Infection prevention and control practices of non-medical individuals in a neonatal intensive care unit: A Donabedian approach

Abstract

Objective: To describe the infection prevention and control practices of non-medical individuals in a neonatal intensive care unit, using the Donabedian model.

Design: We used an observational descriptive qualitative approach, collecting data over 38 h of non-participant, unstructured observations. An interprofessional observational team recorded their observations.

Setting: Observations were collected in the neonatal intensive care unit of a regional hospital in Gauteng, South Africa.

Participants: We observed non-medical individuals involved in the day-to-day operations related to infection prevention and control in a neonatal intensive care unit, specifically the cleaners and laundry staff, maintenance and technical services, and significant others. Individuals were selectively observed due to their proximity and convenient presence in the neonatal intensive care unit at the time of observation.

Measurements and findings: Data were deductively analysed and categorised into Donabedian's pre-existing structure- process- outcome framework. Themes that evolved were the absence of policies and procedures, inadequate written information, unsuitable physical layout of the neonatal intensive care unit, non-adherence to hand hygiene, lack of personal protective equipment, poor cleaning practices, poor service delivery and unavailability of documented evidence on cleaning routines, delivery of supplies and infection prevention and control training.

Key conclusions: In the neonatal intensive care unit, non-medical individuals did not adhere to infection prevention and control measures. The absence of standard operating procedures may contribute to cross contamination and an increase in hospital acquired infections.

Implications for practice: Infection prevention should be regarded as an interprofessional team effort and requires situational awareness. The infection prevention control practitioner and unit manager should collaborate with support services and significant others to ensure that these individuals have appropriate knowledge about and adhere to infection prevention control practices in a neonatal intensive care unit. The infection prevention control committee should be expanded to include support staff managers. Orientation programmes should be implemented to raise the awareness of non-medical individuals about the important role they play in infection prevention and control.

Keywords: Donabedian model; Hospital associated infections; Neonatal ICU; Non-medical, Significant others, Support services; Observational approach.