Knowing and Respecting Support Staff: A Vital Step in the Journey to Reducing Healthcare-Associated Infections

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by Lydia Di Stefano
Research Assistant, Maternal and Newborn Health Group – London School of Hygiene and Tropical Medicine

 

I met Dorcas Gwata during the London School of Hygiene and Tropical Medicine’s 120th anniversary celebrations. An alumni, Dorcas had returned to present on her inspiring career as a public health specialist and activist.

While her achievements are remarkable and many, they weren’t what caught my attention. Rather, it was what she had done at the beginning of her career that intrigued me: Dorcas began in the relatively unglamorous role of a hospital cleaner.

Through my work with BASICS (Bold Action to Stop Infections in Clinical Settings), I know  the importance of support workers in healthcare settings – cleaners, porters and security guards – in contributing to a functioning system. In particular, their vital role in hygiene: low-cost interventions aimed at educating and training workers in water, sanitation and hygiene (WASH) are an important way to reduce healthcare-associated infections.  But there are barriers to their education and training.

One barrier is the lack of value and respect for cleaners and their exclusion from the umbrella term “health workers.” BASICS pioneer Professor Wendy Graham has written about how to overcome such barriers elsewhere.   

I was intrigued about Dorcas’ journey from student in Zimbabwe, to hospital cleaner in Scotland, to specialist nurse in London. Dorcas has been on two sides of the hospital workforce – as a support worker and a professional – so I was intrigued about her view of the lack of value that cleaners can face and how to combat this. Finally, as someone with experience in  health systems in low- and high-income countries, I was curious about how she would compare the two settings.

Dorcas attended school until she was 18. However, she didn’t get the marks to pursue the nursing career her mother wanted for her. After graduating, she pursued occupational courses but nothing really stuck. She spent time volunteering in a health clinic.

When Dorcas joined her sister in Scotland, she found work as a cleaner at a local hospital. Although it wasn’t her first preference, she reflected “out of all the jobs I’ve had so far, that is probably the one where I learnt the most.” The work was demanding – carrying heavy buckets of water and hours of scrubbing.

She received no training – in cleaning, let alone education on infection prevention – and was told in two weeks she’d lose her job if she wasn’t good enough. It was hard, physical work. It was also challenging socially.

Despite the difficulties of their job, Dorcas felt that she and the other cleaners were barely acknowledged, let alone thanked by most of the hospital staff. She had come to expect so little in the way of respect, that she would be shocked if clinical staff said “good morning” when they walked past her.

She said that staff should not just see cleaners by their job title, but should look past this to explore the other side of who they are. We should be more curious and ask people about their stories: where they’re from, what they do on weekends, who their children and grandchildren are.

Imagining how things might be different in a low-income setting like Zimbabwe, Dorcas suggested that cleaners may actually be more respected there, where they would be known by their totem (tribe name). Dorcas feels that there is strong sense of cultural capital that comes with respect and validation in Zimbabwe, which is lacking in high-income countries.

Dorcas was ambitious to move to a clinician role. She once asked a matron what she could do to join the profession and was ignored, yet this did not put her off. Eventually, she moved to London, where she visited hospitals to offer her services. After a day, she had two job offers: one as a cleaner and the other as a healthcare assistant. She took the assistant job and has worked her way up to where she is today.

When we spoke, Dorcas wondered where she would be now, had she been offered two cleaning jobs that day.

I think everyone who works in hospitals can take Dorcas’ advice and try a little harder to acknowledge all staff, including cleaners. My challenge to health workers reading this is to get to know the cleaners on your ward. Although their jobs aren’t necessarily the most glamorous, they are essential to a functioning health care system and are key to infection prevention efforts.

Photo credit: Save the Children

Basics: Scaling Up Affordable and High-Impact Healthcare Practices

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by the BASICS Team

Bold Action to Stop Infections in Clinical Settings (BASICS) is centered on an important principle: low-cost interventions accompanied by minimal changes in healthcare practices will have a considerable impact on disease incidence. The cost of preventing an infection is a fraction of the cost of treating one. High infection prevalence and infection-related mortality are a sizeable economic and social burden, especially in low-income countries. BASICS will catalyze marginal resources in four demonstration countries – Bangladesh, Cambodia, Nigeria and Tanzania – to reduce that burden significantly.

The evidence from high-income countries on the economic impact of reducing healthcare-associated infections (HAIs) is compelling, and suggestive of what might be achieved in lower resource settings (though with different cost structures). One study estimated that the costs of one single severe lower respiratory infection in a U.S.-based hospital would cover the annual budget for antiseptics used for hand hygiene (Boyce, 2001)1  .  A study of a Russian neonatal ICU found that one healthcare associated bloodstream infection would cover 3,265 days of hand antiseptic use (Brown, 2003)2  . A Swiss study found that the total cost of hand hygiene promotion was roughly one percent of the cost of nosocomial infections (Pittet et. al, 2004)3  .

BASICS is metric driven, which allows us to capture the economic impacts in lower-resource settings. It will establish a baseline of current expenditures, track recurrent and investment costs and link those to program outcomes.

BASICS will generate substantial savings from its projected reduction of 1.4 million patient stay days. Our economic analysis will illustrate those savings and build a government and stakeholder coalition to fund BASICS in national and local budgets.

More developed healthcare systems have learned the lessons on hygiene and taken them to scale. The past several years have seen a groundswell of global attention and support towards achieving universal access to quality of healthcare (Sustainable Development Goal 3). Many of these efforts – some listed below – directly address, or align with, water, sanitation and hygiene (WASH) and infection-related challenges in healthcare:

  • The World Health Organization’s (WHO) Global Action Plan on Antimicrobial Resistance (2015)
  • WHO’s Guidelines on Core Components of Infection Prevention and Control Programmes (2016)
  • WHO’s Supporting Countries to Achieve Health Service Resilience (2016)
  • Every Woman Every Child Global Strategy to end all preventable maternal, newborn and child deaths, including stillbirths, by 2030, and improving their overall health and wellbeing
  • Launch of the Quality, Equity, Dignity (QED) Network for pregnant women and newborn infants (2016)
  • WHO’s Standards for improving Quality of Maternal and Newborn Care in Health (2016)
  • WHO Handbook for National Quality Policy and Strategy (2018)

BASICS will develop a scaling pathway for countries with fewer resources. Global health expenditure has risen progressively since 1995 (Global Burden of Disease Health Financing Collaborator Network, 2019)4  , providing some fiscal space to allocate government resources to BASICS once the payoffs are demonstrated. Securing government commitment will be critical in the four BASICS countries, as the public budget accounts for most health expenditure in these countries. The BASICS teams will engage with health ministries on the implications of BASICS for the composition of a country’s health expenditure.

The four BASICS demonstration countries have already shown strong political will to improve infection prevention procedures.

BASICS will deliver cumulative local impacts in each country that will deepen their commitment to the approach. Our learning model will engage government, civil society and private partners on the lessons being generated on the costs and benefits of BASICS, building a powerful local coalition for change. Once that change is delivered, the economic impacts should ultimately prove irresistible to other countries interested in infection prevention.

Ways countries have demonstrated political will on this topic:

Cross-country:

  • All four of our demonstration countries have shown a commitment to improve infection prevention and broader quality of care priorities.
  • All four countries signed onto the 2019 World Health Assembly Resolution to improve WASH in healthcare facilities and are engaged in post-resolution implementation activities.
  • All four countries have national action plans to combat anti-microbial resistance.
  • Three of the four countries (Bangladesh, Nigeria, Tanzania) signed up to be initial priority countries under the QED Network.

 Bangladesh:

  • In 2017, the Community Based Health Care (CBHC) under Directorate General of Health Services of the Ministry of Health and Family Welfare conducted a rapid assessment of the state of WASH in 13,000 community clinics with help from WaterAid, WHO and UNICEF.
  • Formal guidelines on WASH for community clinics in 2019 with the support of WaterAid, WHO and UNICEF.

Cambodia:

  • In 2016, in response to a baseline study assessing the status of WASH led by the National Institute for Public Health, the Ministry of Health set water and sanitation targets as part of its National Health Strategic Plan 3.
  • In addition, the national quality of care mechanism, which has been rolled out across all public health care facilities, has WASH targets which are tied to performance-based financing mechanisms.
  • In 2019, national guidelines on WASH in health care facilities were endorsed.

Nigeria:

  • In 2018, the government created a new Infection Prevention Coordinator position within the Ministry of Health to lead the design and implementation of a national infection prevention improvement strategy.

Tanzania:

  • In 2019, the government announced a commitment to develop a national roadmap to improve WASH in healthcare facilities, implement improvements in 1,000 facilities and to integrate WASH into new health sector policies.

 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

 

1. Boyce JM. Antiseptic technology: access, affordability, and acceptance. Emerging Infectious Diseases. 2001;7:231–233. 

2. Brown SM, et al. Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infection Control and Hospital Epidemiology. 2001;7:231–233. 
3. Pittet, D., Sax, H., Hugonnet, S., & Harbarth, S. (2004). Cost Implications of Successful Hand Hygiene Promotion. Infection Control & Hospital Epidemiology 
4. Pittet, D., Sax, H., Hugonnet, S., & Harbarth, S. (2004). Global Burden of Disease Health Financing Collaborative. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050. 2019.  The Lancet.
 

Letter G Makes Me Learn More

By: Sherin

Edited by: Yasintha Bere, Data Quality and Communication Officer

I am Sherin. That’s what my friends always call me. I am a little girl and I am 8 years old from a beautiful village far from the city. I am a third grader now since two months ago. Walking down the street with friends to school every day is the thing I love the most. We have much fun taking one kilo meter distance to and from school with lots of chit chats and singings. I have much love to my friends.

It was like just yesterday I entered primary school. There was an enthusiasm for making new friends, yet anxiety there was also for not performing well at school. Soon there were many in my list of great friends, yet I also started learning with some difficulties to recognize letters. Letter “A” became my favorite, simply because it’s the first letter alphabetically and that it was easy to write. It is not that easy, even quite difficult for letter “G” in comparison. Thanks to my great teacher who always assisted me through this learning process. I had my days full of learning letters, but also coupled with fun activities like singings, dancing, and plays.

In the second grade, I experienced new thing in my learning. Save the Children ran a program to assist us in the improvement of our literacy. It was started by some kind of test on our reading capabilities. Then came activities such as setting up our classroom with colorful letters and books and even providing us with books at community level. The latter is called “Reading Post”. I really like the reading post at community since it allows me to play and learn to read with my friends after school. It is open every Friday. We are facilitated by a community volunteer, who is, by chance, my pre-school teacher.

Sherin and her friend drawing in Reading Post

I have a favorite book at reading post. It is about caring for sick people. I love reading this book again and again, as I want to become a doctor. We are even allowed to borrow book for a week and I will always bring home this book. Besides, we are also provided at reading post with additional lessons on healthy life style and the importance of regular shower and breakfast. I see this as an important addition to my future goal.

With involvement in these activities, I find myself well improving in reading ability. I can now read long text and can assist my friends who are still strive with reading. I am confident that soon my friends and I can read as fluent as the older grader.

Sherin and friends reading during Reading Post

The Strong Will of a Father

His name is Hamissou Ibrahim. Kids affectuously call him uncle Ibrah because of his volunteering actions for the cause of children.
Married and father of four children, Ibrahim was one of the first students in his village. After six years in primary school, he failed his secondary school entrance examination.

This failure did not taint his life. Like other peasants in his village, Ibrahim makes a living by farming and herding animals.

However, the failure of the first generation of students in the village has been the main cause of parents’ neglect and lack of confidence in education.
People who have succeeded in being self-sufficient in this community are traders and those who travel abroad in neighboring countries. Parents, because of their lack of confidence in schools, encourage children to learn trading, herding and farming.

Hamissou feeding his animals

In 2016, the sponsorship program started in his community with ambitious objectives for children. Through parents, teachers and children’s sensitization and training, and innovative projects such as literacy boost and positive discipline, reading clubs and early childhood care centers were implemented in communities with many varieties of toys and learning materials.

Having failed in his own education, Hamissou decided to devote his time to the sponsorship program.

As a community volunteer for sponsorship operations, a reading club host, and a kindergarten teacher, Hamissou has become a pillar for the sponsorship program in his community. He helps community development agents locate children and monitor their presence at school, he teaches younger children in kindergarten, and helps pupils with reading difficulties at school in reading clubs.

Hamissou reading a letter to Harira, a sponsored child in Niger

“Parent ignorance has handicapped children’s education for decades in my village. When I was made aware of the objectives set by the sponsorship program, I decided to devote all my time for children’s welfare,” Hamissou said.

“Changes brought in communities by the sponsorship program are evidenced in every child’s behavior. Good hygiene habits, body cleanliness and the children’s high performance in secondary entrance examination (62 %) in my community.”

All these changes have allowed for parents to have a new vision of school and has created a new light of hope in every child’s life.
Children, parents and teachers do not run out of praises for Save the Children for all the efforts made in changing life at village and at school.
Hamissou concluded by saying, “the sponsorship program has succeeded liberate parents from ignorance and has fashioned our life for better. We earned something which remains a treasure forever, our behavior change”.