Of the targeted 75 health care workers from 15 health facilities in Goromonzi district 71 of them were interviewed giving a response rate of 94%. Five key informants were recruited namely DMO, hospital services administrator, IPC focal person, HIV focal person and TB focal person.
Demographic characteristics of health care workers
Out of the 71 participants 46 (64.8%) were females. Registered general nurses were more than a third 25/71 (35%) of the participants. Primary care nurses contributed 15/71 (21%) of participants and 12/71 (16.9%) were general hands. Environmental health technicians (EHTs) had only 1/71 (1.4%) participant. The median age of the participants was 38.5 years and median time in service was 9.5 years. (Table 1)
Availability of IPC resources in the 15 health facilities
All 15 health facilities had adequate and had never experienced stock outs in HIV test kits and PEP kits. Out of the 15 health facilities 14 (93%) had functional autoclaving equipment and 13/15(87%) had inadequate toilets for the patients. Out of the 15 facilities 12 (80%) had adequate gloves with no stock outs recorded since January 2018. Only 8/15(53%) of the facilities had adequate cleaning materials like brooms and mops. Adequate bins, bin liners and detergents were found in only 3/15 (20%) of health facilities. None of the facilities had specific budget plans for IPC. (Table 2)
Processes for the IPC program
For the period under review, Goromonzi district had four planned IPC trainings which were not implemented since January 2018 to October 2018. Out of the 15 health facilities in Goromonzi district none of them managed to hold a single IPC meeting in 2018. No IPC mentorship activities were carried out in the district during the same period. Although all the 15 facilities reported that they received quarterly support and supervision on IPC only 6/15 (40%) had minutes. We noted that these support and supervisions visits were not specific for IPC but rather a component of result based funding (RBF) supervision.
Although 49/71 (35%) respondents reported that they held monthly IPC meetings at their facilities, no proof of minutes were available. None of the 15 facilities had ever held a HAI surveillance meeting. All the 15 facilities in Goromonzi district were providing TB infection control education to their clients as required. Examination of food handlers was being done yearly and all food handlers in the hospital kitchen had valid certificates. (Table 3)
Outputs for the IPC program
In Goromonzi district, there was no health workers trained in IPC for the period January 2018 to October 2018. Out of the 323 health workers in the district only 37 (11.5%) were screened at least once for TB since January 2018. Out of the 13 health care workers who had needle pricks only 7 (54%) received PEP with 2/7 (29%) of them finishing the course.
Severe side effects of PEP was cited as the major reason for not finishing the course by 5/7(71%) of respondents. The district never held an IPC meeting out of the 135 (15 facilities x 9 months) expected since January 2018. Only 5/15(33%) of health facilities in Goromonzi district had isolation areas for communicable diseases. Only 1/15 (6.7%) of the facilities had an IPC committee and this is the district hospital. Eight seven percent (13/15) of the health facilities including the two hospitals had no incinerators. Eleven (100%) kitchen workers had valid food handler’s examination certificates. (Table 4)
Knowledge of participants on IPC in Goromonzi district, 2018.
The overall knowledge rating was fair with 33/71(47%) answering between four and five knowledge attributes correctly and only 15/71(11%) were rated as good. Out of 71 participants 67 (94.4%) have ever heard of IPC and 49/71(69%) knew its ultimate goal. Half of the participants knew how to dilute disinfectants with 34/71(47%) knowing at least 3 standard precautions of IPC. Although 43/71 (61.4%) were aware that waste should be segregated only 17/71(24%) knew the bin colour coding used for segregation. Only 23/71(32%) of respondents were aware that they should be screened biannually for TB and 22/71(31%) had been screened at least once since January 2018. (Table 5)
Outcomes of the IPC program in Goromonzi district from January 2018 to October 2018.
None of the 15 health facilities in Goromonzi district had an effective HAI surveillance system hence could not ascertain its prevalence. Apart from that only 1/15 (6.7%) which is the district hospital had a patient waiting time monitoring system at its OI/TB clinic.
Reasons for poor performance in IPC in Goromonzi district
The majority 64/71 (90.1%) of participants cited lack of resources which include detergents, bins, bin liners, cleaning equipment and PPEs as the major drawback in the IPC program. Almost two thirds 46/71 (65%) mentioned inadequate knowledge with 43/71 (60.6 %) reporting inadequate support and supervision on IPC. High workload was cited by 43/71 (60.6%) and the majority were nurses from clinics. Half of the respondents 36/71 (51%) mentioned inadequate guidelines on IPC as a contributory factor to poor performance.
IPC practices in Goromonzi district, 2018
Correct disposal of waste
Out of 71 participants 28 (39%) cited correct waste disposal as one of the IPC precautions. It was noted that 13/15 (87%) of health facilities including the two hospitals were using pits as incinerators and 10/15 (67%) had improvised cardboard boxes that were used as bins. Only 3/15 (20%) of facilities had bin liners with only 1/15 (6.7%) having both red and black colours.
Sterilization of medical equipment
At the time of the research all 15 facilities had sterilizing equipment with Ruwa clinic mentioning that they had no gas. At 1/15 (7%) facility, the sterilizing equipment was being kept in the toilet. At another facility, the equipment was not being used cautiously with a broken gas stove being used for heating near paper bins. At the district hospital theatre equipment was seen outside for sun drying prior to sterilization.
Prevention of needle pricks
Out of the 71 participants 29 (41%) reported prevention of needle pricks at workplace as an IPC standard precaution. Due to lack of incinerators 9/15 (60%) of health facilities were burning their waste and needles in open pits and at 6/15 (40%) of facilities, full sharps boxes and empty drug vials were seen piled either outside or inside the facilities.
Hand washing with soap
Although the majority 43/71 (61%) of participants cited hand hygiene as a standard precaution of IPC only 6/15 (40%) of facilities had soap at their handwashing facilities. Makumbe hospital had no enough hand washing facilities in the male and female wards. Out of the 17 health care workers who were observed during consultation only seven (41%) were seen washing their hands with soap after examining or dressing a patient.