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The Global Handwashing Partnership

Nurses and midwives are critical to teaching hand hygiene in Pakistan

Published: May 4, 2020

This case study was originally posted on WHO’s website

Sania, a midwife in a governmental hospital in Islamabad, Pakistan vividly remembers the first time she met her patient Razia, a 25-year-old women expecting her second child.

“Razia was terrified and instantly broke into tears as soon as she entered the examination room for her first antenatal visit,” Sania remembers. “I was taken back, as often my patients are filled with anticipation when checking in on their baby’s growth.”

Sania tried to ease Razia’s fears, and then asked her why she was crying. Through tears, she recounted the story of her first born.

Belonging to a poor family, Razia lives in a joint family system where all decisions are made by the elders, including where women give birth. Her first childbirth took place at home with the assistance of a local dai or an untrained traditional birth attendant.

She endured many complications: a vaginal tear and bleeding followed by a fever that lasted for days. Her newborn daughter’s umbilical cord got infected, and later she had bouts of diarrhea and struggled to gain weight.

This time, Razia discussed the birth with her husband and knew she wanted to go to a hospital, but she still had fears. The COVID-19 pandemic was now her biggest worry, and she struggled with whether it was safer to give birth in the hospital or at home.

Sania gave her the confidence she needed. She sat beside Razia and explained to her how the COVID-19 virus spreads. She told her that if proper precautions are taken, such as thoroughly cleaning hands with soap and water or alcohol-based hand rub, COVID-19 can be prevented. She even took a further step and showed Razia how to properly wash her hands.

Razia’s nerves calmed, and she decided to register for delivery in the hospital. She’s now taking the COVID-19 precautions Sania taught her and practising hand hygiene and social distancing at home.

Improving patient safety in Pakistan’s hospital

The hospital where Sania works is one of more than 80 hospitals in Pakistan that are implementing the “Patient Safety Friendly Hospital Initiative” (PSFHI), a WHO-led programme that involves implementation of a harmonized set of evidence-based patient safety standards to which hospitals should adhere to ensure safer care. It offers a platform for integrating patient safety priorities where infection prevention and control (IPC), including hand hygiene and standard precautions, are critical components. Now with the COVID-19 crisis, IPC is ever more important.

In the midst of the pandemic, Pakistan developed and launched National Guidelines for Infection Prevention and Control and inaugurated a new Center for Occupational and Patient Safety (COPS) at the National Institute of Health (NIH). The centre provides strategic direction for health professionals to embrace, create and implement transformational changes in the neglected domain of occupational safety.

“There could not have been a better time to discuss infection prevention and control in Pakistan,” said Dr. Zafar Mirza, the prime minister’s special assistant on health on the eve of inauguration. “The role of health workers, particularly nurses and midwives, in dealing with COVID-19 is greatly appreciated.”

It turns out teaching patients about health education, like Sania teaching Razia to practice hand hygiene, is not unusual. Many hospitals across the country are now conducting regular education both for patients, as well as health workers about hand hygiene.

Nurses are critical to ensuring quality care. They engage and empower patients to speak up on their own behalf, and also enforce hand hygiene measures with colleagues from all levels of the hospital hierarchy.

“Nurses are the key watchdogs of patients, so it’s absolutely critical that all of them prioritize patient safety and take responsibility for hand hygiene compliance,” said Dr Palitha Gunarathna Mahipala, WHO Representative Pakistan. “All hospitals worldwide must empower their health professionals to ensure safe care.”

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