Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.

中文翻译：

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评估清洁计划对产房和新生儿病房环境卫生的影响：冈比亚的一项探索性研究

医院内有效的表面清洁对于防止病原体传播至关重要。然而，由于资源有限和培训不足，低收入和中等收入国家的医院面临清洁挑战。我们评估了针对培训师改进的 TEACH CLEAN 计划在减少冈比亚三级转诊医院新生儿病房表面微生物污染方面的有效性。我们采用了准实验设计，并将数据与产房的数据进行了比较。还进行了对清洁实践的直接观察和关键知情人访谈，以明确该计划的影响。在2021年7月至9月（干预前）和2021年10月至12月（干预后）期间，每周在新生儿病房和产房进行表面采样。该培训包于 2021 年 10 月交付，此后，其表面微生物污染在两种临床环境中均恶化。虽然一些清洁标准有所提高，但使用新清洁布和一刷法等关键方面却没有提高。对高级部门和医院管理人员的采访揭示了卫生系统中持续存在的挑战，阻碍了改进清洁实践的能力，包括 COVID-19、人员不足、供水中断和清洁材料短缺。保持医院清洁是良好护理的基础，但在这个低收入国家新生儿病房培训医院清洁人员未能降低表面污染水平。进一步的定性调查揭示了多个外部因素，这些因素对清洁计划可能产生的影响构成了挑战。需要开展进一步的工作来解决低收入医院的医院清洁障碍。