Strengthening neonatal care through ward assistants: a Kenyan case study in enhancing infection prevention and control practices.
Maina M., Odinga N., Kagonya V., Ngaiza G., Fuller S., Onyango O., Waithira C., Oluoch D., Gathara D., Mwangi P., Mwangi L., Musyoka P., Kinyua L., Thuranira L., Njoroge V., Mwangi N., Kioni Z., English M., Mutua E.
BACKGROUND: Infection prevention and control (IPC) is a critical component of neonatal care, particularly in low- and middle-income countries (LMICs), where healthcare settings face unique challenges. Neonates, especially preterm and low birth weight infants, are at higher risk for infections, including healthcare-associated infections. In Kenya, neonatal units struggle with limited resources, understaffing, and shortages of essential supplies, significantly impeding effective IPC practices. METHODS: This study employed a mixed methods approach in four public neonatal units in Kenya to assess the impact of deploying ward assistants on IPC practices. Data collection included structured and unstructured observations, in-depth interviews, and focus group discussions with healthcare workers and caregivers. The intervention aimed to address gaps in routine cleanliness, waste management, and adherence to IPC protocols. RESULTS: The introduction of ward assistants led to noticeable improvements in overall ward cleanliness and waste disposal, highlighting the potential for enhanced infection control. Mothers' hand hygiene practices improved, driven by targeted sensitization efforts. Despite these gains, significant challenges remained. Hand hygiene adherence among healthcare providers was inconsistent, and equipment cleaning and decontamination were frequently compromised by insufficient supplies and overwhelming patient demand. The findings underscored the critical role of resources and the need for consistent supervision and training to support sustainable IPC improvements. CONCLUSION: Deploying ward assistants in neonatal units can positively influence IPC practices, particularly in addressing environmental cleanliness and waste management. However, these benefits alone are insufficient to address systemic barriers to IPC, including resource constraints and variability in adherence among staff. To sustain these gains, robust training, consistent supervision, and adequate resourcing are imperative. Future research should explore the long-term impact of such interventions and design context-specific strategies to overcome persistent barriers, ensuring safer neonatal care in resource-limited settings. CLINICAL TRIAL NUMBER: Not applicable.