Implementation of surgical site infection surveillance in low- and middle-income countries: A position statement for the International Society for Infectious Diseases

Mehtar, Shaheen; Wanyoro, Anthony; Ogunsola, Folasade; Ameh, Emmanuel A.; Nthumba, Peter; Kilpatrick, Claire; Revathi, Gunturu; Antoniadou, Anastasia; Giamarelou, Helen; Apisarnthanarak, Anucha; Ramatowski, John W.; Rosenthal, Víctor D.; Storr, Julie; Osman, Tamer; Solomkin, Joseph S.

doi:10.1016/j.ijid.2020.07.021

Cited by 34 publications

(32 citation statements)

References 62 publications

(70 reference statements)

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“…Selected international organizations have also published summary statements of expert opinions on IPC implementation examples in low-resource settings. For example, the International Society for Infectious Diseases published a position statement in 2020 on the implementation of surgical site infection surveillance in low- and middle-income countries [ 29 ]. This statement highlights implementation steps including identifying index operations for targeted surveillance, identifying IPC “champions” and empowering health care workers, using multimodal improvement measures, positioning hand hygiene programs as the basis for IPC initiatives, and use of telecommunication devices for surveillance and health outcome follow-ups.…”

Section: Discussionmentioning

confidence: 99%

Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis

Tomczyk

Storr

Kilpatrick

et al. 2021

Antimicrob Resist Infect Control

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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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Section: Discussionmentioning

confidence: 99%

Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis

Tomczyk

Storr

Kilpatrick

et al. 2021

Antimicrob Resist Infect Control

Self Cite

View full text Add to dashboard Cite

show abstract

“…Selected international organizations have also published summary statements of expert opinions on IPC implementation examples in low-resource settings. For example, the International Society for Infectious Diseases published a position statement in 2020 on the implementation of surgical site infection surveillance in low-and middle-income countries (28). This statement highlights implementation steps including identifying index operations for targeted surveillance, identifying IPC "champions" and empowering health care workers, using multimodal improvement measures, positioning hand hygiene programs as the basis for IPC initiatives, and use of telecommunication devices for surveillance and health outcome follow-ups.…”

Section: Discussionmentioning

confidence: 99%

Infection Prevention and Control (IPC) Implementation in Low-Resource Settings: A Qualitative Analysis

Tomczyk

Storr

Kilpatrick

et al. 2021

Preprint

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BackgroundThe 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.MethodsSemi-structured interviews were conducted with IPC experts from low-resource settings, using 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 reviewed to ensure validity. Sub-themes appearing ≥3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively.ResultsInterviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes 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.ConclusionsThese IPC implementation themes offer important qualitative evidence for IPC professionals to consider.

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“…[ 22 ] Furthermore, the involvement of actively engaged champions and role models, who build organizational support, address barriers, and promote culture change, has contributed to the success of numerous initiatives. [ 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Improving sterile processing practices in Cambodian healthcare facilities

Fast

Dosani

Uzoka

et al. 2020

Infection Prevention in Practice

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Summary Background Sterile processing practices in low-resource countries contribute to greater post-operative infection rates compared to high-resource countries. Provision of a sterile processing training program in Tanzania and Ethiopia demonstrated statistically significant improvements in sterile processing practice, a key requisite for safe surgical care. Aim To determine if a sterile processing program in a South East Asia country would result in improved conditions and practice in urban and rural healthcare facilities. Methods In 2019, a mixed-methods study was conducted with two cohorts in Cambodia, involving a total of eight healthcare facilities and 43 healthcare workers. Quantitative data were collected using a sterile processing assessment tool and a multiple-choice test pre- and post-training. Qualitative data in the form of interviews were obtained several months post-training. Findings Test results showed statistically significant and sustained effect of training over a four-six month period, as well as a large positive effect on SP knowledge in both cohorts. Analysis of hospital assessment data revealed an aggregate improvement of 36% in sterile processing benchmarks. While all participants reported increased knowledge and confidence (quantitative), rural participants conveyed a lack of support (qualitative) to implement practice changes. Conclusion The training course produced improvements in both rural and urban facilities. Findings highlight the importance of informing administrators of the rationale for needed improvements, ensuring funding is available to implement recommendations, and for governments to hold administrators accountable for improvements aligning with universally recommended sterile processing standards.

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Implementation of surgical site infection surveillance in low- and middle-income countries: A position statement for the International Society for Infectious Diseases

Cited by 34 publications

References 62 publications

Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis

Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis

Infection Prevention and Control (IPC) Implementation in Low-Resource Settings: A Qualitative Analysis

Improving sterile processing practices in Cambodian healthcare facilities

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