Infection prevention and control during the COVID-19 pandemic: challenges and opportunities for Kenyan public hospitals

Background: Infection prevention and control, and water sanitation and hygiene have an essential role in ensuring the quality of care and patient outcomes in hospitals. Using a modification of the World Health Organization’s water sanitation and hygiene facility improvement tool, we undertook assessments in 14 public hospitals in Kenya in 2018. The hospitals received written feedback on areas where they could make improvements. Following the first confirmed cases of COVID-19 in Kenya, we were drawn to ask whether the results of our pre-pandemic survey had led to action, and whether or not the threat of COVID-19 had focused more attention on infection prevention and control and water sanitation and hygiene. Methods: Using a semi-structured interview guide, we carried out phone interviews with key hospital leaders in 11 of the 14 hospitals. The data were transcribed and coded into thematic areas. We draw on these interviews to describe the status and awareness of infection prevention and control. Results: The infection prevention and control committee members are training health workers on infection prevention and control procedures and proper use of personal protective equipment and in addition, providing technical support to hospital managers. While some hospitals have also accessed additional funds to improve infection prevention and control, they tended to be small amounts of money. Long-standing challenges with supplies of infection prevention and control materials and low staff morale persist. Crucially, the reduced supply of personal protective equipment has led to fear and anxiety among health care personnel. Conclusions: As funds are mobilised to support care for COVID-19, we ask that funds prioritise infection prevention and control measures. This would have a profoundly positive effect on within hospital virus transmission, patient and staff safety but also lasting benefits beyond the COVID-19 pandemic.

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Infection control practices and challenges in Pakistan during the COVID-19 pandemic: a multicentre cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211012761 ◽

2021 ◽

pp. 175717742110127

Author(s):

Salma Abbas ◽

Faisal Sultan

Keyword(s):

Personal Protective Equipment ◽

Prevention And Control ◽

Infection Prevention ◽

Hospital Staff ◽

Cross Sectional Study ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Cross Sectional ◽

Healthcare Facilities ◽

And Control

Background: Patient and staff safety at healthcare facilities during outbreaks hinges on a prompt infection prevention and control response. Physicians leading these programmes have encountered numerous obstacles during the pandemic. Aim/objective: The aim of this study was to evaluate infection prevention and control practices and explore the challenges in Pakistan during the coronavirus disease 2019 pandemic. Methods: We conducted a cross-sectional study and administered a survey to physicians leading infection prevention and control programmes at 18 hospitals in Pakistan. Results: All participants implemented universal masking, limited the intake of patients and designated separate triage areas, wards and intensive care units for coronavirus disease 2019 patients at their hospitals. Eleven (61%) physicians reported personal protective equipment shortages. Staff at three (17%) hospitals worked without the appropriate personal protective equipment due to limited supplies. All participants felt overworked and 17 (94%) reported stress. Physicians identified the lack of negative pressure rooms, fear and anxiety among hospital staff, rapidly evolving guidelines, personal protective equipment shortages and opposition from hospital staff regarding the choice of recommended personal protective equipment as major challenges during the pandemic. Discussion: The results of this study highlight the challenges faced by physicians leading infection prevention and control programmes in Pakistan. It is essential to support infection prevention and control personnel and bridge the identified gaps to ensure patient and staff safety at healthcare facilities.

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Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis in an Egyptian University Hospital.

10.21203/rs.3.rs-410882/v1 ◽

2021 ◽

Author(s):

Anna-Leena Lohiniva ◽

Iman Heweidy ◽

Samiha Abdu ◽

Abouelata Omar ◽

Caroline Ackley ◽

...

Keyword(s):

Behaviour Change ◽

Prevention And Control ◽

Infection Prevention ◽

Theoretical Domains Framework ◽

Control Measures ◽

World Health ◽

Infection Prevention And Control ◽

Surgical Prophylaxis ◽

Context Specific ◽

And Control

Abstract Background: Antimicrobial resistance (AMR) is increasingly pervasive due to multiple, complex prescribing and consuming behaviours. Accordingly, behaviour change is an important component of response to AMR. Little is known about the best approaches to change antibiotic use practices and behaviours. This project aims to develop a context-specific behaviour change strategy focusing on promoting appropriate prescription practices following the World Health Organization recommendations for surgical prophylaxis in an orthopaedic surgery unit in Egypt.Methods: The project included a formative qualitative research study was based on the Theoretical Domains Framework (TDF) to explore the determinants for inappropriate prescription of surgical antibiotic prophylaxis at an orthopaedic unit. The intervention was developed to following the Behaviour Change Wheel (BCW) in a knowledge co-production workshop with infection prevention and control experts that ensured that the theory based intervention was a culturally acceptable, practical and implementable intervention. Results: The prescription of surgical prophylaxis was influenced by five TDF domains including, knowledge, belief in consequences (mistrust towards infection prevention and control measures), environmental factors (lack of prescription guidelines) , professional role and reinforcement (a lack of appropriate follow up actions influenced prescription of surgical prophylaxis). The appropriate set of behaviour change functions of BCW and related activities to improve the current practices included education, enablement, persuasion, environmental restructuring and restriction. Conclusions The study showed that a theory based and context specific intervention can be created by using the TDF and BCW together with knowledge-co creation to improve the prescription of surgical prophylaxis in and Egyptian orthopaedic unit. The intervention need to piloted and scaled up.

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Personal protective equipment and infection prevention and control: a national survey of UK medical students and interim foundation doctors during the COVID-19 pandemic

Journal of Public Health ◽

10.1093/pubmed/fdaa187 ◽

2020 ◽

Author(s):

Emma Jane Norton ◽

Ioannis Georgiou ◽

Alex Fung ◽

Armin Nazari ◽

Soham Bandyopadhyay ◽

...

Keyword(s):

Medical Students ◽

Personal Protective Equipment ◽

Prevention And Control ◽

Infection Prevention ◽

Online Survey ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Cross Sectional ◽

Multi Centre Study ◽

And Control

Abstract Background The adequacy of personal protective equipment (PPE) and infection prevention and control (IPC) training in UK medical students and interim Foundation Year 1 (FiY1) doctors during the COVID-19 pandemic is unknown, as is its impact on COVID-19-related anxiety. Methods Cross-sectional, multi-centre study analysing self-reported adequacy of PPE and IPC training and correlation to a modified pandemic anxiety scale. Participants were current medical students and FiY1 doctors in the UK. Data were collected by an online survey. Results Participants reported that they received insufficient PPE information (43%) and IPC training (56%). Significantly, fewer participants identifying as women or BAME/mixed ethnicity reported receiving sufficient PPE information, compared with those identifying as men and White British/White Other, respectively. COVID-19-related anxiety was significantly higher in those without sufficient reported PPE or IPC training, in women compared with men, and in FiY1 doctors compared with medical students. Conclusions With medical students currently volunteering in and imminently returning to hospitals in an educational capacity, levels of self-reported PPE and IPC training are sub-optimal. Better training is paramount to avoid harm to patients and healthcare professionals and to reduce COVID-19-related anxiety among medical students and FiY1 doctors.

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Infection Prevention and Control in Liberia 5 Years After Ebola: A Case Study

Workplace Health & Safety ◽

10.1177/2165079921998076 ◽

2021 ◽

pp. 216507992199807

Author(s):

Laura Jean Ridge ◽

Amy Witkoski Stimpfel ◽

Robin Toft Klar ◽

Victoria Vaughan Dickson ◽

Allison Patricia Squires

Keyword(s):

Occupational Health ◽

Personal Protective Equipment ◽

Disaster Response ◽

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Clinician Training ◽

And Control

Background: Effective management of health emergencies is an important strategy to improve health worldwide. One way to manage health emergencies is to build and sustain national capacities. The Ebola epidemic of 2014 to 2015 resulted in greater infection prevention and control (IPC) capacity in Liberia, but few studies have investigated if and how that capacity was sustained. The purpose of this study was to examine the maintenance of IPC capacity in Liberia after Ebola. Methods: For this case study, data were collected via direct observation of nurse practice, semistructured interviews, and document collection. Data were collected in two counties in Liberia. Data were analyzed using directed content and general thematic analysis using codes generated from the safety capital theoretical framework, which describes an organization’s intangible occupational health resources. Findings: Thirty-seven nurses from 12 facilities participated. Ebola was a seminal event in the development of safety capital in Liberia, particularly regarding nurse knowledge of IPC and facilities’ investments in safety. The safety capital developed during Ebola is still being applied at the individual and organizational levels. Tangible resources, including personal protective equipment, however, have been depleted. Conclusions/Application to Practice: IPC capacity in Liberia had been sustained since Ebola but was threatened by under-investments in physical resources. Donor countries should prioritize sustained support, both financial and technical, in partnership with Liberian leaders. Occupational health nurses participating in disaster response should advocate for long-term investment by donor countries in personal protective equipment, access to water, and clinician training.

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Infection prevention and control situation in public hospitals of Islamabad

The Journal of Infection in Developing Countries ◽

10.3855/jidc.12779 ◽

2020 ◽

Vol 14 (09) ◽

pp. 1040-1046

Author(s):

Saba Savul ◽

Farida Khurram Lalani ◽

Aamer Ikram ◽

Muhammad Amjad Khan ◽

Mumtaz Ali Khan ◽

...

Keyword(s):

Public Sector ◽

Prevention And Control ◽

Infection Prevention ◽

Public Hospitals ◽

World Health ◽

Infection Prevention And Control ◽

Global Public Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

And Control

Introduction: Healthcare-associated infections represent a global public health challenge and are associated with significant mortality and morbidity. Infection Prevention and Control (IPC) is a neglected area in healthcare facilities across Pakistan. The objective of our study was to elucidate the current state of infection prevention and control practices in public sector hospitals of Islamabad to underscore potential areas for improvement. Methodology: A cross-sectional survey was conducted between November and December 2019 at five public sector hospitals of Islamabad. The World Health Organization’s Infection Prevention and Control Assessment Framework (IPCAF) was used to assess the strengths and weaknesses of hospitals regarding infection prevention and control. Adapted tools derived from Centers for Disease Control and Prevention and Infection Prevention Society were used for detailed assessment of various departments. Data was analyzed using Microsoft Excel 2016. Results: In all five hospitals, the total IPCAF score was less than 200 denoting that infection prevention and control implementation is deficient and significant improvement is needed. The median IPCAF score was 117.5 with an interquartile range of 53.75. With the exception of central sterile services unit at one hospital, departments at all hospitals failed to meet even 50% of required IPC standards. Conclusions: Significant change is needed to improve the existent situation of infection prevention and control in public sector hospitals of Islamabad. This would involve establishment of functional programs, development and implementation of infection prevention and control guidelines and provision of adequate supplies.

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Enhancing Infection Prevention and Control Capacity in Health Facilities Following the 2019 Ebola Outbreak in Kasese, Uganda

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1147 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s471-s471

Author(s):

Maureen Kesande ◽

Mohammed Lamorde ◽

Elizabeth Bancroft ◽

Carolyn Herzig ◽

Judith Nanyondo ◽

...

Keyword(s):

High Risk ◽

Hand Hygiene ◽

Waste Management ◽

Personal Protective Equipment ◽

Prevention And Control ◽

Infection Prevention ◽

Water Source ◽

Infection Prevention And Control ◽

Protective Equipment ◽

And Control

Background: In June 2019, 3 people were diagnosed with Ebola virus disease (EVD) in Kasese district, Uganda, all of whom had come from the Democratic Republic of Congo (DRC). Although no secondary transmission of Ebola occurred, an assessment of infection prevention and control (IPC) using the WHO basic IPC facility assessment checklist revealed significant gaps. Robust IPC systems are critical for the prevention of healthcare-associated infections like EVD. A rapid intervention was developed and implemented in Kasese to strengthen IPC capacity in high-risk facilities. Methods: Of 117 healthcare facilities, 50 were considered at high risk of receiving suspected EVD cases from DRC based on population movement assessments. In August 2019, IPC mentors were selected from 25 high-risk facilities and assigned to support their facility and a second high-risk facility. Mentors ensured formation of IPC committees and implemented the national mentorship strategy for IPC preparedness in non-EVD treatment facilities. This effort focused on screening, isolation, and notification of suspect cases: 4 mentorship visits were conducted (1 per week for 1 month). Middle and terminal assessments were conducted using the WHO IPC checklist 2 and 4 weeks after the intervention commenced. Results were evaluated against baseline data. Results: Overall, 39 facilities had data from baseline, middle, and end assessments. Median scores in facility IPC standard precautions increased from baseline 50% (IQR, 39%–62%) to 73% (IQR, 67%–76%) at the terminal assessments. Scores increased for all measured parameters except for water source (access to running water). Greatest improvements were seen in formation of IPC committees (41% to 75%), hand hygiene compliance (47% to 86%), waste management (51% to 83%), and availability of dedicated isolation areas (16% to 42%) for suspect cases. Limited improvement was noted for training on management of suspect isolated cases and availability of personal protective equipment (PPE) (Fig. 1). No differences were noted in scores for facilities with nonresident mentors versus those with resident mentors at baseline (48% vs 50%) and end assessments (72% vs 74%). Conclusions: This intervention improved IPC capacity in health facilities while avoiding the cost and service disruption associated with large-scale classroom-based training of health workers. The greatest improvements were seen in activities relying on behavior change, such as hand hygiene, IPC committee, and waste management. Smaller changes were seen in areas requiring significant investments such as isolation areas, steady water source, and availability of personal protective equipment (PPE). Mentorship is ongoing in moderate- and lower-risk facilities in Kasese district.Funding: NoneDisclosures: Mohammed Lamorde reports contract research for Janssen Pharmaceutica, ViiV, Mylan.

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