Infection control best practices in clinical research in resource-limited settings

Evaluating infection prevention and control structure of Indonesian COVID-19 referral hospitals

Due to the emergence of COVID-19, hospitals are required to increase vigilance in providing care. However, their readiness for infection prevention and control (IPC) as a referral hospital in providing COVID-19 services has not been determined. This study aims to evaluate the IPC structure of 30 private non-profit Indonesian referral hospitals for COVID-19 based on the World Health Organization Infection Prevention and Control Assessment Framework (WHO IPCAF). A descriptive cross-sectional quantitative study was used, where 30 hospitals as the COVID-19 referral hospital were selected. The data collection was conducted by an online survey using the IPCAF questionnaire created by the WHO and was analysed with descriptive analysis. The majority of the hospitals' IPC level is at an advanced level (73.3%). All type B hospitals have an advanced IPC level, while only 64.7% of type C and 71.4% of type D have an advanced level. The highest average IPC score is on the IPC guidelines component (94.0), while the lowest value of 71.9 is on the Surveillance of HAIs component. In the minimum scores, there were hospitals with the lowest scores in HAI Surveillance and Multimodal strategies, namely 20.0 and 25.0, respectively. Preparing human resource capacities, establishing functional programmes, developing and implementing IPC guidelines, and providing adequate supplies are needed to improve hospital IPC structures.

Contribution

This study demonstrates the necessity to improve hospital IPC structures to increase the resilience of health services to natural hazards and public health emergencies.

Institutional Factors Associated with Infection Prevention and Control Practices Globally during the Infectious Pandemics in Resource-Limited Settings

Healthcare-associated infections lead to considerable morbidity, a prolonged hospital stay, antibiotic resistance, long-term disability, mortality and increased healthcare costs. Based on the literature, some individual and socio-demographic factors including knowledge, age and length of service or work experience, gender and type of profession influence compliance with infection prevention and control procedures. In addition, organizational culture, which refers to the assumptions, values, and norms shared among colleagues, can influence an individual's thinking and healthcare workers' behavior, either positively or negatively. Infection control practices based on the perspective of patients, hospital management and healthcare workers may help develop a better understanding of the factors influencing compliance with infection prevention and control policies and guidelines.

Infection Prevention and Control Preparedness Level and Associated Determinants in 56 Acute Healthcare Facilities in Ghana

Background

Infection prevention and control (IPC) is a globally relevant aspect of all health systems impacting the health and safety of both patients and healthcare workers. However, best practices remain a challenge in healthcare delivery especially in resource limited situations. The primary objective of this study was to assess the infection prevention and control (IPC) preparedness levels of acute healthcare facilities in Ghana and to determine the factors associated with the overall IPC preparedness levels in acute healthcare facilities.

Methods

A cross-sectional study adapting the IPC assessment framework (IPCAF) developed by the World Health Organization (WHO) was conducted. Five of the core components of the WHO IPCAF were used to assess the IPC level of 56 acute healthcare facilities in Ghana.

Results

Of the 56 facilities surveyed, only 19 had an IPC program with clearly defined objectives. Overall, 8 (14.3%) facilities scored an IPC preparedness level of “Advance”, 18 (32.1%) facilities received an “Intermediate” IPC preparedness score, 23 (41.1%) facilities received an IPC preparedness level of “basic” and 7 (12.5%) facilities scored an IPC preparedness level of “inadequate”. IPC materials like detergents, running water and PPEs were not significantly supplied. Government owned facilities performed better in terms of IPC preparedness as compared to privately owned facilities. A PLUM-ordinal regression analysis revealed that an IPC program with clearly defined objectives (OR= 76; 95% CI; 7.23, 808.19), dedicated IPC budget (OR= 13; 95% CI; 3.8–44.3) and regular mandatory training (OR= 50.9; 95% CI; 6.1–425) were associated with increased IPC preparedness.

Conclusion

Generally, the IPC preparedness levels in a majority of the facilities were low and required significant improvements in several areas. Facilities must make periodic reviews and adjust their objectives based on facility priorities.