The Importance of Unstructured Observations and Structured Observations in Two Cambodian Hospitals Open Access

Abstract

Background: Over the past 20 years, maternal and neonatal/infant mortality rates in Cambodia have steadily improved but continue to be among the highest throughout Southeast Asia with 161 maternal deaths/100,000 live births, 15 neonatal deaths/1,000 live births, and 25 infant deaths/1,000 live births. These deaths largely result from preventable infections. The work discussed in this thesis was part of a larger pilot study investigating the causes and routes of transmission of specific healthcare-acquired-infections in maternity wards of two public hospitals in Phnom Penh, Cambodia.

Methods: Researchers conducted unstructured and structured observations of morning rounds, routine cleaning, and post-delivery procedures for one week each in the maternity wards of two hospitals. Researchers used notes from unstructured observations to develop an understanding of typical behaviors in settings of interest and to prepare charts for structured observations.

Results: Healthcare staff were typically not observed wearing gloves during patient interactions. Researchers found that this, as well as other inconsistencies in routine cleaning procedures, were related to the gaps in proper infection-prevention-and-control (IPC) training. In both hospitals, patients and their families in post-delivery rooms were responsible for bringing their own water, food, and hygiene materials, but observations found that many did not always bring hygiene materials with them. Lastly, structured observations found that cleaning and waste disposal procedures in Hospital B had several "poor" IPC practices, but generally adhered to "good" IPC practices in the delivery rooms.

Conclusion: This study has found that existing IPC training procedures need to be strengthened among healthcare workers of both hospitals. Additionally, water-and-sanitation-hygiene educational materials need to be taught or distributed to patients and their families to minimize possible spread of healthcare-acquired infections. Furthermore, water-and-sanitation-hygiene infrastructure needs to be improved in both hospitals to promote better personal hygiene and to provide easy access to safe and clean water for patients, their families, and healthcare staff.

Table of Contents

DEFINITION OF TERMS……………………………………………………………………………………………………………………………vi ACKNOWLEDGEMENTS………………………………………………………………………………………………………………………….vii

CHAPTER 1: BACKGROUND AND LITERATURE REVIEW……….……………………………………………………………………1

BACKGROUND…………………………………………………………………………………………………………………………….1 LITERATURE REVIEW…………………………………………………………………………………………………………………..3

MATERNAL AND INFANT MORTALITY…………………………………………………………………………….3

WASH BEHAVIORS AND IPC PRACTICES IN CAMBODIAN HOSPITALS………………………………6

HEALTHCARE ACCESS IN CAMBODIA………………………………………………………………………………7

THE METHODOLOGY OF OBSERVATIONAL STUDIES………………………………………………………..9

PROBLEM STATEMENT………………………………………………………………………………………………………………12

PURPOSE STATEMENT……………………………………………………………………………………………………………….13

SIGNIFICANCE STATEMENT……………………………………………………………………………………………………….13

CHAPTER 2: MANUSCRIPT……………………………………………………………………………………………………………………..16

INTRODUCTION…………………………………………………………………………………………………………………………18

METHODOLOGY………….…………………………………………………………………………………………………………….20

RESEARCH DESIGN…………………………………………………………………………………………………………………….20

POPULATION AND SAMPLE…………………………………………………………………………………….…………………21

PROCEDURES…………………………………………………………………………………………………………………………….23

INSTRUMENTS…………………………………………………………………………………………………………………………..24

ETHICS………………………………………………………………………………………………………………………………………27

RESULTS……………………………………………………………………………………………………………………………………27

DISCUSSION……………………………………………………………………………………………………………………………...34

LIMITATIONS OF THE STUDY.…………………………………………………………………………………………………….39

CHAPTER 3: PUBLIC HEALTH IMPLICATIONS AND RECOMMENDATIONS……………………………………………….40

TABLE 1: FINAL SELECTION OF SAMPLING LOCATIONS…………………………....……………………………………….…..26

APPENDIX 1: STRUCTURED OBSERVATIONS FORMS………………………………………………………………………………45

REFERENCES………………………………………………………………………………………………………………………………………….50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Health Health Sciences, Nursing
Keyword	Healthcare-associated infections Cambodia Neonatal health IPC Infection Prevention and Control Unstructured observations HAI Maternity wards Water and Sanitation Hygiene Structured observations WASH Maternal health
Committee Chair / Thesis Advisor	Malik, Fauzia Aman, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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