Overview
Maternal health outcomes are closely linked to the level of infection prevention and control (IPC) in obstetrics and gynecology (OB-GYN) departments. In Cameroon, as in many low- and middle-income countries, healthcare-associated infections (HAIs) and unsafe obstetric practices contribute to maternal and neonatal morbidity and mortality. This article highlights current knowledge and practices related to IPC in OB-GYN units at a referral hospital in Cameroon, the challenges faced, and practical recommendations to strengthen IPC and patient safety.
Understanding the IPC Landscape in Cameroon’s OB-GYN Units
ICPs in OB-GYN settings aim to reduce infection risk during delivery, postpartum care, cesarean sections, and routine obstetric procedures. Key components include hand hygiene, use of personal protective equipment (PPE), sterilization and disinfection of instruments, appropriate antibiotic stewardship to prevent resistance, proper waste management, environmental cleaning, and safe surgical practices. In referral hospitals, IPC programs must address both the high volume of obstetric cases and the vulnerability of neonates to infection.
Core IPC Practices in OB-GYN
- Hand hygiene: Adherence to the four moments of hand hygiene before contact with patients, after contact with bodily fluids, and after removing gloves. Alcohol-based hand rubs and soap-and-water washing remain essential, with opportunities for improvement identified through audits and feedback.
- Aseptic technique and sterile equipment: Proper sterilization of instruments, single-use items when possible, and strict adherence to aseptic protocols during delivery, cesarean sections, and intrauterine procedures.
- PPE and contact precautions: Use of gloves, gowns, masks, and eye protection when indicated, particularly during procedures with bleeding risk or suspected infection.
- Environmental cleaning: Regular cleaning of labor rooms, wards, and operating theaters, with attention to high-touch surfaces to reduce environmental reservoirs of pathogens.
- Antibiotic stewardship: Evidence-based antibiotic prophylaxis for cesarean sections and postpartum infections, guided by local resistance patterns and clinical guidelines to minimize antimicrobial resistance (AMR).
- Waste management: Safe handling and disposal of sharps, infectious waste, and laboratory specimens to prevent exposure for patients and staff.
Challenges Specific to the Cameroonian Context
Several factors influence IPC effectiveness in OB-GYN units in Cameroon. Resource constraints, including equipment shortages, limited access to reliable running water, and inconsistent supply chains for PPE, can hinder routine IPC practices. Human factors—such as staffing gaps, uneven training, and high patient loads—also affect compliance with IPC protocols. Cultural norms and patient expectations regarding obstetric care can influence the acceptance of infection control measures, especially in labor and delivery settings where rapid decision-making is required.
Impact on Maternal and Neonatal Outcomes
Inadequate IPC measures are linked to higher rates of postpartum infections, wound infections after cesarean deliveries, neonatal sepsis, and longer hospital stays. Improvement in IPC can translate into lower maternal mortality, reduced neonatal morbidity, and more efficient use of hospital resources. The ultimate goal is to create a risk-informed culture where safety protocols are standard practice, not exceptions.
Strategies to Strengthen IPC in the OB-GYN Department
Implementable strategies focus on leadership, training, monitoring, and community engagement. Hospitals can adopt a phased approach that blends policy development with daily practice improvements.
- Strengthen leadership and governance: Establish dedicated IPC committees within the OB-GYN department, with clear accountability for hand hygiene, sterile processing, and waste management.
- Training and capacity building: Regular, practical IPC training for all obstetric staff, including demonstrations on aseptic technique, proper donning and doffing of PPE, and instrument sterilization methods.
- Auditing and feedback: Simple, repeatable audits (hand hygiene, sterile processing, environmental cleaning) with timely feedback to staff and visible improvement metrics.
- Supply chain reliability: Ensure consistent access to essential IPC supplies such as gloves, alcohol-based hand rub, disinfectants, and sterilization equipment.
- Antibiotic stewardship programs: Local guidelines for prophylaxis and treatment, monitoring of resistance trends, and education on prudent antibiotic use among clinicians and patients.
- Environmental design: Improve layout to reduce cross-contamination risk, ensure clean and dirty zones are distinct in labor rooms and operating theaters, and optimize waste streams.
Conclusion
Efforts to improve IPC in the obstetrics and gynecology department of Cameroonian referral hospitals must be multifaceted, combining governance, training, reliable supplies, and ongoing monitoring. By prioritizing hand hygiene, aseptic technique, environmental cleanliness, and antibiotic stewardship, health facilities can reduce HAIs, protect mothers and newborns, and contribute to better maternal health outcomes in Cameroon.
