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Lee YF, Lai WH, Lee PY, Ting SCY, Nuja IA, Ngian HU, Wang J. Acceptability and tolerability of alcohol-based hand rubs among health workers and concessionaires in Malaysia during the COVID pandemic: a hospital-wide cross-sectional study using a modified WHO protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:3489-3502. [PMID: 38287203 DOI: 10.1080/09603123.2024.2309324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
This study evaluated the acceptability and tolerability of three alcohol-based hand rubs (ABHRs) at Sarawak General Hospital, Malaysia. Conducted from 12-26 November 2021 using a modified WHO Protocol, it involved a survey among health workers and concessionaires, with a 35% response rate (1,598 of 4,628 participants). The majority were nurses (60.8%), with the medical division most represented (28.4%). Most respondents (93.2%) used ABHRs at least five days a week and found them easily accessible (72.3%). Product B was the preferred ABHR (65%), primarily for its color and fragrance, surpassing WHO's 50% approval rate in these aspects. However, no other product features met WHO criteria. There were no significant differences in self-reported skin tolerability across the products, and none achieved overall WHO approval. These results offer important insights for ABHR selection in developing countries and highlight the value of the WHO Protocol in assessing product acceptability and tolerability.
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Affiliation(s)
- Yew Fong Lee
- Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
- School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Wei Hong Lai
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Peh Yee Lee
- Infection Prevention and Control Unit, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Samual Chuo Yew Ting
- Pharmaceutical Services Division, Sarawak State Health Department, Ministry of Health, Kuching, Malaysia
| | - Irena Albert Nuja
- Infection Prevention and Control Unit, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Hie Ung Ngian
- Hospital Director's Office, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Jiancong Wang
- Institute of Biometry and Epidemiology, The German Diabetes Center, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Boyce JM, Pittet D. Rinse, gel, and foam - is there any evidence for a difference in their effectiveness in preventing infections? Antimicrob Resist Infect Control 2024; 13:49. [PMID: 38730473 PMCID: PMC11084031 DOI: 10.1186/s13756-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). METHODS Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. RESULTS The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. CONCLUSIONS Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.
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Affiliation(s)
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Gobte NJ, Gozdzielewska L, Kc D, Sithole BL, Vorndran A, McAloney-Kocaman K, Mehtar S, Price L. Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon. Am J Infect Control 2024; 52:274-279. [PMID: 37741291 DOI: 10.1016/j.ajic.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital. METHODS It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance. RESULTS 5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml). CONCLUSIONS Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.
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Affiliation(s)
- Nkwan J Gobte
- Baptist Training School for Health Personnel, Cameroon Baptist Convention Health Services, Banso, Cameroon
| | - Lucyna Gozdzielewska
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - Deepti Kc
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - Anna Vorndran
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | | | - Shaheen Mehtar
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | - Lesley Price
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
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Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
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Deryabina A, Aiypkhanova A, Juvashev A, Alimbetov K, Tekebayev K, Kassa G, Howard AA. Core components of infection prevention and control programs at the facility level in Kazakhstan: key challenges and opportunities. Antimicrob Resist Infect Control 2023; 12:59. [PMID: 37349829 PMCID: PMC10286477 DOI: 10.1186/s13756-023-01264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Kazakhstan is developing a National Roadmap to strengthen its Infection Prevention and Control (IPC), but until recently has lacked a country-wide facility-level assessment of IPC performance gaps. METHODS In 2021, the World Health Organization (WHO)'s IPC Core Components and Minimal Requirements were assessed at 78 randomly selected hospitals across 17 administrative regions using adapted WHO tools. The study included site assessments, followed by structured interviews with 320 hospital staff, validation observations of IPC practices, and document reviews. RESULTS All hospitals had at least one dedicated IPC staff member, 76% had IPC staff with any formal IPC training; 95% established an IPC committee and 54% had an annual IPC workplan; 92% had any IPC guidelines; 55% conducted any IPC monitoring in the past 12 months and shared the results with facility staff, but only 9% used monitoring data for improvements; 93% had access to a microbiological laboratory for HAI surveillance, but HAI surveillance with standardized definitions and systematic data collection was conducted in only one hospital. Adequate bed spacing of at least 1 m in all wards was maintained in 35% of hospitals; soap and paper towels were available at the hand hygiene stations in 62% and 38% of hospitals, respectively. CONCLUSIONS Existing IPC programs, infrastructure, IPC staffing, workload and supplies present within hospitals in Kazakhstan allow for implementation of effective IPC. Development and dissemination of IPC guidelines based on the recommended WHO IPC core components, improved IPC training system, and implementation of systematic monitoring of IPC practices will be important first steps towards implementing targeted IPC improvement plans in facilities.
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Affiliation(s)
- Anna Deryabina
- Mailman School of Public Health, ICAP at Columbia University, 34/1 Samal-3, 050051, Almaty, Kazakhstan.
| | | | - Almat Juvashev
- Mailman School of Public Health, ICAP at Columbia University, 34/1 Samal-3, 050051, Almaty, Kazakhstan
| | - Kuanysh Alimbetov
- National Centre for Public Health of the Ministry, Astana, Kazakhstan
| | - Kanat Tekebayev
- National Centre for Public Health of the Ministry, Astana, Kazakhstan
| | - Getachew Kassa
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| | - Andrea A Howard
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
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Huang PC, Chien LY, Huang HP. Assessing hand hygiene knowledge, attitude, behavior and adherence among nursing assistants: A cross-sectional study. Geriatr Nurs 2023; 51:232-237. [PMID: 37018849 DOI: 10.1016/j.gerinurse.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE This study explored hand hygiene knowledge, attitude, behaviors and adherence amongst nursing assistants. METHODS This cross-sectional study was conducted with structured questionnaires and direct observation. Nursing assistants were recruited from two long-term care facilities in eastern Taiwan from July to September, 2021. RESULTS The nursing assistants had high levels of hand hygiene knowledge, attitude, and behavior, however, the direct observational revealed hand hygiene adherence at 58.6% with 17.99 seconds duration on average. Comparing with alcohol-based hand rub, the nursing assistants performed very low adherence rate with soap and water wash, and the use of paper towel was the least followed skill applying to soap and water wash. CONCLUSIONS The study finds that hand wash with soap and water has lower adherence than the alcohol-based hand rub. Future innovations in hand hygiene, such as accessible and easy-to-use hand washing agents and easy-to-remember hand cleansing techniques will be valuable.
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Affiliation(s)
- Pei-Chun Huang
- Department of Nursing, Yuanshan Branch, Taipei Veterans General Hospital; Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Tao-Yuan City 33303, Taiwan
| | - Li-Yu Chien
- Department of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Rd., Gui-Shan Dist., Tao-Yuan City 33303, Taiwan
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Rd., Gui-Shan Dist., Tao-Yuan City 33303, Taiwan.
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van Dijk MD, Waltmans-den Breejen CM, Vermeeren JMJJ, van den Berg S, van Beeck EF, Vos MC. Compliance with a novel hand hygiene protocol tailored to non-sterile healthcare workers in the operating theatre. J Hosp Infect 2023; 131:173-180. [PMID: 36328310 DOI: 10.1016/j.jhin.2022.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCWs) in the operating theatre (OT) is challenging as there are no tailored protocols or observation tools. AIM To develop and test a hand hygiene protocol tailored to non-sterile HCWs in the OT. METHODS In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95% confidence intervals (CI) were calculated by type of hospital and type of HCW. FINDINGS The protocol has three sections: (1) written general hand hygiene rules; (2) written hand hygiene rules specific for anaesthesia and surgery; and (3) visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing area. Average HHC of 48.0% (95% CI 45.2-61.2%) was observed in OTs across all hospitals. HHC was highest in the two specialized hospitals (64.0%, 95% CI 30.6-89.8%; 76.7%, 95% CI 62.8-84.5%) and lowest in the academic teaching hospital (23.1%, 95% CI 0.0-45.8%). In terms of type of HCW, HHC was lowest among anaesthesiologists (31.6%, 95% CI 19.2-62.4%) and highest among OT assistants (57.4%, 95% CI 50.1-78.2%). CONCLUSION This uniform way of observing HHC in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50%; this needs to be addressed, particularly in teaching hospitals and among physicians.
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Affiliation(s)
- M D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - C M Waltmans-den Breejen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - J M J J Vermeeren
- Department of Quality and Patient Care, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - S van den Berg
- Department of Anaesthesiology, Ikazia Hospital Rotterdam, Rotterdam, the Netherlands
| | - E F van Beeck
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - M C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Wu S, Wang RS, Huang YN, Wan TTH, Tung TH, Wang BL. Effect of Hand Hygiene Intervention in Community Kindergartens: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14639. [PMID: 36429356 PMCID: PMC9691028 DOI: 10.3390/ijerph192214639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to evaluate the effect of hand hygiene interventions on the overall hand hygiene (HH) status of teaching instruction of hand hygiene in kindergartens, given the vulnerability of kindergarten children and their high risk due to infectious diseases and the current COVID-19 epidemic. We investigated the HH status of teachers from two kindergartens in the same community. The participants were recruited from 28 classes in both kindergartens. After completing the baseline survey, the intervention program consisted of three components: lectures on infectious diseases, lectures on HH, and seven-step hand washing techniques conducted in two kindergartens. The intervention program effectively increased teachers' perceived disease susceptibility (p < 0.05), reduced the total bacterial colonization of children's hands (p < 0.001), and improved the HH environment (p < 0.01). We recommend that health authorities or kindergartens adopt this HH intervention program to effectively improve the HH status in kindergartens and allow for preventive responses to the COVID-19 epidemic or other emerging infectious diseases.
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Affiliation(s)
- Shiyang Wu
- Department of Public Health, Macau University of Science Technology, Macau 999078, China
| | - Richard Szewei Wang
- Affiliation Program of Data Analytics and Business Computing, Stern School of Business, New York University, New York, NY 10012, USA
| | - Yu-Ni Huang
- College of Public Health, National Taiwan University, Taipei 100, Taiwan
| | - Thomas T. H. Wan
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, China
| | - Bing-Long Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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KHosravi N, Alami A, Aelami MH, KHosrovan S. Improving Hand Hygiene Compliance of Intensive Care Unit by Using Pender's Model. Ethiop J Health Sci 2021; 31:553-560. [PMID: 34483612 PMCID: PMC8365475 DOI: 10.4314/ejhs.v31i3.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background Hand hygiene (HH) compliance is an effective behavior in controlling hospital-acquired infection because the hand is the main means of transmitting infections in patient-medical staff communication as well as the inanimate environment. This study aimed to explore the effect of applying Pender's Health Promotion Model on the HH compliance of intensive care unit staff. Methods This quasi-experimental study with a single research group was conducted from January to July in 2019. The required data were collected from 90 staff of the intensive care units of Imam Reza Hospital in Mashhad, Iran through 1796 and 2343 opportunity of monitoring before and after the intervention. The data collection instruments were a standard HH observation form and a researcher-made HH questionnaire in the light of Pender's health promotion model. The data were statistically analyzed in SPSS using Paired-samples T-test and Chi-squared test. Results The mean age of the 90 included participants was 35.92 (± 6.5) years and the mean length of their work experience was 10 (±1.5). The hand hygiene index rose from 23% before the intervention to 41.4% after the intervention (p=0.001). Moreover, statistically significant differences were found in moments after touching surroundings (p=0.001), before and after touching a patient (p=0.001), and also in perceived barriers (p=0.015), interpersonal influences (p=0.008) and situational influences (p<0.001). Conclusion Pender's model showed to have improved the staff's HH compliance as a professional behavior.
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Affiliation(s)
- Nasrin KHosravi
- Department of Community Health Nursing & Management Nursing, School of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali Alami
- Department of Social Medicine, Social Determinants of Health Research Center, School of Public Health Faculty, Gonabad University of Medical Sciences, Gonabad, Iran. Orcid ID: https://orcid.org/0000-0002-8882-3110
| | - Mohammad Hasan Aelami
- Department of Pediatrics, School of Medicine, Antimicrobial Resistance Research Center, Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahla KHosrovan
- Department of Community Health Nursing & Management Nursing, School of Nursing, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad
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Tomczyk S, Storr J, Kilpatrick C, Allegranzi B. Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis. Antimicrob Resist Infect Control 2021; 10:113. [PMID: 34332622 PMCID: PMC8325287 DOI: 10.1186/s13756-021-00962-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
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.
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Affiliation(s)
- Sara Tomczyk
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Julie Storr
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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