To enhance providers' ability to deliver safe and effective reproductive health care services, AVSC develops curricula and other training materials for use in a variety of training courses. Before producing a final version of a curriculum, AVSC "field tests" a draft version in several countries to assess the curriculum's usefulness, completeness, and adaptability in the various settings in which we work.
As an editor and writer at AVSC, I often work with teams of experts to develop training materials. In February, I observed a field test in India of AVSC's infection prevention curriculum, which trains health care workers in how to reduce the risk of transmitting infections between clients, staff, and the community. The feedback received from the course participants and facilitators, as well as my own observations, will inform our team's work as we revise the curriculum.
Orientation in Lucknow
To begin the training process, AVSC held a workshop in Lucknow,
the capital of the state of Uttar Pradesh, to orient local facilitators
to the curriculum and get their assistance in developing daily agendas
for using the curriculum in different settings. Eight doctor-trainers
participated in the workshop to increase their familiarity with
AVSC's approach to infection prevention training, develop facilitation
techniques for use with the curriculum, and learn how to assess
a health care facility's infection prevention practices and needs.
After the workshop, the participants split into teams to give three-day infection prevention trainings at community health centers (CHCs) and block-level primary health centers (PHCs) in five districts in Uttar Pradesh: Gorakhpur, Jhansi, Kanpur, Sitapur, and Varanasi. Each team paired one experienced workshop facilitator with a doctor who would be giving the infection prevention training for the first time.
On to Kanpur
I observed the training given at the Bidhnoo CHC in Kanpur. Known
for the production of leather goods, Kanpur encompasses both an
industrial area and a rural area, where the clinic is located.
Like other CHCs, Bidhnoo serves an area containing roughly 1 to 1 1/2 million people. It has about 30 beds and provides some specialty services. The clinic and its accompanying maternal-child health facility typically provide female sterilization, IUD insertion, abortion (which is unrestricted in India), and delivery services.
The Training Begins
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Many people believe that infection prevention practices are expensive and time-consuming and require high-tech equipment. But this is not the case. The universally accepted infection prevention practices outlined in AVSC's curriculum are simple and require inexpensive and readily available supplies.
For example, running water and electricity are not required to follow proper infection prevention practices; a bucket with a tap can serve as an acceptable alternative when running water is not available. Complicated or costly waste-disposal mechanisms are also unnecessary; a simple pit dug in the ground outside the facility can serve as a place for burying or burning medical and chemical waste products.
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The training team consisted of Dr. Alok Banerjee, a senior program associate at AVSC, and Dr. Asha Kocchar, a consultant to AVSC. They began and ended each day with a classroom session in which infection prevention principles were introduced and discussed. In between, the trainers observed the staff performing their regular duties and demonstrated infection prevention practices that the staff could incorporate into their work.
For example, on the first training day the trainers showed the "ward boy," who cleans the procedure rooms and processes instruments for reuse, how to make a chlorine solution from powdered bleach and water. They also demonstrated the proper way to decontaminate instruments to make them safer for handling by staff who will clean them. Later, the trainers worked with the operating theater staff to demonstrate such practices as how to properly handle used needles and syringes to avoid needlesticks, how to swab a surgical site with an antiseptic solution to reduce postoperative infections, and how to use gloves and other surgical attire to protect staff and clients from infections during procedures.
On-Site Location
One of the aims of the India field test was to assess the curriculum's use in an "on-site" training. At each of the five training locations, all levels of staff--including doctors, nurses, laboratory technicians, midwives, "ward boys," and sweepers--from a single facility were trained at the facility where they work. This is in contrast to the traditional "off-site" training format, in which service providers (doctors and nurses) from a variety of facilities attend a training course held at a central location, often a nonclinical setting such as a hotel.
One benefit of having on-site training at the Bidhnoo clinic was that all the staff could be trained together and work as a group to identify practices needing improvement. They could then all participate in developing an action plan for reducing the risk of infection at their sites. This is especially important for infection prevention, since--unlike many clinical or surgical procedures--infection prevention must be practiced by all levels of staff.
The on-site location also allowed the trainers to observe the facility's current infection prevention practices as they were being performed and to give immediate guidance for improvement. This should prove to be an effective aspect of the training, as adults tend to learn more effectively if training is based on real-life situations and is applied as soon as possible.
Support All Around
The success of a training program such as this one often depends on more than the training itself. Staff involvement and administrative support are key elements in ensuring that the practices will continue to be followed at the facility.
The clinic staff were very receptive to the training, which they
exhibited in many ways. For example, when the trainers and I visited
the "ward boy's" work station on the second training day, he showed
us the chlorine solution he had mixed earlier that morning, having
learned the procedure the day before. When we arrived at the operating
theater, a nurse pointed out the box she had constructed for placing
used needles and other sharp objects.
Two high-level administrators demonstrated their commitment to the training. The clinic ad-ministrator showed his support by attending the classroom sessions and encouraging the staff to attend. The chief medical officer, who oversees all of Kanpur's public-sector facilities, showed his endorsement, as well. On the last training day, he made the hour-long trip from his office to the clinic to express his support for the practices and offer his help in obtaining infection prevention supplies.
In addition to providing input for revising the curriculum, the field test helped forge a partnership between AVSC and many of our direct contacts in the field. The opportunity to share expertise in developing the curriculum--a fundamental characteristic of all AVSC materials--promises to benefit both the curriculum and its users.
Karen Landovitz is an editor and writer at AVSC International.
