback from the prospector which indicated the need
of further modification in the plan and the success of the project.
It also comprised of a summative evaluation as a final step of the
problem solving process to identify whether our implementation
program proved to be successful. We can say that our project might
be a minor contribution towards infection prevention in Labor
room, however, we could not measure that change quantitatively
due to lack of time and strict deadline. In addition, we also made
observations by spot checks to assess staff’s practices and we
found improvement in their practices.
Conclusion
Infection is a common issue in the hospital setting
and we
tried to assess the factors of infection in the labor room. We
identified multiple factors of infection and tried to address those
factors through a simple action plan. We found that infection
can be controlled by taking very simple precautionary measures
without incurring a lot of cost. This project was a great learning for
us and it developed our organization and communication skills
too. Moreover, we also learned how to make and implement an
action plan to prevent the occurrence of any bad outcome very
effectively. Apart from this, we also learned how to handle such
large group efficiently, especially by maintaining their interest in
the session. Our group got great support from all the staff and our
clinical faculty throughout our project. Their encouragement and
support were vital in the success of this project.
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