Title

Factors influencing infection control management at Civil Hospital Karachi : a qualitative case study

Date of Award

2008

Document Type

Thesis

Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

Department

Community Health Sciences

Abstract

Background Over 1.4 million people worldwide are suffering from nosocomial infections. In underdeveloped countries the risk of acquiring NCIs is 2 to 20 times higher than developed countries. Consequences are increased clinical complications of patients, prolonged stays in hospital, long-term disability, death, additional treatment costs and massive additional financial burden on individuals and health care systems. Management functions play a central role in proper implementation of infection control practices at hospitals to decrease NCIs and occupational risks to health care providers. In Pakistan no study has been conducted or published to study the management issues associated with infection control in hospitals. This study aims to understand the factors influencing management of infection control at civil hospital Karachi using McKinsey 7S framework of management. The study focuses on to explore the management strategies, structure, system, style, skills and the issues related to implementation of standard infection control practices at CHK. Methods A facility-based qualitative case study was conducted at CHK during July to September 2008. Twenty interviews were conducted from the higher management which included MS, AMS and DMS of CHK, Middle managers who are the head of the departments and lower management personnel like steward, nursing superintendent, technician incharges and OPD incharge. Purposive sampling was done to cover all levels and types of managers potentially involved in the administration of a typical public sector hospital. McKinsey 7s model of management was used as framework for the study and a pretested semi-structured questionnaire for in-depth interviews was used as the data collection tool. Review of available documents relevant to hospital infection control was done to triangulate the findings from in-depth interviews. All data was handled manually and the analysis was done in groups ensuring the confidentiality of individuals. Themes were generated out of nodes and sub-nodes of the collected data. Information was triangulated within and between the managers and with the documentary evidence found. Results The interaction and enquiry with the management staff enlightened us with the real problems and issues faced by the management to implement standard infection control practices at CHK. The analysis and triangulation of the collected data revealed that there is no well established IC policy or strategy present at CHK for infection control management. The participants expressed lack of attention and lack of administrative will as the main reasons why CHK does not have an IC policy. As a result, infection control at CHK is managed in a fragmented and adhoc manner which is dependent upon the interest of HOD of an individual ward. There is no infection control committee and team present at CHK. There is no system of accountability and a centralized system for proper documentation of NCIs is also absent. Lack of communication between various departments and scarcity of human and financial resources are the highlighted reasons for this adhoc management of IC. Lack of skilled IC staff is another impeding factor which influences proper implementation of IC practices at CHK. IC is considered to be important by the employees but it is not shared as a value among all the employees of CHK and it is given low priority on the management agenda of CHK as well. Lack of trained IC personnel and ongoing trainings and refreshers in addition, presents a dire need to have more attention and focus on this area. Conclusion Improvement of infection control management at CHK is a pressing issue at present. CHK lacks clearly defined strategy for infection control. The whole system and structure for hospital IC is lacking. There is `adhocism' prevailing for the management of IC at individual ward level. There are no skilled IC personnel and the staff lacks motivation also. IC is not shared as a value among employees and the culture is highly ignorant about the implementation of IC standards at CHK. It is the need of the hour to develop proper IC policies and McKinsey 7S framework is recommended for the alignment of management functions of hospital infection control.

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