Musculoskeletal disorders and its associated factors among hospital cleaners in Addis Ababa, Ethiopia

There is a paucity of published evidence about musculoskeletal disorders among hospital cleaners in Ethiopia. Therefore, this study was conducted to assess the prevalence of musculoskeletal disorders and its associated factors among hospital cleaners in Addis Ababa, Ethiopia. A total of 437 hospital cleaners participated in the study. A standardized questionnaire adapted from the Nordic musculoskeletal questionnaire was used for data collection. Bivariate and multivariable logistic regression analyses were used to determine factors associated with musculoskeletal disorders. The prevalence of work-related musculoskeletal disorders among hospital cleaners was 57.2% with 95% CI (52.6-62.0). Occupational safety training [AOR: 2.34, 95% CI (1.47-3.73)], repetitive tasks [AOR: 3.09, 95% CI (1.61-5.94)], heavy lifting [AOR: 5.21, 95% CI (3.20-8.48)], work-related stress [AOR: 2.42, 95% CI (1.48-3.97) and work-related dissatisfaction [AOR: 1.97, 95% CI (1.23-3.13)] were identified as associated factors for the development of musculoskeletal disorders. In conclusion the study revealed a high prevalence of musculoskeletal disorder. Notably, work related and organizational factors emerged as key contributing factors to the development of disorders. The identified associations underscore the importance of targeted interventions promoting organizational change involving managers to mitigate the risk of musculoskeletal disorders and enhance overall occupational health and well-being.

Factors associated with environmental service worker cleaning practices in health care settings: A systematic review of the literature

INTRODUCTION

Health care-associated infections can be reduced through better environmental disinfection practices. Central to effective disinfection is the environmental service worker (ESW). The aim of this systematic literature review was to identify factors associated with the disinfection practices of ESWs in health care settings.

METHODS

A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles. Ten online databases and search engines were selected for the review of English-language studies published between 2000 and 2019.

RESULTS

Thirty-one (31) eligible studies were identified. Environmental disinfection was associated with many factors (eg, knowledge, perceptions) as well as ESW exposure to education/training sessions. When education/training was combined with performance evaluation/feedback, significant improvement in ESW disinfection practices was reported.

CONCLUSIONS

To sustain improvements in disinfection practices, education/training sessions need to be continuous. The long-term commitment of an organization is also essential for continuous improvement in disinfection outcomes. While knowledge transfer is critical for behavior change, education/training also needs to focus on the skills and perceptions of ESWs. Future studies need to use a randomized controlled design with larger sample sizes to determine a true effect.

Time for a renewed focus on the role of cleaners in achieving safe health care in low- and middle-income countries

Water, sanitation and hygiene, collectively known as WASH, is an enabler of infection prevention and control (IPC), both of which contribute to safe, quality health care and the prevention of spread of antimicrobial resistance (AMR). This discussion paper considers the importance placed on the role of hygiene, including cleaning and those who clean, in health care facilities, within the context of existing data, guidelines and initiatives. Informed by this, the paper presents five areas for consideration that have the potential to strengthen and further demonstrate the value of this important cadre of staff and their role in clean, safe healthcare, particularly in low- and middle-income countries. The considerations centre around actions to overcome the current data gaps, including the paucity of national data on environmental cleaning and the training of cleaners; strengthening the implementation of norms and standards; combining global and national advocacy efforts; revisiting investment; and addressing research gaps on the issue. The need to act, in line with WHO and UNICEF recommendations to address this overlooked and undercompensated workforce and to elevate their status as important contributors to IPC, WASH and AMR is a pressing one.

Changes in knowledge and attitudes of hospital environmental services staff: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study

BACKGROUND

The Researching Effective Approaches to Cleaning in Hospitals (REACH) study tested a multimodal cleaning intervention in Australian hospitals. This article reports findings from a pre/post questionnaire, embedded into the REACH study, that was administered prior to the implementation of the intervention and at the conclusion of the study.

METHODS

A cross-sectional questionnaire, nested within a stepped-wedge trial, was administered. The REACH intervention was a cleaning bundle comprising 5 interdependent components. The questionnaire explored the knowledge, reported practice, attitudes, roles, and perceived organizational support of environmental services staff members in the hospitals participating in the REACH study.

RESULTS

Environmental services staff members in 11 participating hospitals completed 616 pre- and 307 post-test questionnaires (n = 923). Increases in knowledge and practice were seen between the pre-and post-test questionnaires. Minimal changes were observed in attitudes regarding the role of cleaning and in perceived organizational support.

CONCLUSION

To our knowledge, this is the first study to report changes in knowledge, attitudes, and perceived organizational support in environmental services staff members, in the context of a large multicenter clinical trial. In this underexplored group of hospital workers, findings suggest that environmental services staff members have a high level of knowledge related to cleaning practices and understand the importance of their role.

The Views of Domestic Staff and Porters when Supporting Patients with Dementia in the Acute Hospital: An Exploratory Qualitative Study

There is increasing recognition that very many hospital patients have dementia but there are many concerns about the quality of care and support they receive. Consequently there have been numerous calls for hospital staff to have dementia training. While cleaning or domestic staff and porters form considerable parts of the hospital workforce they are infrequently considered in discussions of dementia care training and practice. This exploratory study aimed to investigate the experiences of domestic staff and porters working in an acute hospital setting who are in contact regularly with patients with dementia. Semi-structured interviews were undertaken in 2016 with seven domestic staff and five porters in one English acute hospital to investigate their views and experiences. Data were analysed thematically by constant comparison technique and theoretical sampling. Themes were identified and realistic concepts developed. Participants observed that caring attitudes and behaviour in their encounters with patients with dementia are important but challenging to put into practice. Several would have valued more information about dementia. Some noted situations in the hospital stay that seemed particularly difficult for patients with dementia such as travelling to different parts of the hospital for treatments. The study suggests the need for improving the dementia-related knowledge and skills of all non-clinical staff especially those new to the NHS. The impact of witnessing dementia symptoms and distress on emotional well-being requires further research so that ancillary staff can improve the hospital stay of patients with dementia.

Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial

Background

The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices.

Methods/design

The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle.

The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital.

Discussion

Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals.

Trial registration

Australia New Zealand Clinical Trial Registry ACTRN12615000325505