Currently in the maternity units of three busy hospitals in Dar Es Salaam, Tanzania, data collectors are measuring how well cleaners are performing their job and how clean the environment is for patients; this is the CLEAN study. It includes the implementation of the TEACH CLEAN training package plus the first formal evaluation of how it improves cleanliness on the wards. Soapbox was awarded the funding for this study after a successful Joint Global Health Trials application, in collaboration with Ifakara Health Institute and the London School of Hygiene & Tropical Medicine.
In January this year, Muhimbili University of Health & Allied Sciences (MUHAS) trained ‘cleaning champions’ from each hospital in infection prevention and control (IPC) and environmental hygiene theory, best cleaning practice, participatory training methods and how to support healthcare staff with cleaning responsibilities and assess their abilities.
On completion of this training, the ‘cleaning champions’ were ready to go and train the healthcare staff with cleaning responsibilities. In these particular hospitals, it is not only cleaning staff who deal with ward hygiene, but also Medical Attendants and Nursing Officers as well as those who handle used linen. As the ‘champions’ train these members of staff, best cleaning practices spread throughout the hospitals.
Prior to the training of ‘champions’, the experienced trainers at MUHAS assessed the needs of the hospitals and adapted the TEACH CLEAN package, with advice from local infection prevention experts, to fit the Tanzanian setting and to meet national guidelines. For example, photographs were taken to illustrate good and bad cleaning practice; this helps to give a sense of ownership to those using TEACH CLEAN and ensures its relevancy in the local context.
The evaluation has a number of components. As well as measuring cleanliness before and after the training, changes in staff attitude and knowledge of cleaning are also being assessed. Additionally, the quality of the water used for cleaning is being tested and different ways to measure how many mothers and babies develop infection after birth are being investigated.
Over the course of the next few months we plan to have results which demonstrate the improvement TEACH CLEAN has made to the cleanliness on maternity wards in Tanzania and to reducing the risk of infection for mothers and babies. Already, MUHAS is so impressed with the TEACH CLEAN package that they are keen to start training staff at other hospitals in the country.