From Soapbox’s inception in 2012 to its completion in 2019, the charity had set out to understand the drivers of poor hygiene in maternity units and the opportunities for improvement. In collaboration with partners, Soapbox conducted assessments of water, sanitation and hygiene (WASH) and infection prevention control (IPC), including environmental hygiene, in maternity units in a number of diverse low and middle income countries.
Needs Assessments in Zimbabwe (2012-2015)
In 2012, Soapbox entered a partnership with Geneva–based charity, ZimHealth to support infection prevention and control (IPC) training at healthcare facilities in the Kadoma and Kwekwe regions of Zimbabwe. Soapbox assisted with a multi-tool needs assessment in Rimuka Maternity Home and Kwekwe General Hospital to discover and prioritise areas for improvement and identify the most effective interventions to improve cleanliness and hygiene across these facilities.
Participatory training in IPC was delivered to over 90 healthcare workers, including midwives, doctors, environmental health technicians and ambulance drivers. New IPC equipment was also supplied based on the needs of each hospital and the state of the infrastructure. The Soapbox-led evaluation found a positive impact on hygiene behaviour at Rimuka Maternity Home - with all objectives of the training met and positive feedback from mothers on the cleanliness of the labour wards. The four council clinics in Kwekwe also made an outstanding impact on improving IPC at each facility, with an IPC committee established to monitor improvements.
Soapbox also supported the development of an observational hand hygiene audit tool, and hand hygiene workshops for skilled and non-skilled workers were developed and implemented in these facilities using a ‘Training The Trainer’ approach.
The Deliver Life Project in Malawi (2016—2018)
As part of the Deliver Life Project, funded by DFID under the UK Aid Match Scheme, Soapbox provided technical support to improve access to, and use of, sustainable water, sanitation and hygiene (WASH) services in communities and health facilities in marginalised districts of Malawi. Soapbox Research Fellow, Dr Sandra Virgo, assisted with needs assessments conducted in 16 facilities across Malawi, along with data collectors and collaborators from WaterAid.
Questionnaires, checklists and interview questions were constructed and adapted to suit the local requirements, with local data collectors trained to collect information using qualitative and quantitative techniques. This led to a rich set of results, comprising findings on infrastructure, equipment and supplies, cleanliness and IPC programmes, and training supervision.
The data collected was passed to WaterAid to inform the requirements for building work and changes to infrastructure at these facilities. This has led to valuable improvements in these areas, helping to improve the quality of care and lower the risk of potentially fatal infections, such a sepsis, in mothers and newborns.
Collaborations in Ghana (2017)
Dr Jolene Moore (NHS Grampian) visited Tema General Hospital on behalf of Soapbox to conduct observational assessments on the maternity and neonatal units. Tema’s maternity unit sees around 7000 deliveries each year, with a notable seasonality to births.
Challenges to providing quality care, such as limited staffing and resources, were found to be compounded by overcrowding during these busy periods. Jolene also met with Tema’s biomedical scientists to pilot Soapbox’s laboratory questionnaire. The questionnaire was developed to assess a facility’s capacity to design and implement microbiology-based projects in order to assess, monitor and improve environmental cleanliness. Following the visit, Tema was established as a host for University of Aberdeen students conducting elective projects.
Soapbox also conducted a series of needs assessments in India & Bangladesh, Zanzibar and Myanmar.
An invisible workforce: the neglected role of cleaners in patient safety on maternity units
A striking finding of the needs assessments in maternity units in low and middle-income countries was the critical lack of formal training for staff with cleaning responsibilities despite their key role in maintaining environmental hygiene and IPC.
Yet within health facilities, staff who clean are the interface between WASH and IPC. They work in environments where healthcare-associated infections (HAIs) are unacceptably high and the widespread use of antibiotics due to unclean, unsafe environments is driving the threat of antimicrobial resistance.
Published in Global Health Action by Soapbox and partners in January 2019, An invisible workforce: the neglected role of cleaners in patient safety on maternity units highlights how low status within facilities, wider societal marginalisation, lack of training, and poor pay and working conditions for cleaning staff contribute to the lack of prioritisation placed on health facility environmental hygiene.
Soapbox’s TEACH CLEAN package is targeted towards this invisible workforce presents information and materials required to deliver comprehensive, participatory training in environmental hygiene and IPC in healthcare facilities.
- Read more about TEACH CLEAN and download the package