PRINCIPLES OF GOOD CARE 四2 COMMUNICATION These principles of good care apply to all contacts between the skilled attendant and all women and their babies:they are not repeated in each section.Care-givers should therefore familiarize themselves with the following principles before using the Guide.The principles concern: ■Communication2 WORKPLACE AND ADMINISTRATIVE Workplace and administrative procedures PROCEDURES Standard precautions and cleanliness ■Organizing a visit5 STANDARD PRECAUTIONS AND CLEANLINESS 5ORGANIZING A VISIT A1A1 PRINCIPLES OF GOOD CARE PRINCIPLES OF GOOD CARE Communication PRINCIPLES OF GOOD CARE A2 Communicating with the w oman (and her companion) N Make the woman (and her companion) feel welcome. N Be friendly, respectful and non-judgmental at all times. N Use simple and clear languag e. N Encourage her to ask questions. N Ask and pro vide infor mation related to her needs. N Support her in understanding her options and making decisions. N At any examination or before an y procedure: ¡ seek her per mission and ¡ inform her of what you are doing . N Summarize the most impor tant infor mation, including the infor mation on routine laborator y tests and treatments. Verify that she understands emerg ency signs, treatment instr uctions, and when and where to retur n. Check for understanding b y asking her to explain or demonstrate treatment instructions. Privacy and confidentiality In all contacts with the woman and her par tner: N Ensure a priv ate place for the examinat ion and counselling . N Ensure, when discussing sen sitive subjects, that you cannot be o vrheard. N Make sure you have the woman’s consent before discussing with her par tner or family . N Never discuss confidential infor matin about clients with other pro viders, or outside the health facility . N Organize the examination are a so that, during examination, the woman is protected from the view of other people (cur tain, screen, wall). N Ensure all records are confidential and k ept locked away. N Limit access to logbooks and registers to responsible pro viders only . Prescribing and recommending treatments and pre ventive measures for the w oman and/or her bab y When giving a treatment (drug, vaccine, bednet, condom) at the clinic, or prescribing measures to be followed at home: N Explain to the w oman what the treatment is and why it should be given. N Explain to her that the t reatment will not har m her or her bab y, and that not taking it ma y be more dang erous. N Give clear and helpfu l advice on ho w to take the drug regular ly: ¡ for example: tak e 2 tablets 3 times a day, thus every 8 hours, in the mor ning, afternoon ad evening with some water and after a meal, for 5 days. N Demonstrate the procedure. N Explain how the treatment is giv en to the bab y. Watch her as she does the first treatmen the clinic. N Explain the side-effects to her . Explain that they are not seri ous, and tell her ho w to manage them. N Advise her to retur n if she has any problems or concerns about taking the drugs. N Explore any barriers she or her family m ay have, or have heard from others, about using the treatment, where possible: ¡ Has she or anyone she knows used the treatment or pre ventive measure before? ¡ Were there problems? ¡ Reinforce the cor rect information that she has, and try to clarify the incor rect information. N Discuss with her the importance of buying and taking the prescribed amount. Help her to think about how she will be able to p urchase this. COMMUNICATION Workplace and administrative procedures A3 PRINCIPLES OF GOOD CARE Workplace N Service hours should be clear ly posted. N Be on time with appointments or infor m the woman/women if she/the y need to wait. N Before beginning the ser vices, check that equipment is clean and functioning and that supplies and dr ugs are in place. N Keep the facility clean b y regular cleaning . N At the end of the ser vice: ¡ discard litter and sharps safely ¡ prepare for disinfection; clean and disinfect equipment and supplies ¡ replace linen, prepare for washing ¡ replenish supplies and dr ugs ¡ ensure routine cleaning of all areas. N Hand over essential infor mation to the colleague who follows on duty . Daily and occasional administrative activities N Keep records of equipment , supplies, drugs and vaccines. N Check availability and functioning of essential equipment (order stocks of supplies, drugs, vacines and contraceptiv es before the y run out). N Establish staffing lists and schedules. N Complete periodic repor ts on bir ths, deaths and other indicators s required, according to instructions. Record keeping N Always record finding s on a clinical record and home-base d recor d. Record treatments, reasons for refer ral, and follow-up recommendation s at the time the obser vation is made. N Do not record conf idential information the home-based record if the woman is unwi lling. N Maintain and file appropr iately: ¡ al clinical reco rds ¡ al other docume ntation. International conventions The health facility should not allo w distribution of free or low-cost suplies or products withi n the scope of the Inter national Code of Mark eting of Breast Milk Substitutes. It should also be tobacco free and suppor t a tobacco-free environment. WORKPLACE AND ADMINISTRA TIVE PROCEDURES Standard precautions and cleanliness PRINCIPLES OF GOOD CARE A4 Observe these precautions to protect the woman and her bab y, and you as the health provider , from infections with bacteria and viruses, including HIV. Wash hands N Wash hands with soap and water : ¡ Before and after caring for a w oman or newborn, and before an y treatment procedure ¡ Whenever the hands (or an y other skin area) are contaminated with blood or other body fluids ¡ After removing the glo ves, because the y may have holes ¡ After changing soiled bedsheets or clothing . N Keep nails shor t. Wear gloves N Wear sterile or highly disinfected glo ves when performing vaginal examination, delivery, cord cutting, repair of episiotomy or tear , blood drawing. N Wear long sterile or highly disinfected glo ves for manual remo val f placenta. N Wear clean glo ves when: ¡ Handling and cleaning instr uments ¡ Handling contaminated waste ¡ Cleaning blood and bod y fluid spills N Drawing blood. Protect y ourself from blood and other body fluids during deliv eries ¡ Wear gloves; cover any cuts, abrasions or broken skin with a waterproof bandag e; take care when handling an y sharp instruments (ue good light); and practic e safe sharps disposal. ¡ Wear a long apron made from plasti c or other fluid resistant materia l, and shoes. ¡ If possible, protect y our eyes from splashes of blood. Practice safe sharps disposal N Keep a puncture resistant container nearb y. N Use each needle and syringe only once. N Do not recap, bend or break needles after giving an injection. N Drop all used (disposable ) needles, plastic syringes and blades directly int o this container, without recapping , and without passing to another person. N Empty or send for incinerati on when the container is three-quar ters full. Practice safe waste disposal N Dispose of placenta o r blood, or body fluid contaminated items, in leak-proof container s. N Burn or bury contaminated solid waste. N Wash hands, gloves and containers after disposal of infectious wa ste. N Pour liquid waste do wn a drain or flushable toilet. N Wash hands after di sposal of infectious waste. Deal with contaminated laundry N Collect clothing or she ets stained with blood or body fluids and k eep them separately from other laundr y, wearing gloves or use a plastic bag. DO NOT touch them di rectly. N Rinse off blood or o ther body fluids before washing with soap. Sterilize and clean contaminated equipment N Make sure that instr uments which penet rae the skin (such as ne edles) are adequately sterilized, or that single-use instr uments are disposed of after one use. N Thoroughly clean or disi nfect any equipment which comes into contact with intact skin (according to instr uctions). N Use bleach for clea ning bowls and buck ets, and for blood or bod y flui d spills. Clean and disinfect glo ves N Wash the gloves in soap and water . N Check for damage: Blow gloves full of air ,twist the cuff closed, then hold under clean water and look for air leaks. Discard if damag ed. N Soak overnight in bleach solution with 0.5 available chlorine (made b y adding 90 ml water to 10 ml bleach containing 5% a vailable chlorine) . N Dry away from direct sunlight. N Dust inside with talcum po wder r starch. This produces disinfected gloves. They are not sterile. Good quality latex glo ves can be disinfected 5 or more time s. Sterilize glo ves N Sterilize by autoclaving or highly disinfect by steaming or boiling . UNIVERSAL PRECA UTIONS AND CLEANLINESS Organizing a visit A5 PRINCIPLES OF GOOD CARE Receive and respond immediately Receive ever y woman and newbor n baby seeking care immediately after ar rival (or organize rception b y another pro vider). N Perform Quick Check on all ne w incoming women and babies and those in the waiting room, especially if no-one is receiving them B2. N At the first emerg ency sign on Quick Check, begin emerg ency assessment and management (RAM) B1-B7 for the woman, or examine the ne wborn J1-J11. N If she is in labour , accompany her to an appropriate place and follo w the steps as in Childbirth: labour, delivery and immediate postpartum careD1-D29. N If she has priority signs, examine her immediately using Antenatal car e, Postpartum or Post-abortion care char ts C1-C18E1-E10B18-B22. N If no emergency or priority sign on RAM or not in labour , invite her to wait in the waiting room. N If baby is newly bor n, looks small, examine immediately. Do not let the mother wait in the queue. Begin each emerg ency care visit N Introduce y ourself. N Ask the name of the w oman. N Encourage the companion to sta y with the w oman. N Explain all procedures, ask permission, and keep the woman infor med as much as you can about what you are doing . If she is unconscious, talk to the companion. N Ensure and respect priv acy during examination and discussion. N If she came with a bab y and the bab y is well, ask the companion to tak e care of the baby during the mate rnl examination an d treatment. Care of woman or bab y refer red for special care to secondar y level facility N When a woman or bab y is refer red to a secondary level care facility becaus e of a specific probl em or complications, the underlying assumption of the Guide is that, at refer ral level, the woman/baby will be assessed, treated, counselled and ad vised on follow-up for that par ticular condition/ complication. N Follow-up for that specific condi tion will be either: ¡ organized by the refer ral facility or ¡ written instr uctions will be giv en to the woman/baby for the skilled atendant at the primar y level who refer red the woman/ baby. ¡ the woman/baby will be ad vised to g o for a follow-up visit within 2 w eeks according to severity of the condition. N Routine care continues at the primar y care level where it was initiated. Begin each routine visit (for the woman and/or the bab y) N Greet the woman and offer her a seat. N Introduce y ourself. N Ask her name (and the name ofthe baby). N Ask her: ¡ Why did you come? For y ourself or for y our baby? ¡ For a scheduled (routine) visit? ¡ For specific complain ts about y ou or your baby? ¡ First or follo w-up visi t? ¡ Do you want to in clude your companion or other family membe r (parent if adolescent) in the examinati on and discussion? N If the woman is recently deliv ered, assess the baby or ask to see the baby if not wit h the mother . N If antenatal care, always revise the birth plan at the end of the visit afte r completi ng the char t. N For a postpar tum visit, if she came with the baby, also examine the bab y: ¡ Follow the appropr iate char ts according to pregnancy sta tus/age of the baby and purpose of visit. ¡ Follow all steps onthe chart and in relevant boxes. N Unless the condition of the woman or the baby requires urg ent refer ral to hosp ital, give preventive measures if due even if the woman has a condition "in y ellow" that requires special treatment. N If follow-up visit is within a w eek, and if no other complaints: ¡ Assess the woman for the specific condit requiring follo w-up only ¡ Compare with ear lir assessment and re￾classify. N If a follow-up visit is more than a week after the initial examination (but not the next scheduled visit): ¡ Repeat the whole assess ment as required for an antenatal, post-abortion, postpartum or newborn visit according to the s chedule ¡ If antenatal visit, revise the bir th plan. During the visit N Explain all procedures, N Ask permission before under taking an examination or test. N Keep the woman infor med throughout. Discuss findings with her (and her par tner). N Ensure priv acy duri ng the examination and discussion. At the end of the visi t N Ask the woman if she has an y questions. N Summarize the most impor tant messa ges with her. N Encourage her to return for a routine visit (tell her when) and if she has an y concer ns. N Fill the Home-Base d Mater nal Record (HBMR) and give her the approp riate infor mation sheet. N Ask her if there are an y poits which need to be discussed and w ould she lik e suppor t for t his. ORGANIZING A VISIT A2 COMMUNICATION A3 WORKPLACE AND ADMINISTRATIVE PROCEDURES A4 STANDARD PRECAUTIONS AND CLEANLINESS A5 ORGANIZING A VISIT These principles of good care apply to all contacts between the skilled attendant and all women and their babies; they are not repeated in each section. Care-givers should therefore familiarize themselves with the following principles before using the Guide. The principles concern: N Communication A2 . N Workplace and administrative procedures A3 . N Standard precautions and cleanliness A4 . N Organizing a visit A5