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

Abstract

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.

Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings: a qualitative study

“…The use of IPC champions as trainers and mentors is an approach recommended by WHO in their Core Components for Infection Prevention and Control at the healthcare facility [ 31 ]. Bundled IPC interventions have also seen success in low-resource settings, with potential to be implemented in conflict-affected settings such as those in this study [ 42 , 43 ]. Across fifteen LMICs and 86 intensive care units, an intervention bundle including education, constant performance feedback and outcome and process surveillance improved IPC protocol adherence among staff and the incidence of the HAI under study [ 44 ], demonstrating the potential of low-cost and high-impact multi-component interventions in these settings.…”

“…One example includes the response to global PPE shortages, a challenge that was common for hospitals in our study before the onset of the pandemic. In such settings where supply chain disruptions and insecurity can result in inadequate PPE supply, the WHO’s guidance on the rational use, decontamination and reprocessing of PPE for covid-19 could be reviewed to create locally tailored solutions to mitigate the impact of PPE shortages [ 42 ].…”

A hospital-based prospective cohort study to assess the factors associated with transmission dynamics of SARS CoV-2 among healthcare workers in Delhi

“…15 Apart from training, building and promoting an IPC resilient system requires input from IPC professionals, thus building a career path in facilitating a behaviour change among HCWs at the state and national levels. 17,18 Ensuring adequate supplies of PPE, sanitizers and handwashing stations, placed at easily visible and accessible places, could enhance the utilization of these resources. 18 The chances of secondary infection were seen to be significantly higher among those with face-to-face exposure (p = 0.039), contact with patient body fluid fluids (p = 0.014), or patient materials (p < 0.001).…”

“…17,18 Ensuring adequate supplies of PPE, sanitizers and handwashing stations, placed at easily visible and accessible places, could enhance the utilization of these resources. 18 The chances of secondary infection were seen to be significantly higher among those with face-to-face exposure (p = 0.039), contact with patient body fluid fluids (p = 0.014), or patient materials (p < 0.001). This was surprising considering that these routes of transmission are less commonly recognized yet showed significant risk of infection.…”

A hospital-based prospective cohort study to assess the factors associated with transmission dynamics of SARS CoV-2 among healthcare workers in Delhi

“…15 Apart from training, building and promoting an IPC resilient system requires input from IPC professionals, thus building a career path in facilitating a behaviour change among HCWs at the state and national levels. 17,18 Ensuring adequate supplies of PPE, sanitizers and handwashing stations, placed at easily visible and accessible places, could enhance the utilization of these resources. 18 The chances of secondary infection were seen to be significantly higher among those with face-to-face exposure (p = 0.039), contact with patient body fluid fluids (p = 0.014), or patient materials (p < 0.001).…”