Background and Aim: The applicability of internationally-accepted infection control guidelines in rural Indonesia is questionable due to differences in resources availability and local contexts. Infection control barriers specific to rural Indonesia therefore need to be identified to assist in developing targeted infection control programs that are resource- and context-appropriate at the institutional, regional and national levels. Methods: This mixed methods study of ten healthcare facilities (hospitals and clinics, public and private) in a rural Indonesian district, all with severely limited resources, explored clinical practices in four areas: intravenous therapy, antibiotic usage, instrument reprocessing and hand hygiene. The quantitative methods used included univariate, multivariate and survival analyses of primary and secondary clinical data. The qualitative methods included a grounded theory analysis of observations, short and in-depth interviews and focus group discussion data. These two components of the study were synthesised to ascertain the magnitude and underlying factors of healthcare-associated infection risks and barriers to infection control programs. Findings: Inappropriate clinical practices caused excessive and unrecognised risks of primary bloodstream infection, surgical site infection, blood borne virus infection, and the development and spread of multi-resistant bacteria. The four diverse clinical practice areas exhibited common and interwoven underlying factors, which were: healthcare workers?? inadequate clinical knowledge, a lack of managerial support, and cultural beliefs shared by the healthcare workers and community members that prevailed over evidence-based knowledge. Non-clinical factors from inside and outside the healthcare facilities were inter-related and cannot be separated from the ensuing clinical practice inadequacies. An analytical framework that categorises infection control barriers into clinical and non-clinical domains as well as internal and external factors is therefore proposed to ensure a comprehensive infection control program design. Conclusion: The current clinically-focused infection control programs are likely to have limited and temporary results in rural Indonesia due to barriers being in the main non-clinical in origin. An effective and sustainable infection control program needs to concurrently address basic clinical practice improvements and the underlying managerial, attitudinal and cultural barriers. This public health aspect of infection control is often neglected yet crucial for the success of any infection control program in rural Indonesia.
| Identifer | oai:union.ndltd.org:ADTP/258404 |
| Date | January 2009 |
| Creators | Marjadi, Brahmaputra, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Publisher:University of New South Wales. Public Health & Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://unsworks.unsw.edu.au/copyright, http://unsworks.unsw.edu.au/copyright |
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