الفهرس 
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Abstract
Hospital acquired Infections are a major health problem in all societies. The unhygienic delivery practices by health personnel, shortage of suitable IC supplies contribute to maternal infection. Infection control measures aim to avoid infection by improving hand hygiene practices, aseptic techniques, environmental hygiene, cleaning, disinfection and sterilization of equipment and waste management and training of HCWs.
The aim of the present work was to study infection control practices of obstetricians and nurses during normal labor in maternity hospitals in Alexandria. Specific objectives were to assess knowledge and actual infection control practices of obstetricians and nurses during normal labor in maternity hospitals and to design, implement and evaluate an intervention program for infection control according to previous results for obstetricians and nurses in the labor room.
A cross-sectional design followed by an intervention study (pretest-posttest) was conducted in labor rooms of the obstetric wards of El-Shatby University hospital (representing the University hospitals) and Dar Ismail hospital (representing the MOHP hospitals) in Alexandria Governorate. The target population was obstetricians and nurses working in the studied maternity hospitals.
For assessment of knowledge and IC practices, all obstetricians and nurses in the labor rooms in the selected two maternity hospitals were included in the study. The total sample size accounted to 135 obstetricians and 30 nurses. For the intervention program, all obstetricians and nurses with poor practices were invited to attend the intervention program. All obstetricians and nurses were included and were observed three times taking into consideration representation of different shifts. Predesigned self-administered questionnaires and observation checklists were prepared by the researcher based on existing available tools and National Guideline for Infection Control of Egyptian Ministry of Health and Population (2016). These questionnaires were used to collect data from the obstetricians and nurses about their personal characteristics and their knowledge regarding IC and an observation checklist were prepared for IC. The observation checklists were used to collect data about the IC practices of obstetricians and nurses. In addition another checklist was used to assess the delivery room environment.
Concerning implementation of the intervention program, as regards obstetricians, in Dar Ismael Hospital were divided into four groups, each consisting of 25 obstetricians. In El Shatby Hospital, obstetricians were divided into two groups, each consisting of 15 or 20 obstetrician. Four educational sessions were implemented for each group in both hospitals. Regarding nurses, they were divided into two groups, one group in Dar Ismael Hospital (16 nurses) and another group in El Shatby Hospital (14 nurses). Also four educational sessions were implemented for each group in both hospitals. Sessions were implemented in the educational rooms at Dar Ismail Hospital and El-Shatby hospital. Each session was around 30-45 minutes. Evaluation of the effectiveness of the program was done through six weeks later evaluation. A comparison between pre and post intervention was done to find out the change in the level of practices after application of the program.The study revealed the following results:
• The age of obstetricians ranged between 26 and 42 years with mean age of 29.85 ± 3.459years, while the age of nurses the age ranged between 20 and 43 years with mean age of 32.90 ± 7.69 years.
• More than half of obstetricians (52.6%) were males.
• More than three quarters of obstetricians (77.8%) had Bachelor degree and 73.3% of nurses had Diploma of nursing.
• More than two thirds of obstetricians (68.9%) had one to less than 10 years of experience and about one third (36.7%) of nurses had 10 to less than 20 years of experience.
• Near half of obstetricians (48.9%) and 60.0% of nurses attended training programs related to IC.
• The majority of obstetricians (89.6%) and all nurses knew the standard IC precautions and listed their items.
• About three quarters of obstetricians (74.8%) stated that non-sterile latex gloves should be used during vaginal examination, while 77.8% of obstetricians and 76.7% of nurses stated that sterile gloves should be used during normal labor.
• More than one third of obstetricians (38.5%) and 46.7% of nurses mentioned that masks should be used during normal labor.
• Regarding other PPE, 25.2% of obstetricians and 36.7% of nurses stated that protective eyewear should be used during normal labor, more than two thirds of obstetricians (68.9%) and half of nurses mentioned that sterile gowns should be used during normal labor. The majority of obstetricians (86.7%) and 96.7 % of nurses stated that boots should be used during normal labor.
• Obstetricians and nurses had a good level of knowledge regarding standard IC precautions (95.6% and 96.7% respectively).
Observations of IC practices of obstetricians and nurses revealed the following:
• Obstetricians used non-sterile latex gloves during vaginal examination in all observations, while obstetricians and nurses used sterile gloves during normal labor in 47.7% and 27.8% of observations respectively.
• Masks were used during normal labor in 12.6% and 3.3% of observations of obstetricians and nurses respectively, while gowns were used in 42.7% and 36.7% of observations of obstetricians and nurses respectively.
• Nearly two thirds of obstetricians (65.9%) had poor level of practice while 34.1% had fair level of practice pre intervention. Post intervention 53.3% and 46.7% had poor and fair level of practice respectively.
• Also, nurses had poor and fair levels of practice (90.0% and 10.0% respectively), whereas post intervention program, 43.3% and 50.0% had poor and fair level of practice respectively.Based on the results of the study, the following could be concluded: Most of obstetricians and nurses had a good level of knowledge regarding standard IC precautions. Knowledge of obstetricians and nurses was good regarding hand hygiene, Personal Protective Equipment (PPE), disinfection and sterilization, and waste management.
Knowledge of obstetricians and nurses was good regarding hand hygiene, Personal Protective Equipment (PPE), disinfection and sterilization, and waste management.
Total knowledge score was higher in nurses than in obstetricians.
The intervention program had an effect on practices of obstetricians and nurses.
The difference between pre and post intervention program was statistically significant for the practice scores.
The percent change of obstetricians’ total practice score was 5.13%, while it was for nurses 21.30%.
The percent change of hand hygiene and PPE in nurses was higher than in obstetricians.
Concerning availability of PPE, disposable latex gloves, masks, overhead and Mackinitosh/plastic gowns were available in both hospitals. Sterile gloves were available only in El Shatby hospital. Sterile gowns were not available in both hospitals. Boots or special footwear was available only in Dar Ismael hospital.
Based on the previous conclusions, the following recommendations are suggested:
Infection Control as should be taken into consideration when developing strategies aiming at improving the maternal health.
Booklet IC manual should be available for all HCWs.
Implementation of the Ministry of Health and Population IC guidelines for delivery in all maternity hospitals.
Providing sufficient supply of PPE, safety boxes and disposable syringes and needles.
Hospital IC committee should organize more training programs for obstetricians and nurses to improve their IC practices.
Continuous supervision and evaluation of IC practices of obstetricians and nurses by the hospital IC team. Investigation of IC practices in other maternity hospitals to know the exact magnitude of the problem.