Core components of infection prevention and control programs at the facility level in Georgia: key challenges and opportunities

Abstract

Background The Georgia Ministry of Labor, Health, and Social Affairs is working to strengthen its Infection Prevention and Control (IPC) Program, but until recently has lacked an assessment of performance gaps and implementation challenges faced by hospital staff. Methods In 2018, health care hospitals were assessed using a World Health Organization (WHO) adapted tool aimed at implementing the WHO’s IPC Core Components. The study included site assessments at 41 of Georgia’s 273 hospitals, followed by structured interviews with 109 hospital staff, validation observations of IPC practices, and follow up document reviews. Results IPC programs for all hospitals were not comprehensive, with many lacking defined objectives, workplans, targets, and budget. All hospitals had at least one dedicated IPC staff member, 66% of hospitals had IPC staff with some formal IPC training; 78% of hospitals had IPC guidelines; and 55% had facility-specific standard operating procedures. None of the hospitals conducted structured monitoring of IPC compliance and only 44% of hospitals used IPC monitoring results to make unit/facility-specific IPC improvement plans. 54% of hospitals had clearly defined priority healthcare-associated infections (HAIs), standard case definitions and data collection methods in their HAI surveillance systems. 85% hospitals had access to a microbiology laboratory. All reported having posters or other tools to promote hand hygiene, 29% had them for injection safety. 68% of hospitals had functioning hand-hygiene stations available at all points of care. 88% had single patient isolation rooms; 15% also had rooms for cohorting patients. 71% reported having appropriate waste management system. Conclusions Among the recommended WHO IPC core components, existing programs, infrastructure, IPC staffing, workload and supplies present within Georgian healthcare hospitals should allow for implementation of effective IPC. Development and dissemination of IPC Guidelines, implementation of an effective IPC training system and systematic monitoring of IPC practices will be an important first step towards implementing targeted IPC improvement plans in hospitals.

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

“…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.…”

“… 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 …”

“…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. 17 has demonstrated the crucial role of these aspects to reduce pathogen transmission, particularly in outbreak situations.…”

Designing an optimal infection prevention service: Part 1

“…This was indeed highlighted by participants in this phase of this study. Another study by Deryabina et al (2021) used the WHO IPC core components to perform an assessment of IPC practice across 41 hospitals in Georgia. They also reported that most IPC programmes were not comprehensive and that they did not articulate clear objectives, workplans, targets or budgets.…”

“…Additionally, IPC staff shortages prevented regular education to be delivered. A recent study by Deryabina et al (2021) used the WHO IPC core components to perform an assessment of IPC practice across 41 hospitals in Georgia. They also found that IPC education provided for healthcare professionals was considerably variable, inconsistent, and inadequate in that it did not result in improved staff knowledge and patient outcomes.…”