P269: Infection control practices during labor and delivery and newborn care in resource limited settings: assessment and recommendations for improvement

Introduction

India is amongst the countries with high maternal mortality rate (MMR) & infant mortality rate (IMR). Most of these deaths occur due to sepsis. UNICEF initiated a review of infection control practices (ICP) during labor & delivery (L&D) & in newborn care at two states of Rajasthan & Odisha, India.

Objectives

To assess current ICP during L&D and newborn care with an aim to improve ICP to reduce MMR & IMR due to infections.

Methods

A two member consultant team was constituted by UNICEF Delhi, India. The team conducted a structured assessment of different facilities (sub-district and district hospitals in Rajasthan & Odisha) on ICP in L&D rooms & Special Care Newborn Units (SCNUs). The team completed the assessments using the Infection Control Assessment Tool [1, 2]. Draft reports were provided to the respective offices on the evening of the assessments.

Results

Assessments were completed in 5 community health centers and district hospitals with L&D rooms and SCNUs. Defined systems for cleanliness and general hygiene were conspicuously absent. Hand hygiene practices were poor due to lack of awareness & supplies. Biological waste segregation was not appropriate and there were concerns regarding storage and disposal of bio-medical waste. Exposure risk to healthcare workers including doctors, nursing staff, and support staff is area of major concern.

Conclusion

The National Program has provided funds and brought enormous patient load to healthcare setting. However, training and uninterrupted supplies for L&D and SCNU must be ensured. Specific recommended role of UNICEF and state health ministry of two states were highlighted.