A national survey on the implementation of key infection prevention and control structures in German hospitals: results from 736 hospitals conducting the WHO Infection Prevention and Control Assessment Framework (IPCAF)

Abstract

Background Healthcare-associated infections (HAI) pose a burden on healthcare providers worldwide. To prevent HAI and strengthen infection prevention and control (IPC) structures, the WHO has developed a variety of tools and guidelines. Recently, the WHO released the Infection Prevention and Control Assessment Framework (IPCAF), a questionnaire-like tool designed for assessing IPC structures at the facility level. The IPCAF reflects the eight WHO core components of IPC. Data on the implementation of IPC measures in German hospitals are scarce. Therefore, it was our objective to utilize the IPCAF in order to gather information on the current state of IPC implementation in German hospitals, as well as to promote the IPCAF to a broad audience. Methods The National Reference Center for Surveillance of Nosocomial Infections (NRZ) sent a translated version of the IPCAF to 1472 acute care hospitals in Germany. Data entry and transfer to the NRZ was done electronically between October and December 2018. The IPCAF was conceived in a way that depending on the selected answers a score was calculated, with 0 being the lowest possible and 800 the highest possible score. Depending on the overall score, the IPCAF allocated hospitals to four different “IPC levels”: inadequate, basic, intermediate, and advanced. Results A total of 736 hospitals provided a complete dataset and were included in the data analysis. The overall median score of all hospitals was 690, which corresponded to an advanced level of IPC. Only three hospitals (0.4%) fell into the category “basic”, with 111 hospitals (15.1%) being “intermediate” and 622 hospitals (84.5%) being “advanced”. In no case was the category “inadequate” allocated. More profound differences were found between the respective core components. Components on multimodal strategies and workload, staffing, ward design and bed occupancy revealed the lowest scores. Conclusions IPC key aspects in general are well established in Germany. Potentials for improvement were identified particularly with regard to workload and staffing. Insufficient implementation of multimodal strategies was found to be another relevant deficit. Our survey represents a successful attempt at promoting the IPCAF and encouraging hospitals to utilize WHO tools for self-assessment. Electronic supplementary material The online version of this article (10.1186/s13756-019-0532-4) contains supplementary material, which is available to authorized users.

Evaluating infection prevention and control programs in Austrian acute care hospitals using the WHO Infection Prevention and Control Assessment Framework

“…However, given the rather low scores achieved by Austrian hospitals for CC5 (Multimodal Strategies for Implementation of IPC Interventions), it appears that awareness for and implementation of multimodal strategies are not yet fully accomplished. A similar deficit was illustrated in an analysis of the German IPCAF data [8]. A conclusion, which could be derived from these data, is that any efforts to strengthen IPC in high-income countries, should place an emphasis on multimodal strategies.…”

“…Participation was on a voluntary basis. The specifics of survey organization were described in more detail in a previous publication [8]. To comply with data protection regulations, no linkage of survey data with other structural and process parameters, or data on HAI was undertaken.…”

“…Due to the novelty of the IPCAF, data on results derived from its application are scarce. In a previous publication, we described the use of the IPCAF in the context of a national survey in Germany [8]. The survey demonstrated that IPC is generally at a high level in German acute care hospitals, particularly with regard to HAI surveillance.…”

Infection prevention and control situation in public hospitals of Islamabad

“…Likewise, a study conducted in Nepal, a developing Asian country, reported that only 27% of the participants (doctors and nurses) had received infection prevention and control training [19]. This is in stark contrast to results of a study conducted in a developed country where high proportion (> 99%) of the healthcare facilities imparted educational courses about infection prevention and control [15]. Health education and training is crucial to impart knowledge regarding IPC and thereby improve IPC implementation.…”

“…Our results are in contrast to developed countries like Germany, where a nationwide study was conducted using the IPCAF tool in 736 hospitals. Only three facilities fell into the category of basic (score between 200 and 400) and 622 facilities were in the advanced group (score between 600 and 800) [15]. The classification of inadequate was not assigned to any healthcare facility.…”