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Brainard J, Swindells IC, Wild J, Hammer CC, Hornsey E, Mahamed HO, Willet V. Emergency infection prevention and control training in fragile, conflict-affected or vulnerable settings: a scoping review. BMC Health Serv Res 2024; 24:937. [PMID: 39152446 PMCID: PMC11328436 DOI: 10.1186/s12913-024-11408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND It is uncertain what could be the best training methods for infection prevention and control when an infectious disease threat is active or imminent in especially vulnerable or resource-scarce settings. METHODS A scoping review was undertaken to find and summarise relevant information about training modalities, replicability and effectiveness of IPC training programmes for clinical staff as reported in multiple study designs. Eligible settings were conflict-affected or in countries classified as low-income or lower-middle income (World Bank 2022 classifications). Search terms for LILACS and Scopus were developed with input of an expert working group. Initially found articles were dual-screened independently, data were extracted especially about infection threat, training outcomes, needs assessment and teaching modalities. Backwards and forwards citation searches were done to find additional studies. Narrative summary describes outcomes and aspects of the training programmes. A customised quality assessment tool was developed to describe whether each study could be informative for developing specific future training programmes in relevant vulnerable settings, based on six questions about replicability and eight questions about other biases. FINDINGS Included studies numbered 29, almost all (n = 27) were pre-post design, two were trials. Information within the included studies to enable replicability was low (average score 3.7/6). Nearly all studies reported significant improvement in outcomes suggesting that the predominant study design (pre-post) is inadequate to assess improvement with low bias, that any and all such training is beneficial, or that publication bias prevented reporting of less successful interventions and thus a informative overview. CONCLUSION It seems likely that many possible training formats and methods can lead to improved worker knowledge, skills and / or practice in infection prevention and control. Definitive evidence in favour of any specific training format or method is hard to demonstrate due to incomplete descriptions, lack of documentation about unsuccessful training, and few least-biased study designs (experimental trials). Our results suggest that there is a significant opportunity to design experiments that could give insights in favour of or against specific training methods. "Sleeping" protocols for randomised controlled trials could be developed and then applied quickly when relevant future events arise, with evaluation for outcomes such as knowledge, practices, skills, confidence, and awareness.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School University of East, Anglia Norwich, UK.
| | | | | | | | - Emilio Hornsey
- London School of Hygiene & Tropical Medicine, UK Public Health Rapid Support Team, UK Health Security Agency, and , London, UK
| | - Hibak Osman Mahamed
- Country Readiness Strengthening, World Health Organization, Geneva, Switzerland
| | - Victoria Willet
- Country Readiness Strengthening, World Health Organization, Geneva, Switzerland
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Kopuit P, Bier L, Abu-Gush S, Smadga H, David R, Shraga T, Dery I, Ezagui BS, Yinnon AM, Benenson S. How effective are monthly departmental tracer surveys? A 5-year retrospective study of 138 surveys in 96 departments. Am J Infect Control 2024; 52:872-877. [PMID: 38583776 DOI: 10.1016/j.ajic.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Repeat department-wide surveys are commonly employed for infection control. There remains debate concerning their cost-effectivess. The aim of the study was to measure the impact of repeat department-wide surveys in major in-patient departments (IPDs) and ambulatory facilities (AFs) in a tertiary care hospital. This was a retrospective study of 138 surveys condcuted in 96 departments over a 5-year period. METHODS Two itemized questionnaires were designed to assess the most frequently inadequately adhered to infection control measures: one for IPD (with 21 items) and the other for AF (with 17 items). RESULTS A total of 72 surveys were conducted in 49 IPDs, of which 39 (54%) were repeat surveys, and 66 surveys in 47 AFs, of which 33 (50%) were repeat surveys. The baseline rate of adherence/department was 71% ± 14 for the IPD, with an increase from the first to the last survey to 82% ± 13 (P = .037). In 15/21 measured infection control items, adherence improved. Adherence to infection control items was lower at baseline in the AFs than in the IPDs (63 ± 27), with an increase to 76 ± 20 (non significant). Although adherence improved for 9 items, it deteriorated in another 8, producing an overall statistically unchanged outcome. CONCLUSION Repeat whole-department surveys contribute moderately to increased adherence to infection control guidelines. AFs demonstrate lower rates of adherence to infection control guidelines and are less receptive to educational measures.
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Affiliation(s)
- Puah Kopuit
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Liora Bier
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Samar Abu-Gush
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Hanna Smadga
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth David
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tova Shraga
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ilana Dery
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Bath Sheva Ezagui
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amos M Yinnon
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew-University Hadassah Medical School, Jerusalem, Israel.
| | - Shmuel Benenson
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew-University Hadassah Medical School, Jerusalem, Israel
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Lau LHW, Lam QSK, Siu MMY, Tang TSK, Suen LKP, Lam SC. Compliance of healthcare workers in a psychiatric inpatient ward to infection control practices during the COVID-19 pandemic: a participant observation study supplemented with a self-reported survey. BMC Infect Dis 2024; 24:592. [PMID: 38886634 PMCID: PMC11181547 DOI: 10.1186/s12879-024-09429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND As an emerging infectious disease with a heterogenous and uncertain transmission pattern, coronavirus disease 2019 (COVID-19) has created a catastrophe in healthcare-associated infections (HAIs) and posed a significant challenge to infection control practices (ICPs) in healthcare settings. While the unique characteristics of psychiatric patients and clinical settings may make the implementation of ICPs difficult, evidence is lacking for compliance with ICPs among healthcare workers (HCWs) in a psychiatric setting during the COVID-19 pandemic. METHODS A cross-sectional multi-method study based on participant unobtrusive observation coupled with the completion of a self-administered ICP survey was conducted to assess compliance with ICPs among HCWs in a psychiatric inpatient ward in a regional hospital. An online checklist, called eRub, was used to record the performance of HCWs in hand hygiene (HH) and other essential ICPs. Furthermore, a well-validated questionnaire (i.e., Compliance with Standard Precautions Scale, CSPS) was used to collect the participants' self-reported ICP compliance for later comparison. RESULTS A total of 2,670 ICP opportunities were observed from January to April 2020. The overall compliance rate was 42.6%. HCWs exhibited satisfactory compliance to the wearing of mask (91.2%) and the handling of clinical waste (87.5%); suboptimal compliance to the handling of sharp objects (67.7%) and linen (72.7%); and poor compliance to HH (3.3%), use of gloves (40.9%), use of personal protective equipment (20%), and disinfection of used surface/area (0.4%). The compliance rates of the nurses and support staff to HH were significantly different (χ2 = 123.25, p < 0.001). In the self-reported survey, the overall compliance rate for ICPs was 64.6%. CONCLUSION The compliance of HCWs in a psychiatric inpatient ward to ICPs during the COVID-19 pandemic ranged from poor to suboptimal. This result was alarming. Revisions of current ICP guidelines and policies that specifically target barriers in psychiatric settings will be necessary.
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Affiliation(s)
| | | | - Minnie Mei Yi Siu
- School of Nursing, Union Hospital, New Territories, Hong Kong SAR, China
| | | | | | - Simon Ching Lam
- School of Nursing, Tung Wah College, Kowloon, Hong Kong SAR, China.
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Asgedom AA. Status of infection prevention and control (IPC) as per the WHO standardised Infection Prevention and Control Assessment Framework (IPCAF) tool: existing evidence and its implication. Infect Prev Pract 2024; 6:100351. [PMID: 38469414 PMCID: PMC10926125 DOI: 10.1016/j.infpip.2024.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Healthcare settings have a high prevalence of infectious agents. This narrative review examines the existing evidence regarding infection prevention and control (IPC) using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool in healthcare facilities. A total of 13 full length papers from Africa, Asia and Europe were considered for this review. The findings showed that there are discrepancies in the IPCAF values from insufficient to advanced level. The current review shows an advanced IPCAF level in middle income and high income countries. Low income countries showed a lower IPCAF score. There is a need to enhance the IPC capacity building and to supply infection prevention resources to prevent healthcare associated infection (HAI) with a focus on low income countries.
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Affiliation(s)
- Akeza Awealom Asgedom
- Department of Environmental Health Science, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Monari C, Onorato L, Coppola N, Raviglione MCB, Gon G. Burden of Antimicrobial Resistance Among Women with Post-Partum Infections in Low-Middle Income Countries: A Systematic Review. J Epidemiol Glob Health 2024; 14:274-290. [PMID: 38630391 PMCID: PMC11176113 DOI: 10.1007/s44197-024-00222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/26/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Due to the rising incidence of multidrug-resistant (MDR) pathogens, especially in Low-Middle-Income Countries (LMIC), post-partum infections represent a significant treatment challenge. METHODS We performed a systematic review of the literature from January 2005 to February 2023 to quantify the frequency of maternal post-partum infections due to MDR pathogens in LMICs, focusing on methicillin-resistant Staphylococcus aureus (MRSA) and/or extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales. SECONDARY OBJECTIVES description of antimicrobials' prescriptions. FINDINGS We included 22 studies with 14,804 total bacterial isolates from 12 countries, mostly from WHO African-Region. Twelve papers described wound- and 10 puerperal-infections. Seven were high-quality articles. Seventeen studies reported data on MRSA, and 18 on ESBL-producing Enterobacterales. Among high-quality studies, MRSA ranged from 9.8% in Ghana to 91.2% in Uganda; ESBL-producing Enterobacterales ranged from 22.8% in Ukraine to 95.2% in Uganda. Nine articles, mostly on C-sections, described different protocols for antibiotic prophylaxis and/or post-partum treatment. INTERPRETATION We described a high burden of post-partum infections caused by MRSA and/or ESBL-producing Enterobacterales in LMICs, but only a few studies met quality standards. There is an urgent need for high-quality studies to better describe the real burden of antimicrobial resistance in low-resource settings and inform policies to contain the spread of multidrug-resistant organisms.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, AOU Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Onorato
- Section of Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Nicola Coppola
- Section of Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
| | | | - Giorgia Gon
- Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, London, UK
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Tartari E, Kilpatrick C, Deeves M, Pittet D, Allegranzi B. Enhancing innovative training and education in infection prevention and control: a call to action for World Hand Hygiene Day 2024. Lancet Glob Health 2024; 12:e907-e908. [PMID: 38710184 DOI: 10.1016/s2214-109x(24)00117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Ermira Tartari
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland; Faculty of Health Sciences, University of Malta, Triq Dun Karm, Msida, Malta
| | - Claire Kilpatrick
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland
| | - Mandy Deeves
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Unit and Hub, Department of Integrated Health Services, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland.
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Ehsan A, Ehsan F, Hanif H. Infection control practices in public sector hospitals of Punjab: a critical analysis. BMJ Open Qual 2024; 13:e002380. [PMID: 38719521 PMCID: PMC11086194 DOI: 10.1136/bmjoq-2023-002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/29/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is imperative towards patient safety and health. The Infection Prevention and Control Assessment Framework (IPCAF) developed by WHO provides a baseline assessment at the acute healthcare facility level. This study aimed to assess the existing IPC level of selected public sector hospital facilities in Punjab to explore their strengths and deficits. METHODS Between October and April 2023, 11 public sector hospitals (including tertiary, secondary and primary level care) were selected. Data were collected using the IPCAF assessment tool comprising eight sections, which were then categorised into four distinct IPC levels- inadequate, basic, intermediate and advanced. Key performance metrics were summarised within and between hospitals. RESULTS The overall median IPCAF score for the public sector hospitals was 532.5 (IQR: 292.5-690) out of 800. Four hospitals each scored 'advanced' as well as 'basic' IPC level and three hospitals fell into 'intermediate level'. Most hospitals had IPC guidelines as well as IPC programme, environments, materials and equipments. Although 90% of secondary care hospitals had IPC education and training, only 2 out of 5 (40%) tertiary care and 2 out of 3 (67%) primary care hospitals have IPC or additional experts for training. Only 1 out of 5 tertiary care hospitals (20%) were recorded in an agreed ratio of healthcare workers to patients while 2 out of 5 (40%) of these hospitals lack staffing need assessment. CONCLUSION Overall the sampled public sector (tertiary, secondary and primary) hospitals demonstrated satisfactory IPC level. Challenging areas are the healthcare-associated infection surveillance, monitoring/audit and staffing, bed occupancy overall in all the three categories of hospitals. Periodic training and assessment can facilitate improvement in public sector systems.
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Affiliation(s)
| | - Fatima Ehsan
- Physiology, Riphah International University, Islamabad, Pakistan
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Vicentini C, Bussolino R, Gastaldo C, Castagnotto M, D'Ancona FP, Zotti CM. Level of implementation of multimodal strategies for infection prevention and control interventions and prevalence of healthcare-associated infections in Northern Italy. Antimicrob Resist Infect Control 2024; 13:39. [PMID: 38605378 PMCID: PMC11010422 DOI: 10.1186/s13756-024-01398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND In November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions. METHODS A PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0-1 or 0-2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient. RESULTS In total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25-12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman's Rho -0.340, p 0.034). No other significant correlation was found. CONCLUSIONS This study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 Bis, 10126, Turin, Italy.
| | - Roberta Bussolino
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 Bis, 10126, Turin, Italy
| | - Claudia Gastaldo
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 Bis, 10126, Turin, Italy
| | - Marta Castagnotto
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 Bis, 10126, Turin, Italy
| | - Fortunato Paolo D'Ancona
- Epidemiology, Biostatistics and Mathematical Modeling Unit (EPI), Department of Infectious Diseases, Istituto Superiore Di Sanità (ISS), Viale Regina Elena 299, 00161, Rome, Italy
| | - Carla Maria Zotti
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 Bis, 10126, Turin, Italy
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Ruef M, Emonet S, Merglen A, Dewez JE, Obama BM, Catho G, Andrey DO, Kowalski M, Harbarth S, Combescure C, Wagner N, Galetto-Lacour A. Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 70:102508. [PMID: 38500839 PMCID: PMC10945212 DOI: 10.1016/j.eclinm.2024.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Background The increasing resistance of Enterobacterales to third-generation cephalosporins and carbapenems in sub-Saharan Africa (SSA) is a major public health concern. We did a systematic review and meta-analysis of studies to estimate the carriage prevalence of Enterobacterales not susceptible to third-generation cephalosporins or carbapenems among paediatric populations in SSA. Methods We performed a systematic literature review and meta-analysis of cross-sectional and cohort studies to estimate the prevalence of childhood (0-18 years old) carriage of extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) or carbapenem-resistant Enterobacterales (CRE) in SSA. Medline, EMBASE and the Cochrane Library were searched for studies published from 1 January 2005 to 1 June 2022. Studies with <10 occurrences per bacteria, case reports, and meta-analyses were excluded. Quality and risk of bias were assessed using the Newcastle-Ottawa scale. Meta-analyses of prevalences and odds ratios were calculated using generalised linear mixed-effects models. Heterogeneity was assessed using I2 statistics. The protocol is available on PROSPERO (CRD42021260157). Findings Of 1111 studies examined, 40 met our inclusion criteria, reporting on the carriage prevalence of Enterobacterales in 9408 children. The pooled carriage prevalence of ESCR-E was 32.2% (95% CI: 25.2%-40.2%). Between-study heterogeneity was high (I2 = 96%). The main sources of bias pertained to participant selection and the heterogeneity of the microbiological specimens. Carriage proportions were higher among sick children than healthy ones (35.7% vs 16.9%). The pooled proportion of nosocomial acquisition was 53.8% (95% CI: 32.1%-74.1%) among the 922 children without ESCR-E carriage at hospital admission. The pooled odds ratio of ESCR-E carriage after antibiotic treatment within the previous 3 months was 3.20 (95% CI: 2.10-4.88). The proportion of pooled carbapenem-resistant for Enterobacterales was 3.6% (95% CI: 0.7%-16.4%). Interpretation This study suggests that ESCR-E carriage among children in SSA is frequent. Microbiology capacity and infection control must be scaled-up to reduce the spread of those multidrug-resistant microorganisms. Funding There was no funding source for this study.
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Affiliation(s)
- Micaela Ruef
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephane Emonet
- Division of Infectious Diseases, Hospital of Valais, Sion, and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud Merglen
- Division of General Paediatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Juan Emmanuel Dewez
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
| | - Basilice Minka Obama
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Regional Hospital Centre for Ebolowa, Cameroon
| | - Gaud Catho
- Infectious Diseases Division, Central Institute, Hospital of Valais, Switzerland
- Infection Control Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Diego O. Andrey
- Division of Infectious Diseases, Department of Medicine and Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Morgane Kowalski
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme and World Health Organization Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Combescure
- Centre for Clinical Research, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noémie Wagner
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Paediatric Emergency Medicine, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Gastaldi S, Festa MG, Nieddu A, Zavagno G, Cau E, Barbieri C, Beccaria E, D'Ancona F. Identification of essential contents and a standard framework for the development of an Infection Prevention and Control manual for healthcare facilities: A scoping review. Am J Infect Control 2024; 52:358-364. [PMID: 37689122 DOI: 10.1016/j.ajic.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Several international organizations have outlined the components of infection prevention and control (IPC) programs. To successfully implement an IPC program, hospital staff may adopt a manual that provides support for implementing the IPC measures, even requiring significant efforts. This study aims to identify essential aspects and develop a standardized structure for an IPC manual. The IPC manual framework can be customized and utilized by any health care facility, thereby facilitating adherence to international and national legislation. METHODS The study was conducted using the Joanna Briggs Institute methodology for scoping reviews. Reporting followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews standard. The search for evidence was performed on PubMed and Web of Science. Methodological quality was evaluated blindly by 2 reviewers using the Critical Appraisal Skills Program checklist. RESULTS Nineteen papers were included in the review. Data extraction considered the most recent guidelines and the categorization into the 8 Core Components established by the World Health Organization. Through the literature review, the essential elements and challenges of an IPC hospital manual were identified, and a framework was proposed. CONCLUSIONS By incorporating these essential elements into their IPC manual, health care facilities can establish a robust IPC framework. A potential future development stemming from this work could involve the creation of a standardized national IPC manual tailored for hospital settings.
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Affiliation(s)
- Silvana Gastaldi
- National Association of Nurses for Prevention of Hospital Infections (ANIPIO), Bologna, Italy.
| | | | - Alma Nieddu
- HAI Group Contact, Hospital and Territory Clinical Government Operating Unit, USL Parma, Parma, Italy
| | - Giulia Zavagno
- Sant'Antonio Hospital, San Daniele del Friuli (ASUFC-Azienda Sanitaria Universitaria Friuli Centrale), Udine, Italy
| | - Ennio Cau
- Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Catania, Italy
| | - Corinna Barbieri
- AULSS 3 Serenissima, Medical Department Ospedale dell'Angelo - Mestre, Venice, Italy
| | | | - Fortunato D'Ancona
- Department of Communicable Diseases, Istituto Superiore di Sanità, Rome, Italy
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Chen N, Li S, Kuang Z, Gong T, Zhou W, Wang Y. Identifying a competency improvement strategy for infection prevention and control professionals: A rapid systematic review and cluster analysis. HEALTH CARE SCIENCE 2024; 3:53-66. [PMID: 38939168 PMCID: PMC11080890 DOI: 10.1002/hcs2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 06/29/2024]
Abstract
Remarkable progress has been made in infection prevention and control (IPC) in many countries, but some gaps emerged in the context of the coronavirus disease 2019 (COVID-19) pandemic. Core capabilities such as standard clinical precautions and tracing the source of infection were the focus of IPC in medical institutions during the pandemic. Therefore, the core competences of IPC professionals during the pandemic, and how these contributed to successful prevention and control of the epidemic, should be studied. To investigate, using a systematic review and cluster analysis, fundamental improvements in the competences of infection control and prevention professionals that may be emphasized in light of the COVID-19 pandemic. We searched the PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases for original articles exploring core competencies of IPC professionals during the COVID-19 pandemic (from January 1, 2020 to February 7, 2023). Weiciyun software was used for data extraction and the Donohue formula was followed to distinguish high-frequency technical terms. Cluster analysis was performed using the within-group linkage method and squared Euclidean distance as the metric to determine the priority competencies for development. We identified 46 studies with 29 high-frequency technical terms. The most common term was "infection prevention and control training" (184 times, 17.3%), followed by "hand hygiene" (172 times, 16.2%). "Infection prevention and control in clinical practice" was the most-reported core competency (367 times, 34.5%), followed by "microbiology and surveillance" (292 times, 27.5%). Cluster analysis showed two key areas of competence: Category 1 (program management and leadership, patient safety and occupational health, education and microbiology and surveillance) and Category 2 (IPC in clinical practice). During the COVID-19 pandemic, IPC program management and leadership, microbiology and surveillance, education, patient safety, and occupational health were the most important focus of development and should be given due consideration by IPC professionals.
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Affiliation(s)
- Nuo Chen
- School of Public Health and ManagementHubei University of MedicineShiyanChina
| | - Shunning Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of OptometryTianjin Medical University Eye HospitalTianjinChina
| | - Zhengling Kuang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeTianjin Institutes of Health ScienceTianjinChina
| | - Ting Gong
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical SciencesFudan UniversityShanghaiChina
| | - Weilong Zhou
- Department of Infection Control and Prevention, West China Second University HospitalSichuan UniversityChengduChina
| | - Ying Wang
- Department of Infection Prevention and Control ManagementZhongnan Hospital of Wuhan UniversityWuhanChina
- Hubei Engineering Center for Infectious Disease Prevention, Control and TreatmentWuhanChina
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Özçelik E, Lerouge A, Cecchini M, Cassini A, Allegranzi B. Estimating the return on investment of selected infection prevention and control interventions in healthcare settings for preparing against novel respiratory viruses: modelling the experience from SARS-CoV-2 among health workers. EClinicalMedicine 2024; 68:102388. [PMID: 38273892 PMCID: PMC10809104 DOI: 10.1016/j.eclinm.2023.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024] Open
Abstract
Background Insufficient infection prevention and control (IPC) practices in healthcare settings increase the SARS-CoV-2 infection risk among health workers. This study aimed to examine the level of preparedness for future outbreaks. Methods We modelled the experience from the COVID-19 pandemic and assessed the return on investment on a global scale of three IPC interventions to prevent SARS-CoV-2 infections among health workers: enhancing hand hygiene; increasing access to personal protective equipment (PPE); and combining PPE, with a scale-up of IPC training and education (PPE+). Our analysis covered seven geographic regions, representing a combination of World Health Organization (WHO) regions and the Organisation for Economic Co-operation and Development (OECD) countries. Across all regions, we focused on the first 180 days of the pandemic in 2020 between January 1st and June 30th. We used an extended version of a susceptible-infectious-recovered compartmental model to measure the level of IPC preparedness. Data were sourced from the WHO COVID-19 Detailed Surveillance Database. Findings In all regions, the PPE + intervention would have averted the highest number of new SARS-CoV-2 infections compared to the other two interventions, ranging from 6562 (95% CI 4873-8779) to 38,170 (95% CI 33,853-41,901) new infections per 100,000 health workers in OECD countries and in the South-East Asia region, respectively. Countries in the South-East Asia region and non-OECD countries in the Western Pacific region were poised to achieve the highest level of savings by scaling up the PPE + intervention. Interpretation Our results not only support efforts to make an economic case for continuing investments in IPC interventions to halt the COVID-19 pandemic and protect health workers, but could also contribute to efforts to improve preparedness for future outbreaks. Funding This work was funded by WHO, with support by the German Federal Ministry of Health for the WHOResearch and Development Blueprint for COVID-19.
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Affiliation(s)
- Ece Özçelik
- Organisation for Economic Co-operation and Development, 2 Rue André-Pascale, 75016, Paris, France
| | - Aliénor Lerouge
- Organisation for Economic Co-operation and Development, 2 Rue André-Pascale, 75016, Paris, France
| | - Michele Cecchini
- Organisation for Economic Co-operation and Development, 2 Rue André-Pascale, 75016, Paris, France
| | - Alessandro Cassini
- Infection Prevention and Control Unit, Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Benedetta Allegranzi
- Health Emergencies Programme, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland
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Shehu N, Okwor T, Dooga J, Wele A, Cihambanya L, Okonkon I, Gadanya M, Sebastine J, Okoro B, Okafor O, Abejegah C, Oragunye D, Olayinka A. Train-the-trainers intervention for national capacity building in infection prevention and control for COVID-19 in Nigeria. Heliyon 2023; 9:e21978. [PMID: 38034678 PMCID: PMC10682610 DOI: 10.1016/j.heliyon.2023.e21978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Background The first case of COVID-19 in Nigeria was reported on February 27, 2020, and over time, spread across the country leading to many healthcare worker infections. The risk of transmission of COVID-19 within healthcare facilities makes it necessary to establish infection prevention and control measures. The World Health Organisation supported the Nigeria Centre for Disease Control to conduct a train-the-trainers workshop on infection prevention and control for key healthcare workers across Nigeria. Aim/Objectives This study aims to describe the process and results of train-the-trainers as an intervention for national capacity building in infection prevention and control for COVID-19 among healthcare workers in Nigeria. Methods Eight-hour sessions were held over three days with face-to-face instruction and practical hands-on experience in April 2020. A total of 61 healthcare workers participated across the six geographic zones of Nigeria: North Central, North East, North West, South West, South East, and South South. The training included slide presentations, case-based scenarios, and practical hands-on sessions with plenary discussions. Pre- and post-test assessments were used to evaluate knowledge of COVID-19, triage, and infection prevention and control among healthcare workers. Finding/Results 69 % (42) of the participants were male 31 % (19) were female, and the majority (67 %) were medical doctors. Others attending were nurses or health administrators. Of the 70 % (26) of the states with existing infection prevention and control structures within the COVID emergency response, only 40 % were functional. The average percentage of pre-test and post-test scores were 60.8 ± 13.4 and 67.8 ± 9 0.3 respectively, showing a statistically significant difference (p > 0.001) in trainee knowledge. Additionally, 70 % of participants evaluated the training workshop as "satisfactory" or higher in training format, relevance for daily clinical work, active participation, learning new concepts, and logistics. Conclusion Nationwide infection prevention and control training is feasible during a national health crisis. Infection prevention and control is cardinal in the containment of epidemic-prone diseases like COVID-19 and is invaluable in the prevention of healthcare-associated infections in healthcare settings.
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Affiliation(s)
- N.Y. Shehu
- West African Center for Emerging Infectious Diseases (WAC-EID), Jos University Teaching Hospital, Nigeria
| | - T. Okwor
- Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria
| | - J. Dooga
- Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria
| | - A.M. Wele
- University of Port Harcourt Teaching Hospital, Nigeria
| | - L. Cihambanya
- World Health Organization AFRO Regional Office, Brazzaville, People’s Republic of Congo
| | | | - M. Gadanya
- Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria
| | - J. Sebastine
- Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria
| | - B. Okoro
- Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria
| | - O. Okafor
- Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria
| | | | - D. Oragunye
- Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria
| | - A. Olayinka
- World Health Organization AFRO Regional Office, Brazzaville, People’s Republic of Congo
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Moghnieh R, Al-Maani AS, Berro J, Ibrahim N, Attieh R, Abdallah D, Al-Ajmi J, Hamdani D, Abdulrazzaq N, Omar A, Al-Khawaja S, Al-Abadla R, Al-Ratrout S, Gharaibeh M, Abdelrahim Z, Azrag H, Amiri KM, Berry A, Hagali B, Kadhim J, Al-Shami H, Khan MA, Husni R, Heweidy I, Zayed B. Mapping of infection prevention and control education and training in some countries of the World Health Organization's Eastern Mediterranean Region: current situation and future needs. Antimicrob Resist Infect Control 2023; 12:90. [PMID: 37667340 PMCID: PMC10478460 DOI: 10.1186/s13756-023-01299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND A strong understanding of infection prevention and control (IPC) procedures and comprehensive training among healthcare workers is essential for effective IPC programs. These elements play a crucial role in breaking the chain of nosocomial infections by preventing the transmission of resistant organisms to patients and staff members. This study mapped the components of IPC education and training across various member states of the World Health Organization (WHO) in the Eastern Mediterranean Region (EMR) at national, academic, and healthcare institutional levels. METHODS A self-administered structured online questionnaire based on the WHO "Core Component 3" of IPC programs at the national and acute healthcare facility levels (IPC education and training) was given to national IPC focal persons in each of the WHO's EMR countries between February and March 2023. RESULTS From 14 of the 22 countries,15 IPC persons participated in the survey. Most countries have scattered nonhomogeneous IPC education programs in human health undergraduate majors without considering it a standalone module. Academic institutions are rarely involved, and elaborate and predefined undergraduate IPC education programs provided by universities are present in 21.4% of the countries. In 71.4% of these countries, postgraduate training targeting IPC professionals is provided by national IPC teams, primarily based on national IPC guidelines developed with the aid of the WHO. Generally, healthcare worker training relies heavily on healthcare facilities in 92.9% of the countries, rather than on a national training program. In 42.9% of the countries, practicing IPC physicians are not necessarily specialists of infectious disease or medical microbiologists and IPC nurses are not required to specialize in IPC. However, nonspecialized IPC professionals are expected to undergo training upon employment and before beginning practice. Nongovernmental organizations such as the WHO play a significant role in IPC education and in supporting national IPC authorities in establishing national IPC guidelines, as it is the case in 78.6% of these countries. CONCLUSION Clear disparities exist in IPC education and training across different countries in the WHO's EMR. Establishing a regional scientific network specializing in IPC would help bridge the existing gaps and standardize this education within individual countries and across countries in the region. This region needs to establish IPC certification standards and standardized education curricula.
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Affiliation(s)
- Rima Moghnieh
- Department of Internal Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
- Department of Internal Medicine, Division of Infectious Diseases, Lebanese American University Medical Center, Beirut, Lebanon.
| | - Amal Saif Al-Maani
- Senior Consultant in Pediatric Infectious Diseases & Infection Prevention & Control, Directorate General for Disease Surveillance & Control, Ministry of Health, Muscat, Oman
| | - Jana Berro
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Nour Ibrahim
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Rana Attieh
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Jameela Al-Ajmi
- Senior Consultant Infectious Diseases, Executive Director Infection Prevention & Control, Ministry of Public Health, Doha, Qatar
| | - Dhouha Hamdani
- Infection Control Specialist, Quality Improvement & Patient Safety, Ministry of Public Health, Doha, Qatar
| | - Najiba Abdulrazzaq
- Al Baraha Hospital, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Abeer Omar
- Surveillance Department, Infection Control Directorate, National Focal person of AMR and Head, Ministry of Health, Kuwait City, Kuwait
| | - Safa Al-Khawaja
- Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | - Rami Al-Abadla
- Infection Control Consultant, Director of Safety & Infection Prevention & Control Unit, Gaza, Palestine
| | | | - Mohammad Gharaibeh
- Infection Prevention & Control Program, Ministry of Health, Amman, Jordan
| | - Zakaria Abdelrahim
- Infection Preventionist, Infection Control Office, Jordan University Hospital, Amman, Jordan
| | - Hiba Azrag
- Development and Accreditation, Federal Ministry of Health, Khartoum, Sudan
| | - Karima Mayar Amiri
- General Directorate of Curative Medicine, Ministry of Public Health, Kabul, Afghanistan
| | - Atika Berry
- Department of Preventive Medicine, Ministry of Public Health, Beirut, Lebanon
| | - Bashar Hagali
- General Assembly of Damascus Hospital, Ministry of Health, Damascus, Syrian Arab Republic
| | - Jamal Kadhim
- Infection Prevention & Control Program, Ministry of Health, Baghdad, Iraq
| | - Huda Al-Shami
- Infection Prevention & Control Program, Ministry of Health, Sanaa, Yemen
| | - Mumtaz Ali Khan
- Centers for Disease Control, NIH and Coordinator FELTP, Islamabad, Pakistan
| | - Roula Husni
- Department of Internal Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Iman Heweidy
- Antimicrobial Resistance/Infection Prevention & Control Unit, Infection Prevention & Control Consultant, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Bassim Zayed
- Department of Communicable Disease, Antimicrobial Resistance/Infection Prevention & Control Unit, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
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15
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Margao S, Fofanah BD, Thekkur P, Kallon C, Ngauja RE, Kamara IF, Kamara RZ, Tengbe SM, Moiwo M, Musoke R, Fullah M, Kanu JS, Lakoh S, Kpagoi SSTK, Kamara KN, Thomas F, Mannah MT, Katawera V, Zachariah R. Improvement in Infection Prevention and Control Performance Following Operational Research in Sierra Leone: A Before (2021) and After (2023) Study. Trop Med Infect Dis 2023; 8:376. [PMID: 37505672 PMCID: PMC10383112 DOI: 10.3390/tropicalmed8070376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is crucial to limit health care-associated infections and antimicrobial resistance. An operational research study conducted in Sierra Leone in 2021 reported sub-optimal IPC performance and provided actionable recommendations for improvement. METHODS This was a before-and-after study involving the national IPC unit and all twelve district-level secondary public hospitals. IPC performance in 2021 (before) and in 2023 (after) was assessed using standardized World Health Organization checklists. IPC performance was graded as: inadequate (0-25%), basic (25.1-50%), intermediate (50.1-75%), and advanced (75.1-100%). RESULTS The overall IPC performance in the national IPC unit moved from intermediate (58%) to advanced (78%), with improvements in all six core components. Four out of six components achieved advanced levels when compared to the 2021 levels. The median score for hospitals moved from basic (50%) to intermediate (59%), with improvements in six of eight components. Three of four gaps identified in 2021 at the national IPC unit and four of seven at hospitals had been addressed by 2023. CONCLUSIONS The study highlights the role of operational research in informing actions that improved IPC performance. There is a need to embed operational research as part of the routine monitoring of IPC programs.
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Affiliation(s)
- Senesie Margao
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Christiana Kallon
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ramatu Elizabeth Ngauja
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rugiatu Zainab Kamara
- US Centre for Disease Control and Prevention Country Office, Freetown 00232, Sierra Leone;
| | - Sia Morenike Tengbe
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Matilda Moiwo
- Republic of Sierra Leone Armed Forces, HIV/AIDS/TB Control Program Coordinator, 34th Military Hospital, Wilberforce, Western Area Urban 00232, Sierra Leone;
| | - Robert Musoke
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Mary Fullah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Satta Sylvia T. K. Kpagoi
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Fawzi Thomas
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 047235, Sierra Leone
| | - Margaret Titty Mannah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Victoria Katawera
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva, Switzerland;
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Tesfaye AH, Mekonnen TH, Desye B, Yenealem DG. Infection Prevention and Control Practices and Associated Factors Among Healthcare Cleaners in Gondar City: An Analysis of a Cross-Sectional Survey in Ethiopia. Risk Manag Healthc Policy 2023; 16:1317-1330. [PMID: 37492624 PMCID: PMC10363670 DOI: 10.2147/rmhp.s419110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
Background Healthcare-associated infections are a global health problem and are more prevalent in developing countries such as Ethiopia, but there is a paucity of research on the infection prevention practices of cleaning staff. Therefore, this study aimed to assess infection prevention and control practices and associated factors among cleaners working in healthcare facilities in Gondar City, Ethiopia. Methodology A cross-sectional survey was conducted among healthcare cleaning staff from May to June 2022. A total of 428 cleaners took part in the survey. Data were collected using a semi-structured interviewer-administered questionnaire. The data were entered into EpiData version 4.6 and analyzed using Stata version 14 software. A multivariable binary logistic regression analysis was used to ascertain the significance of associations at <0.05 p-value and the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results Among the 390 study participants included, 294 (75.1%) were female. Of the surveyed participants, 186 (47.7%) had good knowledge of infection prevention and control practices. This study revealed that out of the 390 healthcare cleaners, 204 (52.3%) had good infection prevention and control practices with 52.3% [95% CI (47.2, 56.4)]. Good knowledge of infection prevention and control [AOR: 1.56, 95% CI (1.03, 2.37)] and the availability of infection prevention and control guidelines in the workplace [AOR: 1.54, 95% CI (1.01, 2.33)] were significant factors associated with infection prevention and control practice. Conclusion The present study found that almost half of the healthcare cleaners had poor IPC practices. The finding underlines the importance of good IPC knowledge and the accessibility of IPC guidelines to improve IPC practices among healthcare cleaning staff. The findings of this study also highlight that behavioral change interventions and paying attention, particularly to nonclinical staff such as cleaners in health care settings, are critical to reducing infection in health care settings.
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Affiliation(s)
- Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Hambisa Mekonnen
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belay Desye
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Dawit Getachew Yenealem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Yates TA, Karat AS, Bozzani F, McCreesh N, MacGregor H, Beckwith PG, Govender I, Colvin CJ, Kielmann K, Grant AD. Time to change the way we think about tuberculosis infection prevention and control in health facilities: insights from recent research. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e117. [PMID: 37502244 PMCID: PMC10369445 DOI: 10.1017/ash.2023.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/29/2023]
Abstract
In clinical settings where airborne pathogens, such as Mycobacterium tuberculosis, are prevalent, they constitute an important threat to health workers and people accessing healthcare. We report key insights from a 3-year project conducted in primary healthcare clinics in South Africa, alongside other recent tuberculosis infection prevention and control (TB-IPC) research. We discuss the fragmentation of TB-IPC policies and budgets; the characteristics of individuals attending clinics with prevalent pulmonary tuberculosis; clinic congestion and patient flow; clinic design and natural ventilation; and the facility-level determinants of the implementation (or not) of TB-IPC interventions. We present modeling studies that describe the contribution of M. tuberculosis transmission in clinics to the community tuberculosis burden and economic evaluations showing that TB-IPC interventions are highly cost-effective. We argue for a set of changes to TB-IPC, including better coordination of policymaking, clinic decongestion, changes to clinic design and building regulations, and budgeting for enablers to sustain implementation of TB-IPC interventions. Additional research is needed to find the most effective means of improving the implementation of TB-IPC interventions; to develop approaches to screening for prevalent pulmonary tuberculosis that do not rely on symptoms; and to identify groups of patients that can be seen in clinic less frequently.
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Affiliation(s)
- Tom A. Yates
- Division of Infection and Immunity, Faculty of Medicine, University College London, London, UK
| | - Aaron S. Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- The Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | | | - Nicky McCreesh
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hayley MacGregor
- The Institute of Development Studies, University of Sussex, Brighton, UK
| | - Peter G. Beckwith
- Department of Medicine, University of Cape Town, Rondebosch, South Africa
| | - Indira Govender
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karina Kielmann
- The Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, DurbanSouth Africa
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18
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Deryabina A, Aiypkhanova A, Juvashev A, Alimbetov K, Tekebayev K, Kassa G, Howard AA. Core components of infection prevention and control programs at the facility level in Kazakhstan: key challenges and opportunities. Antimicrob Resist Infect Control 2023; 12:59. [PMID: 37349829 PMCID: PMC10286477 DOI: 10.1186/s13756-023-01264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Kazakhstan is developing a National Roadmap to strengthen its Infection Prevention and Control (IPC), but until recently has lacked a country-wide facility-level assessment of IPC performance gaps. METHODS In 2021, the World Health Organization (WHO)'s IPC Core Components and Minimal Requirements were assessed at 78 randomly selected hospitals across 17 administrative regions using adapted WHO tools. The study included site assessments, followed by structured interviews with 320 hospital staff, validation observations of IPC practices, and document reviews. RESULTS All hospitals had at least one dedicated IPC staff member, 76% had IPC staff with any formal IPC training; 95% established an IPC committee and 54% had an annual IPC workplan; 92% had any IPC guidelines; 55% conducted any IPC monitoring in the past 12 months and shared the results with facility staff, but only 9% used monitoring data for improvements; 93% had access to a microbiological laboratory for HAI surveillance, but HAI surveillance with standardized definitions and systematic data collection was conducted in only one hospital. Adequate bed spacing of at least 1 m in all wards was maintained in 35% of hospitals; soap and paper towels were available at the hand hygiene stations in 62% and 38% of hospitals, respectively. CONCLUSIONS Existing IPC programs, infrastructure, IPC staffing, workload and supplies present within hospitals in Kazakhstan allow for implementation of effective IPC. Development and dissemination of IPC guidelines based on the recommended WHO IPC core components, improved IPC training system, and implementation of systematic monitoring of IPC practices will be important first steps towards implementing targeted IPC improvement plans in facilities.
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Affiliation(s)
- Anna Deryabina
- Mailman School of Public Health, ICAP at Columbia University, 34/1 Samal-3, 050051, Almaty, Kazakhstan.
| | | | - Almat Juvashev
- Mailman School of Public Health, ICAP at Columbia University, 34/1 Samal-3, 050051, Almaty, Kazakhstan
| | - Kuanysh Alimbetov
- National Centre for Public Health of the Ministry, Astana, Kazakhstan
| | - Kanat Tekebayev
- National Centre for Public Health of the Ministry, Astana, Kazakhstan
| | - Getachew Kassa
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| | - Andrea A Howard
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
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Kessy SJ, Gon G, Alimi Y, Bakare WA, Gallagher K, Hornsey E, Sithole L, Onwekwe EVC, Okwor T, Sekoni A, Vahanian A, Vorndran A, Niyoyitungira T, Raji T, Ihekweazu C, Abdulaziz M, Ogunsola F. Training a Continent: A Process Evaluation of Virtual Training on Infection Prevention and Control in Africa During COVID-19. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00051. [PMID: 37116932 PMCID: PMC10141425 DOI: 10.9745/ghsp-d-22-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/14/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Strengthening infection prevention and control (IPC) capacity was identified as a key intervention to prepare African Union member states to curb the COVID-19 pandemic. As part of the Africa Taskforce for Coronavirus, which helped implement the Africa Joint Continental Strategy for COVID-19 Outbreak response, the IPC Technical Working Group (IPC TWG) was convened to coordinate the development of IPC core components for preparedness, response, and recovery from COVID-19. As part of the IPC TWG's work, the Africa Centres for Disease Control and Prevention, in collaboration with the Infection Control Africa Network, delivered virtual IPC training sessions targeted to African Union member states. We aimed to undertake a process evaluation of this training to inform and improve both ongoing and future programming. METHODS The scope of the evaluation was agreed upon through discussion with the training organizers and advisory members and a design workshop. A mixed-methods approach was used; data collection was partly prospective and partly retrospective due to the rapid start of some of the training activities. Existing available data included: usage analytics, the content of questions posed during the webinar and community of practice, and participant feedback survey results. In addition, in-depth qualitative interviews were conducted with a sample of webinar participants. RESULTS The rapid development of this training was efficient and responsive. The training reached more than 3,000 participants across the 2 rounds, but the numbers varied substantially by location. Participants engaged well during the question period during each webinar, but the asynchronous community of practice was less utilized during the evaluation time frame. Many participants appreciated the African focus of the webinars and gave positive feedback on the practical and context-specific content. CONCLUSIONS The move toward online training provides an important opportunity to improve IPC across the African continent.
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Affiliation(s)
| | - Giorgia Gon
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yewande Alimi
- Africa Centres for Disease Control, Addis Ababa, Ethiopia
| | | | | | | | - Lizzi Sithole
- Infection Control Africa Network, Cape Town, South Africa
| | | | - Tochi Okwor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Anna Vorndran
- Infection Control Africa Network, Cape Town, South Africa
| | | | - Tajudeen Raji
- Africa Centres for Disease Control, Addis Ababa, Ethiopia
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20
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Chen X, Zhang P, Zhang R, Li S, Cao R, Hu F, Jin YH, Lin L, Cai L, Feng B, Zhang C, Wang X. Development and validation of the regarding infection prevention and control among environmental service workers on knowledge, attitudes, practise, and experience questionnaire. Front Public Health 2023; 10:1062199. [PMID: 36699941 PMCID: PMC9869485 DOI: 10.3389/fpubh.2022.1062199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose This study aimed to develop and test the validity and reliability of the Knowledge, Attitudes, Practise, and Experience regarding Infection Prevention and Control-associated Questionnaire for environmental service workers. Design This study was a development and validation study of a questionnaire using multiple methods, including literature review, questionnaire survey, and Delphi technique. Methods Phase I of the study entailed the development of items through an extensive literature review and two round Delphi process with 15 experts specialised in infection prevention and control, environmental service worker management, or scale construction to examine the content validity of the questionnaire. Phase II involved administering the questionnaire to a convenience sample of 1,176 environmental service workers from the public hospital from 13 provinces in China to evaluate its construct validity and reliability. Findings In the two rounds of Delphi consultation, the recovery rate were 93.75 and 100%. Moreover, the expert authority coefficient was 0.93, and the coordination coefficients of expert opinions in the first round were as follows: correlation of 0.204 and importance of 0.249 for the first-level index; correlation of 0.128 and importance of 0.142 for the secondary index. In round two, the coordination coefficients of expert opinions were as follows: correlation of 0.221 and importance of 0.221 for the first-level indicators; correlation of 0.096 and importance of 0.101 for the secondary index. The results for the index were P < 0.05 for the two rounds. The pilot survey shows the instrument was excellent content validity (S-CVI/Ave = 0.989). The overall internal consistency was excellent (Cronbach's α = 0.967). The questionnaire ultimately comprised four first-level indices (knowledge, attitudes, practise, and experience) and 49 second-level indices. Conclusion The Questionnaire demonstrated good reliability and validity and is effective in measuring levels of infection prevention and control-related knowledge, attitudes, practise, and experience among environmental service workers. It will provide a tool for future national investigations of the current infection prevention and control situation among environmental service workers. Future research should explore determinants of environmental service workers' knowledge, attitudes, practise, and experience and associations between infection prevention and control knowledge, attitudes, practises, and experience.
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Affiliation(s)
- Xiaohang Chen
- Institute of Hepatobiliary Diseases of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pan Zhang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ruhan Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shuting Li
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui Cao
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fen Hu
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Engineering Center for Infectious Disease Prevention, Control, and Treatment, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Likai Lin
- Institute of Hospital Management, Wuhan University, Wuhan, China
| | - Lin Cai
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bilong Feng
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Engineering Center for Infectious Disease Prevention, Control, and Treatment, Wuhan, China,Bilong Feng ✉
| | - Chunhua Zhang
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China,Chunhua Zhang ✉
| | - Xinghuan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China,Research Center of Wuhan for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China,*Correspondence: Xinghuan Wang ✉
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21
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Robinson J, Price L, Otter J, Burnett E. Designing an optimal infection prevention service: Part 2. J Infect Prev 2023; 24:11-22. [PMID: 36644523 PMCID: PMC9834426 DOI: 10.1177/17571774221127573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/04/2022] [Indexed: 01/18/2023] Open
Abstract
Background The importance of infection prevention and control (IPC) services to prevent threats from healthcare-associated infections and improve the quality of healthcare delivery is undeniable. However, IPC services across the UK and Ireland have substantial variability in terms of team structures and delivery models. Aim The aim of this study was to define an optimal IPC service in different contexts and settings within the United Kingdom and Ireland. Methods This mixed methods study adopted discussion huddles with IPC teams to explore various components of IPC programmes and services. A Nominal Group technique was then undertaken to achieve a group consensus of what an optimal infection prevention service should look like. Results Five discussion huddles were conducted which included 53 participants in total. Key themes arising were IPC Service Priorities, IPC Service Enablers for Success, and Necessary Skills and Expertise Required for Delivering an Effective IPC Service. For the nominal technique, 45 responses were identified which were determining the key priorities for an effective IPC service and 69 responses for establishing key enablers for success. Discussion These findings supported the development of a conceptual model for designing an optimal infection prevention service, which can be used to develop IPC services at an international, national, regional and local level. A focus is required around implementation of these highlighted enablers, so are effectively embedded into infection prevention and control services, and wider healthcare settings.
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Affiliation(s)
- Jude Robinson
- Infection Prevention and control, NHS England and Improvement, Midlands, UK
| | - Lesley Price
- School of Health and life sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jon Otter
- Infection Prevention and control, Guy’s and St Thomas NHS, London, UK
| | - Emma Burnett
- Fatima College of Health Sciences, Al Ain, United Arab Emirates
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22
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Arns B, Agani CAJO, Sesin GP, Horvath JDC, Fogazzi DV, Romeiro Silva FK, Costa LS, Pereira AJ, Nassar Junior AP, Cavalcanti BT, Dietrich C, Veiga VC, Catarino DG, Cheno MY, Biasi A, Ferronatto BR, Bassetti BR, Fernandes CCF, Deutschendorf C, Grion CMC, Vidal CFDL, de Oliveira CD, Caser EB, Boschi E, Silva EM, Pizzol FD, Urbano HCDA, Silva I, Maia IS, Rego LRDM, Oliveira LP, Tavares MB, Dracoulakis MDA, Bainy MP, Golin NA, Tomba PO, Kurtz PMP, Foernges RB, Prestes RM, de Melo RMV, Da Silva RR, Toledo TGP, Lima VP, Fernandes VDF, Lovato WJ, Zavascki AP. Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e79. [PMID: 37179767 PMCID: PMC10173283 DOI: 10.1017/ash.2023.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 05/15/2023]
Abstract
Objective Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. Methods This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. Results In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. Conclusions In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.
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Affiliation(s)
- Beatriz Arns
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Infectious Diseases Service, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Author for correspondence: Beatriz Arns, MD, Rua Ramiro Barcelos, 630, sala 815. Bairro Moinhos de Vento, Porto Alegre - RS, Brazil. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emerson Boschi
- Hospital Geral de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | | | | | | | - Iany Silva
- Santa Casa de Misericórdia de São João Del Rei, São João del Rei, Minas Gerais, Brazil
| | - Israel Silva Maia
- HCor Research Institute, São Paulo, Brazil
- Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil
| | | | | | | | | | - Marina Peres Bainy
- Hospital Escola Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Pablo Oscar Tomba
- Hospital do Cancer Barretos, Unidade Jales, Jales, São Paulo, Brazil
| | | | | | | | | | | | | | - Valéria Paes Lima
- Hospital Universitário de Brasília, Brasília, Federal District, Brazil
| | | | - Wilson José Lovato
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Prehn Zavascki
- Infectious Diseases Service, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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23
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Puro V, Coppola N, Frasca A, Gentile I, Luzzaro F, Peghetti A, Sganga G. Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement. Antimicrob Resist Infect Control 2022; 11:87. [PMID: 35725502 PMCID: PMC9207866 DOI: 10.1186/s13756-022-01125-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/07/2022] [Indexed: 01/04/2023] Open
Abstract
Healthcare-associated infections (HAIs) represent a relevant problem for all healthcare facilities, because they involve both the care aspect and the economic management of the hospital. Most HAIs are preventable through effective Infection Prevention and Control (IPC) measures. Implementation and improvement of IPC programs are critical to reducing the impact of these infections and the spread of multi-resistant microorganisms. The purpose of this Expert Opinion statement was to provide a practical guide for healthcare organizations, physicians, and nursing staff on the optimal implementation of the core components of Infection Prevention and Control, as recommended by a board of specialists after in-depth discussion of the available evidence in this field. According to their independent suggestions and clinical experiences, as well as evidence-based practices and literature review, this document provides a practical bundle of organizational, structural, and professional requirements necessary to promote, through multimodal strategies, the improvement of the quality and safety of care with respect to infectious risk in order to protect the patient, facilities, and healthcare providers.
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24
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Nomoto H, Saito H, Ishikane M, Gu Y, Ohmagari N, Pittet D, Kunishima H, Allegranzi B, Yoshida M. First nationwide survey of infection prevention and control among healthcare facilities in Japan: impact of the national regulatory system. Antimicrob Resist Infect Control 2022; 11:135. [PMID: 36352429 PMCID: PMC9647990 DOI: 10.1186/s13756-022-01175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Infection prevention and control (IPC) measures in Japan are facilitated by a financial incentive process at the national level, where facilities are categorized into three groups (Tier 1, Tier 2, or no financial incentive). However, its impact on IPC at the facility level using a validated tool has not been measured. METHODS A nationwide cross-sectional study was conducted from August 2019 to January 2020 to evaluate the situation of IPC programs in Japan, using the global IPC Assessment Framework (IPCAF) developed by the World Health Organization. Combined with the information on the national financial incentive system, the demographics of facilities and each IPCAF item were descriptively analyzed. IPCAF scores were analyzed according to the facility level of care and the national financial incentive system for IPC facility status, using Dunn-Bonferroni and Mann-Whitney U tests. RESULTS Fifty-nine facilities in Japan responded to the IPCAF survey: 34 private facilities (57.6%) and 25 public facilities (42.4%). Of these, 11 (18.6%), 29 (49.2%), and 19 (32.3%) were primary, secondary, and tertiary care facilities, respectively. According to the national financial incentive system for IPC, 45 (76.3%), 11 (18.6%), and three (5.1%) facilities were categorized as Tier 1, Tier 2, and no financial incentive system, respectively. Based on the IPCAF total score, more than half of the facilities were categorized as "Advanced" (n = 31, 55.3%), followed by "Intermediate" (n = 21, 37.5%). The IPCAF total score increased as the facility level of care increased, while no statistically significant difference was identified between the secondary and tertiary care facilities (p = 0.79). There was a significant difference between Tier 1 and Tier 2 for all core components and total scores. Core components 5 (multimodal strategies for implementation of IPC interventions) and 6 (monitoring/audit of IPC and feedback) were characteristically low in Japan with a median score of 65.0 (interquartile range 40.0-85.0) and 67.5 (interquartile range 52.5-87.5), respectively. CONCLUSIONS The national financial incentive system was associated with IPC programs at facility level in Japan. The current financial incentive system does not emphasize the multimodal strategy or cover monitoring/audit, and an additional systematic approach may be required to further promote IPC for more practical healthcare-associated infection prevention.
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Affiliation(s)
- Hidetoshi Nomoto
- grid.45203.300000 0004 0489 0290Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan ,grid.69566.3a0000 0001 2248 6943Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Hiroki Saito
- grid.8591.50000 0001 2322 4988Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland ,grid.412764.20000 0004 0372 3116Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine Yokohama Seibu Hospital, Kanagawa, Japan ,grid.45203.300000 0004 0489 0290AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- grid.45203.300000 0004 0489 0290Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan ,grid.45203.300000 0004 0489 0290AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiaki Gu
- grid.265073.50000 0001 1014 9130Department of Infectious Diseases, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Ohmagari
- grid.45203.300000 0004 0489 0290Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan ,grid.69566.3a0000 0001 2248 6943Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan ,grid.45203.300000 0004 0489 0290AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Didier Pittet
- grid.150338.c0000 0001 0721 9812Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hiroyuki Kunishima
- grid.412764.20000 0004 0372 3116Department of Infectious Diseases, St Marianna University School of Medicine, Kanagawa, Japan
| | - Benedetta Allegranzi
- grid.3575.40000000121633745Infection Prevention and Control Hub, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Masaki Yoshida
- grid.411898.d0000 0001 0661 2073Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Tokyo, Japan
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Harun MGD, Anwar MMU, Sumon SA, Hassan MZ, Haque T, Mah-E-Muneer S, Rahman A, Abdullah SAHM, Islam MS, Styczynski AR, Kaydos-Daniels SC. Infection prevention and control in tertiary care hospitals of Bangladesh: results from WHO infection prevention and control assessment framework (IPCAF). Antimicrob Resist Infect Control 2022; 11:125. [PMID: 36203207 PMCID: PMC9535892 DOI: 10.1186/s13756-022-01161-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) in healthcare settings is imperative for the safety of patients as well as healthcare providers. To measure current IPC activities, resources, and gaps at the facility level, WHO has developed the Infection Prevention and Control Assessment Framework (IPCAF). This study aimed to assess the existing IPC level of selected tertiary care hospitals in Bangladesh during the COVID-19 pandemic using IPCAF to explore their strengths and deficits. METHODS Between September and December 2020, we assessed 11 tertiary-care hospitals across Bangladesh. We collected the information from IPC focal person and/or hospital administrator from each hospital using the IPCAF assessment tool.. The score was calculated based on eight core components and was used to categorize the hospitals into four distinct IPC levels- Inadequate, Basic, Intermediate, and Advanced. Key performance metrics were summarized within and between hospitals. RESULTS The overall median IPCAF score was 355.0 (IQR: 252.5-397.5) out of 800. The majority (73%) of hospitals scored as 'Basic' IPC level, while only 18% of hospitals were categorized as 'Intermediate'. Most hospitals had IPC guidelines as well as environments, materials and equipments. Although 64% of hospitals had IPC orientation and training program for new employees, only 30% of hospitals had regular IPC training program for the staff. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs. Around 90% of hospitals did not have an active IPC monitoring and audit system. Half of the hospitals had inadequate staffing considering the workload. Bed occupancy of one patient per bed in all units was found in 55% of hospitals. About 73% of hospitals had functional hand hygiene stations, but sufficient toilets were available in only 37% of hospitals. CONCLUSION The majority of sampled tertiary care hospitals demonstrate inadequate IPC level to ensure the safety of healthcare workers, patients, and visitors. Quality improvement programs and feedback mechanisms should be implemented to strengthen all IPC core components, particularly IPC surveillance, monitoring, education, and training, to improve healthcare safety and resilience.
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Affiliation(s)
- Md Golam Dostogir Harun
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - Md Mahabub Ul Anwar
- Centers for Disease Control and Prevention (CDC), Bangladesh Country Office, Dhaka, Bangladesh
| | - Shariful Amin Sumon
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Tahmidul Haque
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Syeda Mah-E-Muneer
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | | | - Md Saiful Islam
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- University of New South Wales, Sydney, Australia
| | - Ashley R Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, 94305, USA
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Amoo OS, Tijani B, Onuigbo TI, Oraegbu JI, Kareithi DN, Obi JC, Adeniji ET, Dosunmu AA, Karera S, Filani T, Akinreni T, Ezike E, Owoseni K, Audu RA, Salako BL. Factors Affecting COVID-19 Testing Behaviours Among the Population in South Western Nigeria. Int J Public Health 2022; 67:1604993. [PMID: 36275434 PMCID: PMC9582156 DOI: 10.3389/ijph.2022.1604993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The objective of this study was to assess the factors affecting testing behaviours amongst the population in Ondo and Lagos States. Methods: A cross-sectional study involving 704 individuals who were considered eligible for COVID-19 testing in 4 local governments in Lagos (307) and Ondo (397) states in Nigeria, was conducted from April-June 2021. Respondents were selected using simple random sampling. A close-ended questionnaire was administered using a digital survey platform known as SurveyCTO. Data were analyzed using R 4.1.0. Results: In Lagos state, 52.4% were females, 47.2% were males while in Ondo, 55.2% were females, 44.6% were male. Chi-square tests of association revealed that socio demographic factors significantly associated with testing patterns was education level in Lagos, and none in Ondo. Testing behavior associated with testing patterns included awareness of nearby COVID-19 testing centers, internet access, knowledge of preexisting conditions and having another member of the family testing positive at 5% significance level. Conclusion: Knowledge of pre-existing conditions, knowledge of COVID-19 symptoms, and knowing where to go when having symptoms were significantly associated with testing and willingness to test.
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Affiliation(s)
| | | | - Tochukwu Ifeanyi Onuigbo
- Nigerian Institute of Medical Research (NIMR), Lagos, Nigeria
- *Correspondence: Tochukwu Ifeanyi Onuigbo,
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Brink AJ, Richards GA. Antimicrobial Stewardship: Leveraging the "Butterfly Effect" of Hand Hygiene. Antibiotics (Basel) 2022; 11:1348. [PMID: 36290006 PMCID: PMC9598193 DOI: 10.3390/antibiotics11101348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 10/18/2023] Open
Abstract
It is vital that there are coordinated, collaborative efforts to address the threat of antimicrobial resistance (AMR) and to prevent and control the spread of hospital-onset infections, particularly those due to multidrug-resistant (MDR) pathogens. The butterfly effect is a concept in which metaphorically speaking, small, seemingly trivial events ultimately cascade into something of far greater consequence, more specifically by having a non-linear impact on very complex systems. In this regard, antimicrobial stewardship programs (ASP), when implemented alongside infection prevention control (IPC) interventions in hospitals, particularly hand hygiene (HH), are significantly more effective in reducing the development and spread of AMR bacteria than implementation of ASP alone. In this perspective, we briefly review the evidence for the combined effect, and call for closer collaboration between institutional IPC and ASP leadership, and for well-functioning IPC programs to ensure the effectiveness of ASP.
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Affiliation(s)
- Adrian John Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Guy Antony Richards
- Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2000, South Africa
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Freeman AYS, Rumunu JP, Modi ZA, Guyo AG, Achier AAU, Alor NAJ, Ochan TDK, Ochan WA, Maleghemi S, Berta KK, Olu OO. Assessment of infection prevention and control readiness for Ebola virus and other diseases outbreaks in a humanitarian crisis setting: a cross-sectional study of health facilities in six high-risk States of South Sudan. Pan Afr Med J 2022; 42:10. [PMID: 36158936 PMCID: PMC9475050 DOI: 10.11604/pamj.supp.2022.42.1.33906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION the study was conducted to assess the readiness and capacity of the core components of infection prevention and control and water, sanitation and hygiene in health facilities to effectively contain potential outbreaks of Ebola virus and other diseases in South Sudan. METHODS it is a descriptive cross-sectional study which was conducted in health facilities in six high-risk States of the country from September 2020 to December 2021. Data was collected using a structured questionnaire and analyzed with Microsoft Excel software. RESULTS one hundred and fifty-one (151) health facilities with a total bed capacity of 3089 were enrolled into the study. Overall, the least prepared infection prevention and control, water and sanitation core components in ascending order were the coordination committee structure (13.19%), guidelines and SOPs (21.85%), vector control (22.02%), staff management (30.63%), and training received (33.64%). The best prepared components in descending order were integrated disease surveillance and response capacity (69.83%), medical waste management system (57.12%) and infrastructure compliance (54.69%). CONCLUSION the findings of this study which is comparable to those of other studies in similar settings validates the perception that Infection Prevention and Control/Water, Sanitation, and Hygiene (IPC/WASH) capacity and readiness is inadequate in South Sudan. To scale up these core components, we recommend development and implementation of a comprehensive and long-term infection prevention and control strategic plan as part of the country's broader health sector recovery planning.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Olushayo Oluseun Olu
- World Health Organization, Juba, South Sudan,,Corresponding author Olushayo Oluseun Olu, World Health Organization, Juba, South Sudan.
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de Kraker MEA, Tartari E, Tomczyk S, Twyman A, Francioli LC, Cassini A, Allegranzi B, Pittet D. Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019. THE LANCET. INFECTIOUS DISEASES 2022; 22:835-844. [PMID: 35202600 PMCID: PMC9132778 DOI: 10.1016/s1473-3099(21)00618-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/02/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey. METHODS From Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation. FINDINGS 3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248-430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55-100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35-75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated. INTERPRETATION Most health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all. FUNDING WHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.
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Affiliation(s)
- Marlieke E A de Kraker
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Sara Tomczyk
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Anthony Twyman
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Laurent C Francioli
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alessandro Cassini
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Tomczyk S, Twyman A, de Kraker MEA, Coutinho Rehse AP, Tartari E, Toledo JP, Cassini A, Pittet D, Allegranzi B. The first WHO global survey on infection prevention and control in health-care facilities. THE LANCET. INFECTIOUS DISEASES 2022; 22:845-856. [PMID: 35202599 PMCID: PMC9132775 DOI: 10.1016/s1473-3099(21)00809-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 12/10/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND WHO core components for infection prevention and control (IPC) are important building blocks for effective IPC programmes. To our knowledge, we did the first WHO global survey to assess implementation of these programmes in health-care facilities. METHODS In this cross-sectional survey, IPC professionals were invited through global outreach and national coordinated efforts to complete the online WHO IPC assessment framework (IPCAF). The survey was created in English and was then translated into ten languages: Arabic, Chinese, English, French, German, Italian, Japanese, Russian, Spanish, and Thai. Post-stratification weighting was applied and countries with low response rates were excluded to improve representativeness. Weighted median scores and IQRs as well as weighted proportions (Nw) meeting defined IPCAF minimum requirements were reported. Indicators associated with the IPCAF score were assessed using a generalised estimating equation. FINDINGS From Jan 16 to Dec 31, 2019, 4440 responses were received from 81 countries. The overall weighted IPCAF median score indicated an advanced level of implementation (605, IQR 450·4-705·0), but significantly lower scores were found in low-income (385, 279·7-442·9) and lower-middle-income countries (500·4, 345·0-657·5), and public facilities (515, 385-637·8). Core component 8 (built environment; 90·0, IQR 75·0-100·0) and core component 2 (guidelines; 87·5, 70·0-97·5) scored the highest, and core component 7 (workload, staffing, and bed occupancy; 70·0, 50-90) and core component 3 (education and training; 70 ·0, 50·0-85·0) scored the lowest. Overall, only 15·2% (Nw: 588 of 3873) of facilities met all IPCAF minimum requirements, ranging from 0% (0 of 417) in low-income countries to 25·6% (278 of 1087) in primary facilities, 9% (24 of 268) in secondary facilities, and 19% (18 of 95) in tertiary facilities in high-income countries. INTERPRETATION Despite an overall high IPCAF score globally, important gaps in IPC facility implementation and core components across income levels hinder IPC progress. Increased support for more effective and sustainable IPC programmes is crucial to reduce risks posed by outbreaks to global health security and to ensure patient and health worker safety. FUNDING WHO and the Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine. TRANSLATIONS For the French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sara Tomczyk
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland; Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Anthony Twyman
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Marlieke E A de Kraker
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ana Paula Coutinho Rehse
- Infectious Hazard Management Programme, Health Emergencies Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Ermira Tartari
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland; Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Msida, Malta
| | - João Paulo Toledo
- Clinical Management of Infectious Diseases, Health Emergencies Department, Pan American Health Organization, Washington, DC, USA
| | - Alessandro Cassini
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
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Fofanah BD, Abrahamyan A, Maruta A, Kallon C, Thekkur P, Kamara IF, Njuguna CK, Squire JS, Kanu JS, Bah AJ, Lakoh S, Kamara D, Hermans V, Zachariah R. Achieving Minimum Standards for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the COVID-19 Era! INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5642. [PMID: 35565037 PMCID: PMC9102022 DOI: 10.3390/ijerph19095642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Good Infection prevention and control (IPC) is vital for tackling antimicrobial resistance and limiting health care-associated infections. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. METHODS Cross-sectional assessments using standardized World Health Organizations IPC checklists. IPC performance scores were graded as inadequate = 0-25%, basic = 25.1-50%, intermediate = 50.1-75%, and advanced = 75.1-100%. RESULTS Overall performance improved from 'basic' to 'intermediate' at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained 'basic' at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined monitoring plan with clear goals, targets and activities. CONCLUSION Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pandemic. There is urgent need to mobilize political will, leadership and resources and make a quantum leap forward.
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Affiliation(s)
- Bobson Derrick Fofanah
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention Center (TBRPC), Yerevan 0014, Armenia;
| | - Anna Maruta
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Christiana Kallon
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Charles Kuria Njuguna
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - James Sylvester Squire
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (J.S.S.); (J.S.K.)
| | - Joseph Sam Kanu
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (J.S.S.); (J.S.K.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
| | - Abdulai Jawo Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
- Institute of Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown 00232, Sierra Leone
| | - Dauda Kamara
- Water, Sanitation, and Hygiene (WASH) Program, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone;
| | - Veerle Hermans
- Médecins Sans Frontières, Operational Centre Brussels, 68, Rue de Gasperich, 1617 Luxembourg, Belgium;
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), Avenue Appia 20, 1211 Geneva, Switzerland;
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Saadeh R, Khader Y, Alyahya M, Al-Samawi M, Allouh MZ. Water, Sanitation, and Hygiene and Infection Prevention and Control in Jordanian Hospitals in the Context of COVID-19: A National Assessment. Risk Manag Healthc Policy 2022; 15:571-582. [PMID: 35411197 PMCID: PMC8994649 DOI: 10.2147/rmhp.s358600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/26/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To identify areas that need improvement in Jordanian health centers regarding infection prevention and control (IPC) programs; water, sanitation, and hygiene (WASH) services; and other protective measures, especially in the context of coronavirus disease (COVID-19). Methods This is a national assessment study that comprised hospitals of different sectors in Jordan, including, Ministry of Health (MoH), private, and military hospitals. The study included 23 Jordanian hospitals. Assessment tools were developed and adapted mainly from the WASH Facility Improvement Tool (WASH FIT) and other tools. Hospitals were assessed to meet targets based on whether indicators were fully met, partially met, or not met. Results The mean percentage of the 150 indicators that met the standards was 83.2% (72.6% for MoH, 84.5% for private, and 90.4% for military hospitals). The percentage of indicators, both WASH/IPC and training and education indicators, that met the targets were higher in military hospitals than in MoH and private hospitals. However, in context of COVID-19, only 64.7% of indicators related to precautionary measures were met by all hospitals. Conclusion The data available on WASH/IPC in Jordan are scarce, and the study findings will help in preventing severe consequences of the COVID-19 pandemic. There is scope for improvement in many WASH/IPC aspects, and urgent actions should be taken, especially to fill the gaps in COVID-19 precautionary measures.
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Affiliation(s)
- Rami Saadeh
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Majid Al-Samawi
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Z Allouh
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Correspondence: Mohammed Z Allouh, Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, P. O. Box: 15551, Al Ain, United Arab Emirates, Tel +97 137 137 551, Email
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Thomas MP, Kozikott S, Kamateeka M, Abdu-Aguye R, Agogo E, Bello BG, Brudney K, Manzi O, Patel LN, Barrera-Cancedda AE, Abraham J, Lee CT. Development of a simple and effective online training for health workers: results from a pilot in Nigeria. BMC Public Health 2022; 22:551. [PMID: 35313834 PMCID: PMC8934907 DOI: 10.1186/s12889-022-12943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Health workers (HWs) in Africa face challenges accessing and learning from existing online training opportunities. To address these challenges, we developed a modular, self-paced, mobile-ready and work-relevant online course covering foundational infection prevention and control (IPC) concepts. Here, we evaluate the first pilot of this course, conducted with HWs in Nigeria. Methods We used a learner-centered design and prototyping process to create a new approach to delivering online training for HWs. The resulting course comprised 10 self-paced modules optimized for use on mobile devices. Modules presented IPC vignettes in which learning was driven by short assessment questions with feedback. Learners were recruited by distributing a link to the training through Nigeria-based email lists, WhatsApp groups and similar networks of HWs, managers and allied professionals. The course was open to learners for 8 weeks. We tracked question responses and time on task with platform analytics and assessed learning gains with pre- and post-testing. Significance was evaluated with the Wilcoxon signed-rank test, and effect size was calculated using Cohen’s d. Results Three hundred seventy-two learners, with roles across the health system, enrolled in the training; 59% completed all 10 modules and earned a certificate. Baseline knowledge of foundational IPC concepts was low, as measured by pre-test scores (29%). Post-test scores were significantly higher at 54% (effect size 1.22, 95% confidence interval 1.00-1.44). Learning gains were significant both among learners with low pre-test scores and among those who scored higher on the pre-test. We used the Net Promoter Score (NPS), a common user experience metric, to evaluate the training. The NPS was + 62, which is slightly higher than published scores of other self-paced online learning experiences. Conclusions High completion rates, significant learning gains and positive feedback indicate that self-paced, mobile-ready training that emphasizes short, low-stakes assessment questions can be an effective, scalable way to train HWs who choose to enroll. Low pre-test scores suggest that there are gaps in IPC knowledge among this learner population.
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Affiliation(s)
- Marshall P Thomas
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA.
| | - Samantha Kozikott
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA
| | | | | | - Emmanuel Agogo
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA
| | | | - Karen Brudney
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA
| | - Olivier Manzi
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA
| | - Leena N Patel
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA
| | | | - Jobin Abraham
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA
| | - Christopher T Lee
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY, USA
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Ayobami O, Brinkwirth S, Eckmanns T, Markwart R. Antibiotic resistance in hospital-acquired ESKAPE-E infections in low- and lower-middle-income countries: a systematic review and meta-analysis. Emerg Microbes Infect 2022; 11:443-451. [PMID: 35034585 PMCID: PMC8820817 DOI: 10.1080/22221751.2022.2030196] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antimicrobial resistance (AMR) and hospital-acquired infections (HAIs) are global health challenges. The burden of antibiotic resistance in HAIs is still unclear in low- and lower-middle-income countries (L-LMICs). This study summarizes recent data on antibiotic resistance in priority HAIs (ESKAPE-E) in L-LMICs and compares them with data from high-income countries (HICs). EMBASE, Web of Science, and Global Index Medicus were searched for studies on AMR patterns in HAIs published from 01/2010 to 10/2020. Random-effects meta-analyses were performed to obtain pooled estimates. In total, 163 eligible studies were included in the review and meta-analysis. The pooled methicillin resistance proportion in Staphylococcus aureus was 48.4% (95% confidence interval [95%CI] 41·7-55·2, n = 80). Pooled carbapenem resistance proportions were high in Gram-negative pathogens: Escherichia coli: 16·6% (95%CI 10·7-23·4, n = 60); Klebsiella pneumoniae: 34·9% (95%CI 24·6-45·9, n = 50); Pseudomonas aeruginosa: 37.1% (95%CI 24·6-45·9, n = 56); Enterobacter spp.: 51·2% (95%CI 27·5-74·7, n = 7); and Acinetobacter baumannii (complex): 72·4% (95%CI 62·1-81·7%, n = 36). A higher resistance proportions were observed for third-generation cephalosporins: Klebsiella pneumoniae: 78·7% (95%CI 71·5-85·2, n = 46); Escherichia coli: 78·5% (95%CI 72·1-84·2%, n = 58); and Enterobacter spp.: 83·5% (95%CI 71·9-92·8, n = 8). We observed a high between-study heterogeneity (I2 > 80%), which could not be explained by our set of moderators. Pooled resistance proportions for Gram-negative pathogens were higher in L-LMICs than regional and national estimates from HICs. Patients in resource-constrained regions are particularly affected by AMR. To combat the high resistance to critical antibiotics in L-LMICs, and bridge disparities in health, it is crucial to strengthen local surveillance and the health systems in general.
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Affiliation(s)
- Olaniyi Ayobami
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Simon Brinkwirth
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Robby Markwart
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Jena University Hospital, Institute of General Practice and Family Medicine, Jena, Germany
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Hammoud S, Amer F, Kocsis B. Examining the effect of infection prevention and control awareness among nurses on patient and family education: A cross-sectional study. Nurs Health Sci 2021; 24:140-151. [PMID: 34792859 DOI: 10.1111/nhs.12905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/23/2022]
Abstract
The significance of patient engagement in infection prevention and control remains to be stressed as a means of improving patient safety. This study aimed to determine nurses' awareness of infection prevention and control, assess patient and family education on infection prevention and control, and examine the effect of nurses' infection prevention and control awareness on patient and family education. A multi-site, cross-sectional study was conducted among 566 nurses in Hungary. Nurses responded to a questionnaire of three parts: demographics, infection prevention, and control awareness; healthcare-associated infections, hand hygiene, and standard precautions; and patient and family education. High scores were reached in overall awareness and standard precautions. Nurses educated patients and family members the most on hand hygiene and respiratory hygiene. Nurses with higher awareness educated patients more than those with lower awareness, but the differences were only significant for respiratory hygiene and the reason for isolation. Nursing leaders are encouraged to enhance the culture that is based on nurse/patient partnership and to develop reminders to emphasize the importance of engaging patients and family members in infection prevention and control.
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Affiliation(s)
- Sahar Hammoud
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Faten Amer
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Béla Kocsis
- Department of Medical Microbiology and Immunology, Medical School, University of Pécs, Pécs, Hungary
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Tomczyk S, Storr J, Kilpatrick C, Allegranzi B. Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis. Antimicrob Resist Infect Control 2021; 10:113. [PMID: 34332622 PMCID: PMC8325287 DOI: 10.1186/s13756-021-00962-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings. METHODS Semi-structured interviews were conducted with IPC experts from low-resource settings, guided by a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and finally reviewed to ensure validity. Sub-themes appearing ≥ 3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively. RESULTS Interviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes including the related critical actions to achieve the WHO IPC core components included: (1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; (2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; (3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; (4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and "data for action"; (5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; (6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and "data for action"; (7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and (8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy. CONCLUSIONS These IPC implementation themes offer important qualitative evidence for IPC professionals to consider.
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Affiliation(s)
- Sara Tomczyk
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Julie Storr
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Patel LN, Kozikott S, Ilboudo R, Kamateeka M, Lamorde M, Subah M, Tsiouris F, Vorndran A, Lee CT. Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative. BMJ Glob Health 2021; 6:e005833. [PMID: 34083244 PMCID: PMC8182752 DOI: 10.1136/bmjgh-2021-005833] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022] Open
Abstract
Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.
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Affiliation(s)
- Leena N Patel
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, New York, USA
| | - Samantha Kozikott
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, New York, USA
| | - Rodrigue Ilboudo
- The Alliance for International Medical Action (ALIMA), Yaoundé, Cameroon
| | - Moreen Kamateeka
- Nigeria Country Office, African Field Epidemiology Network (AFENET), Abuja, Nigeria
| | - Mohammed Lamorde
- Infectious Diseases Institute (IDI), McKinnell Knowledge Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Marion Subah
- Liberia Country Office, Last Mile Health, Monrovia, Liberia
| | - Fatima Tsiouris
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Anna Vorndran
- Infection Control Africa Network, Cape Town, South Africa
| | - Christopher T Lee
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, New York, USA
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