Engaging healthcare workers to prevent and control infections in healthcare centres in Malawi

Isn’t it time to end the loss of life from easily preventable hospital-acquired infections? Abigail Nyaka, Programme Officer at WaterAid Malawi, describes WaterAid’s work with Malawi’s Ministry of Health to train healthcare workers in infection prevention and control.

According to the World Health Organization (WHO), thousands of people die every day around the world from infections acquired while receiving healthcare. 210,000–440,000 patients each year who go to hospital for care suffer some type of preventable harm that contributes to their death,¹ about 12% of which are healthcare-associated infections. How can you, me or healthcare workers change this problem? 

It starts with everyone. “Every human being whether alive or dead can spread infection. The higher the number of people at a place the greater the chances of acquiring or transmitting infection. The hand is number one weapon of germ transmission hence correct way of hand washing is most important in reducing the spread,” said Nelson Msiska, Clinical Officer at Kamuzu central hospital in Lilongwe and Malawi national trainer and assessor on infection prevention and control.

Infographic from World Health Organization. Click here to view >

A global burden

Infections acquired in healthcare settings are one of the leading causes of disease and death globally, but are a particular problem in low-income countries where healthcare centres often lack clean water and decent sanitation facilities, and hygiene behaviours are often poor. WHO estimates that one in ten patients receiving care in regular wards will acquire an infection. For healthcare workers, needle sticks, other accidental injuries, and contact with blood and bodily fluids bring the risk of transmission of hepatitis B or C, HIV and other serious infections.

Breaking the disease transmission cycle

In September 2016, WaterAid Malawi, in partnership with The Soapbox Collaborative, conducted a comprehensive needs assessment of healthcare facilities in Kasunga, Lilongwe and Machinga districts. We investigated gaps in water, sanitation and hygiene (WASH) and in infection prevention and control (IPC) provision in maternity areas, aiming to improve quality of care and lower the risk of potentially fatal infections such as sepsis in mothers and newborns. The findings led to development of the improvement plans described below, and fed into national-level influencing work for improving standards and financing. 

Following this, with support from the DFID UK Aid Match-funded Deliver Life project, WaterAid Malawi is leading efforts to address IPC in 16 health centres across Kasungu, Nkhotakota and Machinga districts. We are partnering with Malawi’s Ministry of Health through the Quality Management Directorate to collaboratively support health centres to prevent and control infections at individual and public health levels using IPC practices.    

The directorate provided consultants/ national trainers who trained, and will continue mentoring, health workers on infection prevention techniques. The trainings were conducted in two cohorts: medical personnel, i.e. nurses, midwives, technicians, medical assistants and clinical officers, who were trained at district level; and non-medical/support staff, i.e. hospital attendants/cleaners, ground labourers, security guards, data management clerks, HIV diagnostic assistants and health surveillance assistants, who were trained at individual health centre level. So far they have trained 239 healthcare workers (82 medical and 157 support staff) in two of the three districts.   

The training focused on breaking the disease transmission cycle. Topics included introduction to infection prevention (purpose, disease transmission cycle, standard precautions, definition of terms), hand hygiene practices (antisepsis, surgical hand scrubbing and strategies to ensure compliance), use of personal protective equipment and the role of drapes, surgical antisepsis and disinfectants, safe practices in the operating room, waste management, high-level disinfection, traffic flow and activity patterns, housekeeping and isolation guidelines. 

Feedback from participants

“This training looks simple but it is very helpful. We have learnt a lot. It has enlightened us on utilisation of hepatitis B vaccine but also proper handwashing.” George Malala, Health Surveillance Assistant, Malowa Health Centre.

“I had learnt about infection prevention and control in 1998 when I had just joined but forgot most of the things; now I have been reminded of many aspects. The new things that I have learnt is that we can use chlorhexidine for sterilisation and decontamination. From now onwards, I will be dipping forceps, surgical blades and suture needle in chlorhexidine during preparation of packs.” MacDonald Kapolo, Hospital Attendant, Linyangwa Health Centre.

“This is such an amazing programme which should not end at a few facilities, but rather expand to all the facilities in the country…it is filling a very serious need, but also making a big difference that could change the way all health centres operate.” Sangwani Mwafulirwa, Medical Assistant, Katimbira health centre. 

“…we have learnt how to control our facility to prevent the spread of infections. We have also learnt how to process instruments, how to control traffic. When I get back, I will make sure that all the staff know the importance of IPC by making a meeting with them so that I transfer the knowledge but also to inform the community at large.” Gladys Chimombo Kalenga, Nurse Midwife Technician, Mtaja health centre. 

The project is also modelling a comprehensive package of WASH improvements which includes installation of a solar powered reticulated water supply system, inclusive toilets and bathrooms, placenta pits, incinerators and ash pits for waste management and rehabilitation of septic tanks. 

Moving forward 

Infection prevention and control is a cross-cutting issue affecting all parts of health facilities. The global and national IPC standards lay out expected IPC performance at each functional area of the health centre – Malawi’s national standards were developed in 2001, but, as we saw, are not always in effect.

To ensure adherence to IPC standards at health centres, WaterAid Malawi has designed a series of on-site strengthening activities to reinforce certain skills. The teams have been encouraged to form IPC committees that work hand in hand with the quality improvement support team from the district hospital and the communities’ health centre advisory committee in supervision, assessment, general monthly meetings and coming up with agendas, action plans and a record of the facility’s needs.

Moving forward, WaterAid Malawi plans to continue working with the Ministry of Health at national level through the Quality of Care Directorate, Reproductive Health Directorate and Preventive Health Care Directorate to institute a continuum of practices aiming to achieve client-centred quality healthcare service delivery, by implementing strategies including the Malawi antimicrobial resistance strategy.

The trainings provided personnel with deep understanding of the issues surrounding prevention of hospital-acquired infections. True understanding of disease transmission cycles and infections, accompanied by the right attitude towards infection prevention and control, may encourage adherence to standards, protocols and good behaviours. Knowledge is power! 

¹ James, JT (2013). A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety. Sep; 9(3): 122–128. DOI: 10.1097/PTS.0b013e3182948a69. Available at www.ncbi.nlm.nih.gov/pubmed/23860193