Saisir la culture de l’hygiène hospitalière en Guinée, une approche mixte pour comprendre les contraintes de la PCI dans le système de santé

Abstract

Background: Healthcare-associated infections (HAIs) are a global safety issue for patients and caregivers. In Guinea, the recurrence of hemorrhagic fever epidemics has highlighted the crucial role of infection prevention and control in the healthcare system. The aim of this study is to provide an overview of the culture and practices relating to hospital hygiene based on an estimation of the proportion of patients who have experienced at least one HAI, the calculation of the incidence rate of infections, and an ethnography of infection prevention and control (IPC).

Method: The quantitative and qualitative data were collected during a mixed observational study that took place from August 2022 to January 2023 in nine (9) healthcare facilities in urban and rural areas. The ethnography involved extended stays in the health services to conduct participant observations (during surgical operations, during patient care), while the public health component involved the longitudinal collection of data on the occurrence of healthcare-associated infections based on clinical signs observed at 72-hour intervals.

Results: Four (4) main paradoxes are the subject of the proposed study: first, the presence of inputs in hospital pharmacies, confirmed by the quantitative survey, but their non-use observed by the qualitative survey; second, the apparent link between compliance with IPC and the time frame (morning, afternoon, night); third, the association between the status of the surgeon performing the procedure and the risk of occurrence of HAIs; and finally, the lack of correlation between training in IPC principles and their application in practice.

Discussion: Support from development aid agencies in the health sector sometimes has unpredictable consequences for infection prevention. For example, donations of hydroalcoholic gels can result in the interruption of local gel production. Furthermore, in the Guinean healthcare system, as elsewhere on the African continent, tasks are systematically delegated. Nurses carry out procedures that should be carried out by doctors, hygienists sometimes carry out injections, and families are expected to assume the role of carers. IPC is part of an ecosystem. This is where the promotion of IPC appears in all of its complexity. It must take its ecosystem into account.

Conclusion: This multidisciplinary project, based on two complementary methods from anthropology and public health, provides a better understanding of IPC in its many dimensions. The combination of objective quantitative data and qualitative data (observations and interviews) makes it possible to identify the grammar of practices relating to IPC, its rules of use, i.e., all the formal and informal norms that underpin the production of IPC.