Achieving Minimum Standards for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the COVID-19 Era!

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.

Establishing an Antimicrobial Stewardship Program in Sierra Leone: A Report of the Experience of a Low-Income Country in West Africa

“…Research from hospitals across Sierra Leone, including Connaught Hospital, found deep-rooted challenges not only in antimicrobial prescribing and antibiotic resistance, but also in IPC [ 17 , 18 , 19 , 20 , 21 , 22 ]. This reinforces the fact that an AMS program should constitute a broad-based membership that includes IPC practitioners [ 23 ].…”

High level of infection prevention and control in surveyed hospitals in Colombia, 2021

“…Although the exact reasons for this high performance are not known, we assume that the higher score could be linked to the high performance in the IPC guidelines and built environment components. Four recent studies from Africa, where the latter component was rated as inadequate, showed that overall IPC performance was lower (14)(15)(16)(17)(18). This highlights the importance of having the necessary infrastructure for optimal IPC practice.…”

“…Studies using the IPCAF in Liberia, Sierra Leone, Uganda and the United Republic of Tanzania have reported low levels of IPC performance in health facilities (14)(15)(16)(17)(18). A study from São Paulo, Brazil, showed large gaps between the recommendations for and use of IPC measures (19).…”

High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study

“…At the time of writing, no studies have been published on the incidence of CAUTI in Sierra Leone. This situation, and the fact that our previous work has shown deep-rooted challenges in the implementation of IPC practices in Sierra Leone prompted us to pilot a surveillance program for CAUTI in two hospitals situated in two geographic regions of Sierra Leone [15][16][17]. In this study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in order to inform preventive interventions.…”