2.8 Cleanliness

Wherever labour and delivery are managed, cleanliness is a first and foremost requirement. There is no need for the form of sterility commonly used in an operating theatre, but nails must be short as well as clean and hands must be carefully washed with soap and water. Attention should be paid to the personal hygiene of birthing women and birth attendants as well as to the cleanliness of the environment and all materials used during birth. In some countries masks and sterile gowns are used traditionally to protect labouring woman from infection. For that purpose they are useless (Crowther et al 1989). However, in regions with a high prevalence of HIV and hepatitis B and C virus protective clothing is useful to protect the caregiver from contact with contaminated blood and other materials (WHO 1995).

WHO has established the contents of a clean delivery kit and its correct, effective use (WHO 1994a). The programmes already in place to advocate the positive effect of the use of the “three cleans” (hands, perineal area, umbilical area) need to be maintained or expanded. The contents of the clean delivery kit may vary from country to country, but they must fit the specific needs of the women giving birth and be easily obtainable at every street corner and in all remote regions of a country. These simple but effective kits can even be assembled at home and include a new, sterile razor blade for the umbilical cord. The clean delivery kit itself and its contents should indeed be clean and need not be sterilized. The disposable materials in the kit should not be reused.

Instruments destined to be reused should be decontaminated appropriately according to guidelines provided by WHO (1995). Equipment which comes into contact with intact skin can be washed thoroughly, instruments which come into contact with mucous membranes or non-intact skin should be sterilized, boiled or chemically disinfected, and instruments which penetrate the skin should be sterilized. These methods serve to prevent the contamination of women and caregivers.

Some measures should be taken during all deliveries, to prevent possible infection of the woman and/or the birth attendant. These measures include the avoidance of direct contact with blood and other body fluids, by the use of gloves during vaginal examination, during delivery of the infant, and in handling the placenta. It is important to reduce the potential for infection by keeping invasive techniques such as episiotomy to the strict minimum and taking additional care with the use and disposal of sharp instruments (for instance during suturing) (ICN 1996).