Evaluation of the implementation of WHO infection prevention and control core components in Turkish health care facilities: results from a WHO infection prevention and control assessment framework (IPCAF)—based survey

Abstract

Background The core components (CCs) of infection prevention and control (IPC) from World Health Organization (WHO) are crucial for the safety and quality of health care. Our objective was to examine the level of implementation of WHO infection prevention and control core components (IPC CC) in a developing country. We also aimed to evaluate health care-associated infections (HAIs) and antimicrobial resistance (AMR) in intensive care units (ICUs) in association with implemented IPC CCs. Methods Members of the Turkish Infectious Diseases and Clinical Microbiology Specialization Association (EKMUD) were invited to the study via e-mail. Volunteer members of any healt care facilities (HCFs) participated in the study. The investigating doctor of each HCF filled out a questionnaire to collect data on IPC implementations, including the Infection Prevention and Control Assessment Framework (IPCAF) and HAIs/AMR in ICUs in 2021. Results A total of 68 HCFs from seven regions in Türkiye and the Turkish Republic of Northern Cyprus participated while 85% of these were tertiary care hospitals. Fifty (73.5%) HCFs had advanced IPC level, whereas 16 (23.5%) of the 68 hospitals had intermediate IPC levels. The hospitals’ median (IQR) IPCAF score was 668.8 (125.0) points. Workload, staffing and occupancy (CC7; median 70 points) and multimodal strategies (CC5; median 75 points) had the lowest scores. The limited number of nurses were the most important problems. Hospitals with a bed capacity of > 1000 beds had higher rates of HAIs. Certified IPC specialists, frequent feedback, and enough nurses reduced HAIs. The most common HAIs were central line-associated blood stream infections. Most HAIs were caused by gram negative bacteria, which have a high AMR. Conclusions Most HCFs had an advanced level of IPC implementation, for which staffing was an important driver. To further improve care quality and ensure everyone has access to safe care, it is a key element to have enough staff, the availability of certified IPC specialists, and frequent feedback. Although there is a significant decrease in HAI rates compared to previous years, HAI rates are still high and AMR is an important problem. Increasing nurses and reducing workload can prevent HAIs and AMR. Nationwide “Antibiotic Stewardship Programme” should be initiated.

Evaluation of the Implementation of WHO Infection Prevention and Control Core Components Among Health Care Facilities

“…Furthermore, this study is inconsistence with other studies done in Turkish health care facilities which indicated a total of 68 HCFs from seven regions in Turkey and the Turkish Republic of Northern Cyprus. 50 (73.5%) HCFs had advanced IPC levels, while 16 (23.5%) of hospitals had intermediate IPC levels [14].…”

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

“…The median IPCAF score varies from ‘inadequate IPC level’ in Pakistan [ 17 ] to an advanced level obtained from Germany, Turkey, India, Austria, and Indonesia. In addition, a difference exists within the eight core components [ [12] , [13] , [14] , 18 , 20 , 21 ]. The IPCAF of each core component showed a low mean value in Pakistan [ 16 ] compared with Austria [ 20 ] as shown in Figure 2 .…”

“…A higher median IPC score was recorded in Turkey and India [ 12 , 14 ] compared with Bangladesh [ 22 ] in each of the IPCAF core components. The higher score obtained from Turkey may be due to the higher income level and more attention given to IPC.…”

Clinical Features and Outcomes of VAP Due to Multidrug-Resistant Klebsiella spp.: A Retrospective Study Comparing Monobacterial and Polybacterial Episodes

“…In addition, our results cannot be generalized for geographical areas with a high prevalence of carbapenemases, and further studies are required, with important implications for stewardship or preventive strategies. The implications for antimicrobial stewardship or VAP prevention are beyond the scope of this article, and we refer the readers to recent updates [ 2 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ] addressing these important issues.…”