Healthcare worker perceptions of the implementation context surrounding an infection prevention intervention in a Zambian neonatal intensive care unit.

TitleHealthcare worker perceptions of the implementation context surrounding an infection prevention intervention in a Zambian neonatal intensive care unit.
Publication TypeJournal Article
Year of Publication2020
AuthorsCowden C, Mwananyanda L, Hamer DH, Coffin SE, Kapasa ML, Machona S, Szymczak JE
JournalBMC Pediatr
Volume20
Issue1
Pagination432
Date Published2020 Sep 10
ISSN1471-2431
Abstract

BACKGROUND: Infants in the neonatal intensive care unit (NICU) are particularly susceptible to healthcare-associated infections (HAIs). NICUs in low- and middle income countries face additional challenges to HAI prevention. There is a need to better understand the role of the implementation context surrounding infection prevention interventions in low- and middle income countries.

AIM: The aim of this study was to identify NICU healthcare worker perceptions of an intervention to reduce bloodstream infections in a large Zambian NICU.

METHODS: Semi-structured interviews were conducted with NICU staff during a prospective cohort study examining the impact of an infection prevention bundle on bloodstream infections. Interviews were analyzed using an integrated approach, combining inductive theme generation with an application of the Consolidated Framework for Implementation Research (CFIR).

RESULTS: Interviews were conducted with 17 NICU staff (5 physicians and 12 nurses). Respondents believed the bundle elements were easy to use, well-designed and facilitated improved performance. Four organizational characteristics that facilitated HAI transmission were identified - (1) lack of NICU admission protocols; (2) physical crowding; (3) understaffing; and (4) equipment shortages. Respondents suggested that NICU resource constraints reflected a societal ethos that devalued the medical care of infants. Despite the challenges, respondents were highly motivated to prevent HAIs and believed this was an achievable goal. They enthusiastically welcomed the bundle but expressed serious concern about sustainability following the study.

CONCLUSIONS: By eliciting healthcare worker perceptions about the context surrounding an infection prevention intervention, our study identified key organizational and societal factors to inform implementation strategies to achieve sustained improvement.

DOI10.1186/s12887-020-02323-2
Alternate JournalBMC Pediatr
PubMed ID32912138
PubMed Central IDPMC7488390
Grant List12036 / / Thrasher Research Fund /