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Preventing hospital-acquired infections


Team of doctors during an operation

A major concern for many Vietnamese hospitals

GIZ supports Vietnamese district hospitals in tackling the issue


Asked about their most pressing problems, a large majority of GIZ’s 29 partner hospitals in Vietnam name the lack of hygiene in operating theatres and the resulting infections as their greatest challenge. While none of the hospitals can provide reliable data on the occurrence of postoperative infections, the fact that so many doctors and hospital managers share this concern indicates that there is a real problem that needs tackling.

According to the WHO, health care associated infections or infections acquired in health-care settings are the most frequent adverse events in health care delivery worldwide and hundreds of millions of patients are affected[1]. These infections do not only cause illness and death but also  present a considerable burden to health systems in low and middle income countries, where they occur much more frequently than in developed countries. 

Vietnam is one of the countries for which these so-called nosocomial infections (infections acquired when being treated in a health care setting) present a major challenge.

A guideline for better hygiene in operating theatres is needed

In meetings with GIZ’s partner hospitals, the lack of hygiene in operating theatres came up time and again. Whilst there was broad agreement that it was a fundamental principle that hospitals keep their theatres extra clean, it turned out that many hospital managers and health workers were not sure how to make sure that such hygiene was maintained at all times.

Hospital staff identifies hygiene problems in operating theatres as urgent and agrees upon the development of cleaning guidelines for district hospitals.

At a meeting of delegated nurses, doctors, cleaners and staff from infection control departments of the project hospitals, it was agreed that a guideline for operating theatre hygiene should be developed under the guidance of Vietnam’s Ministry of Health and GIZ experts.

The topic seemed to be an issue for hospitals across Vietnam. Mrs. Luu, the chairwoman of the Nurse’ Association of Vietnam, immediately agreed to work with the GIZ project team on such a guideline for hygiene in operating theatres of district hospitals. Everyone agreed that the guideline should be comprehensive but at the same time practical and easy to understand and implement.

Developing the guideline, training materials and posters

Demonstration posters

Demonstration posters for illustration of cleaning procedures in operating theatres of district hospitals - © GIZ Viet Nam

Step by step, a draft guideline was developed and shared with all hospitals. Many of them sent detailed comments, mostly in relation to the feasibility of the instructions, and the project team revised the draft accordingly. 

In a test phase, the guideline as well as a set of self-explanatory training materials and demonstration posters were piloted in two of the project hospitals. In a training of trainers, every step was practically demonstrated and then tried out in practice, starting with the preparation of the disinfection solution and the cleaning of essential theatre instruments at the start of the day, covering hygiene measures in between operations and ending with those needing to be implemented at the end of the day.  

The guidelines are presented to the district hospital staff

The guidelines are presented to the district hospital staff - © GIZ Viet Nam

Roll-out across the five provinces

Following the pilot phase, the training introducing the new guideline was rolled-out to all five project provinces. First, the hospital directors informed all their staff (including the cleaners and staff responsible for disinfection and sterilisation) about the new instructions.

Next, the trainer team made sure that everyone understood, and practiced, how to put the guideline into action. Also, they provided all partner hospitals with the required materials such as buckets and mops.

Making the changes sustainable

Experience has shown that it is not sufficient to develop a guideline, explain it to the staff and hope that change will happen overnight and then be permanent. In order to ensure that the improvements take root and can be sustained in the long run, the hospital staff will need continuous supportive supervision and evaluation by the nurse or doctor in charge as well as by the Department of Health, which ensures the implementation of national guidelines at the provincial level. 

To support this kind of supervision, the project team developed a supervision checklist and a tally sheet on which adherence to the guidelines’ instructions can be easily monitored.

Sample Checklist

Sample checklist and tally sheet for supervisors - © GIZ Viet Nam

Measuring the impact of the intervention

To be able to measure whether the introduction of the guidelines is having an impact, hospitals need to start to record the incidence of post-operative infections. In the past this rarely happened because hospitals don’t want to risk their reputation or be downgraded by the Ministry of Health during their annual quality checks. 

The GIZ project staff is aware that a lot of trust must be built before hospital managers and health workers will begin to honestly report nosocomial infections so that potential causes can be identified and addressed. Given their partners’ commitment to quality improvements, however, and the positive relationships they have been able to establish across the project region, they are confident that a change in attitudes is already underway.

See also:

How to improve the Health System in Viet Nam

Quality management for hospitals in Viet Nam

BMZ glossary

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