An exploratory study of infection control practices in home-based care in Durban, South Africa.

Abstract

Infection control practices are a critical element in home-based care for people living with HIV/AIDS. It involves principles and procedures used to minimize the risk of spreading infections in home-based care. Infection control practices help to prevent morbidity, mortality rates and improve health for the volunteer caregivers and the patients. However, most previous studies on home-based care have focused on burdens of care, perceptions of rewards, quality of care and challenges faced by caregivers. Therefore, it is not clear how and to what extent infection control practices are carried out in home-based care. The purpose of this study is to explore the experiences of home-based care coordinators and volunteer caregivers regarding infection control practices in home-based care. Qualitative interviews were conducted with ten home-based care coordinators/project managers and ten focus group discussions were conducted with volunteer caregivers. An interview guide and a focus group schedule with open ended questions were used. Volunteer caregivers in home-based care organizations were faced with practical challenges regarding infection control practices that posed a threat to their work and health. The received insufficient infection control material resources such as gloves, masks and sanitizers. They also mentioned to have received poor quality gloves that easily broke, poor quality aprons that were not tight; easily blown by the wind and also thin masks that could not filter the bad odour. Other challenges that they faced included, insufficient water supply; insufficient knowledge on infection control and lack of cooperation from some patients and some family members regarding the use of protective clothing especially gloves and masks. Most volunteer caregivers were ridiculed by some family, community members and friends. Sometimes they could not access some patient due to HIV related stigma and discrimination. However, volunteers developed various strategies of dealing with these challenges such as replacing the torn gloves with plastics, carrying 2.5 litres of water, educating patients and family members about the importance of wearing gloves and practicing infection control. These findings require the government, NGOs, funders and donors to form a forum with volunteer caregivers to discuss the supply of materials. They need to establish a central administration that will be responsible for allocating adequate and quality materials for infection control practices. This central administration should also be responsible for supervising HBCOs including monitoring and evaluating infection control practices.