15 INFECTION PREVENTION AND CONTROL

Countries should have strong, effective infection prevention and control (IPC) programmes that enable safe health care and essential services delivery and prevention and control of health care acquired infections (HCAIs). It is critical to initially ensure that at least the minimum requirements for IPC are in place, both at the national and facility level, and to gradually progress to the full achievement of all requirements within the WHO IPC core components recommendations.

IMPACT:

Prevent HCAIs and emergence and spread of AMR.

MONITORING AND EVALUATION:

(1) National IPC programme strategy has been developed and disseminated. (2) Implementation of national IPC programme plans, with monitoring and reporting of HCAIs. (3) Established national standards and resources for safe health facilities.

Benchmark 15.1

National and health facility level IPC programmes are in place

Objective To have active IPC programmes implemented at national and healthcare facility levels

01 NO CAPACITY

  1. An active national IPC programme or operational plan according to WHO minimum requirements is not available or is under development.

02 LIMITED CAPACITY

  1. Appoint a full time, dedicated and trained IPC focal point at the national level with defined ToRs.
  2. Establish a national IPC working group/committee involving all relevant stakeholders for IPC in health and relevant sectors, with ToRs, including developing a legal framework for the implementation of IPC programmes at the national, subnational and facility levels. *
  3. Identify an IPC focal person in health facilities to interact with the national IPC working group/committee
  4. Develop/adapt national IPC guidelines and SOPs according to the WHO minimum requirements for IPC programmes. *
  5. Develop IPC components for the national health emergency preparedness, readiness and response operational plan. *
  6. Use the WHO national IPC assessment tool for minimum requirements (IPCAT-MR) to identify and document gaps in the current IPC programe.
  7. Develop evidence-based strategic documents (policies, laws, strategies, etc.) to reinforce responsibility and commitment of the health sector in IPC management at national, subnational and facility levels. *
  8. Develop and advocate for a secure dedicated budget for IPC implementation based on plans, informed by local context budget cycles, local political/legal landscape analyses and impact assessments, utilizing local civil society organizations. Disseminate strategic documents on IPC management to all relevant stakeholders who may provide potential domestic and external sources of funding. *
  9. Establish linkages to complementary areas/programmes (e.g. water, sanitation and hygiene (WASH), quality, patient safety).
  10. Identify other sector focal points for services related to IPC in hospitals and community health facilities (such as environment, education, etc.).

03 DEVELOPED CAPACITY

  1. Disseminate national IPC guidelines to all health facilities.
  2. Design an operational plan, informed by assessment results, following the five step implementation cycle outlined in the WHO Interim practical manual at national level including input from WASH, RCCE and relevant sectors.
  3. Identify and allocate adequate financial resources for the implementation of the operational plan. *
  4. Appoint IPC committees and trained, dedicated IPC focal points in selected healthcare facilities with defined ToRs.
  5. Develop a national IPC curricula for new employee orientation, in-service training and national training programme for health workers based on national standards and guidelines. Include IPC modules in specific preservice health-oriented degrees (such as nursing, medicine, etc.). *
  6. Monitor IPC and WASH implementation in selected health care facilities. *
  7. Develop a national system for M&E of IPC programmes in health facilities for regular monitoring and periodic evaluation of IPC indicators including implementation of standard precautions (such as hand hygiene, WASH and other related IPC practices). *
  8. Develop and share the IPC and WASH operational plans with national, subnational and local IPC committees and incorporate their feedback/guidance. *
  9. Develop necessary infrastructure and supplies to enable implementation of IPC norms, standards and practices in special settings such as points of entry, industrial plants, waste management companies, sewage systems, schools and other community settings, etc.
  10. Include the importance of IPC/WASH including hand hygiene techniques, cough etiquette and other IPC measures to be adhered to by citizens and school children/students in all school curricula as appropriate to age.
  11. Involvement from NGOs and other donor agencies to provide support in developing infrastructure and technical expertise for IPC, particularly at the health facility level, and for the development of a M&E framework for health care professionals.

04 DEMONSTRATED CAPACITY

  1. Use IPC assessment tools at national level (IPCAT2) to identify areas still requiring action and update the operational plan.
  2. Mandate and support IPC improvement at all health facilities, recommending the use of the IPC assessment framework (IPCAF) and the WASH FIT tool. *
  3. Include specific interventions related to IPC for AMR prevention, tailored to the local epidemiological situation, in operational/action plans.
  4. Conduct IPC and WASH trainings for health workers at the commencement of employment, at regular intervals throughout employment and at specific trainings for health workers and IPC focal points at all levels and all health facilities. *
  5. Evaluate the status of IPC outbreak preparedness and readiness by organizing SimEx/AAR/IAR (as relevant) to test the functionality of IPC capacities for responding to health emergencies. *
  6. Monitor IPC implementation in all health facilities to evaluate IPC outcomes, with a target of 75% achieving WHO IPC minimum requirements.
  7. Adjust and increase budgetary allocations, using financial audit and disbursement data, from dedicated budget for IPC implementation, to support activities that require further implementation, additional financial resources and to ensure financial transparency. *
  8. Establish national IPC incident command structures for outbreak emergencies with other ministries and stakeholders. *
  9. Conduct training on WASH and IPC measures in relevant sectors.
  10. Prioritize and allocate space in the media sector to develop public awareness on roles and responsibilities in IPC in healthcare facilities.
  11. Develop standards for IPC measures in all relevant settings (outside of health facilities) such as points of entry, industrial plants, schools, community settings, etc.
  12. Routinely monitor health facility environments for functioning WASH infrastructures and services in relevant.

05 SUSTAINABLE CAPACITY

  1. Provide sustainable support to health facility IPC programmes at all levels. *
  2. Conduct annual IPC and WASH FIT assessments at healthcare facilities as part of their review cycle to address long term sustainability. *
  3. Conduct continuous monitoring of progress in fulfilling the IPC core components (such as assessments repeated annually or more often), tracking changes and scores to develop a long term improvement plan. *
  4. Analyse and regularly report national IPC and WASH data and support discussion on actions to incorporate lessons learned in a long term improvement plan. *
  5. Revise and update IPC and WASH guidance materials such as strategies, plans, SOPs and training materials, based on lessons learned and ongoing assessment results. *
  6. Evaluate the status of health workers’ protection against occupational infections and update as required (plans, SOPs, trainings, etc.). *
  7. Share country experiences in IPC and WASH and participate in international initiatives to strengthen capacities globally. *
  8. Conduct regular monitoring and periodic evaluation of good hygiene and infection prevention measures in all relevant settings (outside of health facilities) such as points of entry, industrial plants, school, community settings, etc.
  9. Regularly update IPC related norms and standards (based on lessons learned) for management of special settings such as points of entry, industrial plants, waste management companies, sewage systems, schools and other community settings, etc. based on normal and special health events in the country or globally

Benchmark 15.2

A functioning healthcare-associated infection (HCAI) surveillance system is in place for public health decision making

Objective To develop and maintain a functioning and effective system for HCAI surveillance (for ongoing surveillance of endemic HCAIs, including AMR pathogens, and for early detection of pathogens prone to infectious disease outbreaks) at national and health facility levels 

01 NO CAPACITY

  1. National HCAI surveillance system or national strategic plan for HCAIs surveillance, including endemic HCAIs, antimicrobial resistant pathogens and pathogens prone to infectious disease outbreaks, is not available or is under development.

02 LIMITED CAPACITY

  1. Identify the development of a HCAI surveillance system as a priority in national working group/committee for IPC. *
  2. Set up a national multidisciplinary technical advisory group for HCAI surveillance, establish a surveillance coordinating centre for HCAI and designate a national reference laboratory. *
  3. Identify and document minimum resources required to establish HCAI surveillance at the national level and selected tertiary facilities. *
  4. Review the availability and functional status of HCAI surveillance in the country.
  5. Design a HCAI surveillance system and designate as a priority action in health sector plans and budgets.
  6. Identify focal points at the national level for HCAI surveillance with linkages to communicable disease, AMR surveillance and WASH monitoring.
  7. Develop a national HCAI surveillance plan that includes standardized definitions and targeted organisms (including AMR pathogens), appropriate methods for surveillance and linkages with existing communicable or integrated disease surveillance systems.
  8. Develop training materials for professionals responsible for conducting HCAI surveillance at all health facility levels based on national standards/guidelines.
  9. Identify other sector focal points for developing and maintaining HCAI surveillance.

03 DEVELOPED CAPACITY

  1. Establish a national HCAI surveillance system as a core component of the national IPC programme, and implement HCAI surveillance (including endemic HCAIs, AMR pathogens and pathogens prone to infectious disease outbreaks) in selected tertiary and secondary health facilities in a stepwise manner.
  2. Develop laboratory capacity and provide resources to identify and report HCAI through a national surveillance system with linkages to communicable disease surveillance systems. *
  3. Include HCAI training into trainings for IPC focal points and relevant health workers within health facilities and conduct trainings regularly.
  4. Identify and allocate trained staff (or provide training to staff) to develop, implement and maintain HCAI surveillance programme at select health facilities.
  5. Coordinate with national and subnational surveillance networks that include syndromic and microbiologic surveillance for diseases with outbreak potential.
  6. Use data for benchmarking purposes (for example, establishing baselines for comparison).
  7. Provide timely feedback reports to relevant stakeholders on the national situation of HCAI and special events, including recommendations. *
  8. Prioritization, by NGOs and other donor agencies, to support establishing HCAI surveillance system and develop technical expertise using national standards/guidelines and associated training materials.

04 DEMONSTRATED CAPACITY

  1. Establish a national HCAI surveillance system (including endemic HCAIs, AMR pathogens and pathogens prone to infectious disease outbreaks, through integrated or separate systems) in all secondary and tertiary health facilities.
  2. Establish an M&E system, including to assess data quality (for example, review of case report forms, microbiology results, denominator determination) and surveillance programme attributes (for example, sensitivity, specificity, user acceptability).
  3. Collect, analyse and provide feedback based on data from HCAI surveillance system to relevant authorities, including AMR focal points, and update plans and actions as required. *
  4. Establish clear and regular reporting lines from facility to the national level.
  5. Conduct nationwide training in all facilities on HCAI surveillance for IPC focal points and other health workers responsible at the facility level at regular intervals.
  6. Identify and support healthcare facilities that are unable to adhere to the HCAI surveillance programme.
  7. Develop and implement linkages between hospital systems and national microbiology and other laboratory capacities to ensure surveillance, early detection and laboratory surge capacity for the rapid identification of diseases with outbreak potential. *

05 SUSTAINABLE CAPACITY

  1. Establish national networks for HCAI surveillance, also in connection to international networks (such as the European HCAI surveillance networks), as appropriate.
  2. Continuously document the incidence of patient and healthcare worker infections and the effectiveness of measures to reduce occurrence.
  3. Revise and update national strategic plans for HCAI surveillance based on data collected/M&E results.
  4. Use data collected to develop targeted prevention efforts, evaluate impact and re-evaluate on a regular basis.
  5. Regularly identify champion hospitals for adherence to HCAI surveillance standards including infections caused by emerging and/or antimicrobial resistant pathogens among humans and ensure feedback is given in a national forum (i.e. reports including data analyses, recommendations, highlights of special events, outbreaks and control measures, etc.).
  6. Share country experience in HCAI surveillance and participate in international initiatives to strengthen capacities globally.

Benchmark 15.3

Provide a safe environment in all health care facilities

Objective To ensure a safe environment in all healthcare facilities for health workers, patients, caregivers, visitors and any other service provider/user

01 NO CAPACITY

  1. National standards and resources for an environment enabling IPC (such as WASH, screening, triage, isolation areas and sterilization services in healthcare facilities), including appropriate infrastructure, materials and equipment are not available or are under development.
  2. Standards for reduction of workload and overcrowding for optimization of staffing levels in healthcare facilities are not available or under development.

02 LIMITED CAPACITY

  1. Review international guideline and the current national status of health care facilities in relation to water, sanitation, hygiene, cleaning, waste and energy services and document gaps or areas for improvement. *
  2. Identify and document gaps in WHO core components for IPC programmes number seven and eight and develop national plan for a safe built environment (core component 8) and overcrowding and optimization of staff levels (core component 7). *
  3. Define standards for IPC and WASH both in hospital and community (primary) health care settings. *
  4. Develop training materials based on national guidelines and standards for the development of a safe built environment, including when to start and stop isolation of patients, donning and doffing PPE and engineering and environmental controls. *
  5. Develop norms and standards in developing the safe built environment of healthcare facilities in relation to IPC, with special reference to crowd control measures, triage facilities, isolation rooms, ventilation, sewerage facilities, waste management, etc. *

03 DEVELOPED CAPACITY

  1. Implement the WHO IPCAF component eight minimum requirements for a safe built environment. *
  2. Mandate and support IPC improvement at all healthcare facilities, based on assessment results using the IPCAF and complimentary WASH FIT tools or national equivalents and use standard checklists to monitor the safety of the hospital environment at regular intervals and take corrective measures. *
  3. Update national building standards, standards for safe water, sanitation, hygiene, waste and clean energy services for healthcare facilities to enable compliance with IPC measures. *
  4. Establish hand hygiene facilities to adhere to hand hygiene requirements in both hospitals and community healthcare facilities. *
  5. Identify, document and practice minimum requirements for staffing, workload and bed occupancy standards to ensure IPC at healthcare facilities.
  6. Support, by NGOs and other donor agencies, to develop infrastructure and technical expertise for IPC.
  7. Establish and maintain sufficient supply of logistics to allow for a safe environment at health facilities.

04 DEMONSTRATED CAPACITY

  1. Organize procurement and make available a sufficient quantity of PPE, hygiene and disinfection products and other IPC related supplies for health workers. *
  2. Develop more advanced standards for water and sanitation services in healthcare facilities, including considering low carbon and environmentally sustainable healthcare facility standards. *
  3. Identify gaps and implement improvement actions in selected reference health facilities for safety in relation to WASH and energy services, built logistics, human resources and equipment and report to higher authorities to take corrective action using IPC assessment and WASH tools. *
  4. Update national and facility IPC action plans based on identified gaps and priority action areas. *
  5. Routinely monitor and evaluate health facility environment to ensure that patient care activities are conducted in a clean and/or hygienic environment, as well as the existence of functioning WASH infrastructures and services, appropriate IPC materials and equipment, and an adequate number and appropriate positioning of hand hygiene facilities, etc. *
  6. Clearly outline requirements for PPE and supplies (including cleaning supplies and equipment, alcohol based hand rub, soap, etc.), and establish contingency plans in the event of supply shortages. *

05 SUSTAINABLE CAPACITY

  1. Update health facility level plans regularly based on lessons learned and gap analysis/evaluations to identify priority areas and monitor progress. *
  2. Implement minimum requirements for a safe built environment, materials and equipment for IPC at the facility level at all levels, supported by a sustainable funding mechanism. *
  3. Provide sustainable financial and other support to healthcare facility IPC programmes at all levels. *
  4. Prioritize a sustainable budget for hospital safety in relation to IPC. *
  5. Prioritize funding to ensure safety and quality standards of environment in healthcare facilities in relation to IPC by domestic funds and donor funding mechanisms. *
  6. Identify and document best practices/lessons learned, and engage the country in peer-to-peer learning programmes at the subnational, national and international levels. *

* Participation and contribution of other sectors to action.

Tools