Clean Care is Safer Care

Case study

District Hospital, Narsinghpur, India

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Submitted by:

Dr Rajan Dubey
District Hospital,

What type of health-care facility or organization are you?

The initiative is implemented in the District Hospital of Narsinghpur in Madhya Pradesh, India. This is a 200 bedded hospital providing secondary services to a population of 1.5 million. Services are both preventive and curative in nature.

What was the situation at your facility with respect to hand hygiene and HAI before you initiated the hand hygiene initiatives?

The wards are crowded and the numbers of workers available to help and counsel patients in maternal and child wards are low for the patient load.

What were the goals of your initiative?

The system is around a process of support called "Yashoda Process". It involves a voluntary worker working in the hospital and focusing on the care of mother and child. The process is supported and mentored by Paramedical managers and Hospital Manager appointed to support the process.

What actions have you planned or already put in place to improve hand hygiene at your facility?

We have ensured zero tolerance on handling any baby without hand washing. The process starts from the labor room and continues till discharge and even later, as counseling when the newborn goes back home. The intention is to reduce infection in the mother during the 42 days of post natal care (PNC) and in the newborn during the first 28 days of life.

Did you encounter any particular problems while planning and implementing your strategy?

Lack of continuity between hospitals and home care, high numbers of patients per paramedical workers in hospital reducing their time for counseling, lack of supervisory skills and follow-up.

What were the outcomes of your initiatives?

We have been training village level ASHA on PNC and new-born care to continue all good practices imparted by Yashoda Process in the district hospital and various Block hospitals.

What were your key learning points?

Logistics and supply of soap and non availability of hand washing area inside the ward combined with poor bathroom maintenance is a big challenge to promoting hand washing.

What are your future directions?

We need skills of plumbing related to hospitals and specific designing of hospital wards. Indian Public Health Standards (IPHS) for Sub-Centers are not clear and implementation is ineffective.