Infection prevention and control situation in public hospitals of Islamabad

Abstract

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.

The first WHO global survey on infection prevention and control in health-care facilities

“…14,15 In Pakistan, the total IPCAF scores among five hospitals in Islamabad scored as inadequate. 23 In our study, HAI surveillance and monitoring and feedback of IPC practices scored lowest among low-income countries, similar to the study in Pakistan and another study in Georgia among 41 hospitals using an adapted version of the IPCAF. 23,25 Core components related to workload, staffing, and bed occupancy and IPC education and training scored the lowest across all income and care levels, irrespective of the fact that evidence supporting the WHO guidelines Only includes complete survey responses from health-care facilities that responded to both surveys overall and for the relevant core components.…”

“…26 Gaps in the effective implementation of IPC training programmes have also been highlighted by other single-country IPCAF surveys. 23,25 In our study, very few facilities in low-income countries had access to a full-time IPC professional and significantly lower scores were found for core components 1 and 2, indicating defective IPC programmes and limited availability of guidelines. Efforts to build or participate in recognised IPC certification pathways should be strongly encouraged, such as the training programmes offered by the European Committee on Infection Control and the Infection Control African Network.…”

Evaluation of Infection Prevention and Control Training Workshops Using Kirkpatrick's Model

“…Participants however felt it would be more useful to distribute hard copies. A few participants (12) were unsatisfied with the length of training whereas 25 remained "neutral". Analysis of open ended questions revealed that participants felt trainings were intense and should have been spread over a longer period.…”

“…Infection prevention and control (IPC) is a largely overlooked domain in healthcare facilities in the country. To assess the existent state of IPC in HCFs, audits were conducted using the WHO's Infection Prevention and Control Assessment Framework (IPCAF) (Savul et al, 2020). All HCFs scored poorly denoting major deficiencies in IPC implementation with need of urgent reforms (Savul et al, 2020).…”

“…A crucial component of IPC is education and training of health workforce for provision of safe and effective healthcare as advocated by the World Health Organization (WHO 2018). Results of IPC audits in Islamabad, Pakistan revealed large numbers of untrained healthcare workers and underscored the critical and immediate need for their training (Savul et al, 2020).…”