Implementation of infection prevention and control in acute care hospitals in Mainland China – a systematic review

Abstract

BackgroundHealthcare-associated infections (HAIs) and antimicrobial resistance (AMR) affect patients in acute-care hospitals worldwide. No systematic review has been published on adoption and implementation of the infection prevention and control (IPC) key components. The objective of this systematic review was to assess adoption and implementation of the three areas issued by the “National Health Commission of the People’s Republic of China” in acute-care hospitals in Mainland China, and to compare the findings with the key and core components on effective IPC, issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).MethodsWe searched PubMed and the Chinese National Knowledge Infrastructure for reports on the areas “structure, organisation and management of IPC”, “education and training in IPC”, and “surveillance of outcome and process indicators in IPC” in acute-care facilities in Mainland China, published between January 2012 and October 2017. Results were stratified into primary care hospitals and secondary/tertiary care hospitals.ResultsA total of 6580 publications were retrieved, of which 56 were eligible for final analysis. Most of them were survey reports (n = 27), followed by observational studies (n = 17), and interventional studies (n = 12), either on hand hygiene promotion and best practice interventions (n = 7), or by applying education and training programmes (n = 5). More elements on IPC were reported by secondary/tertiary care hospitals than by primary care hospitals. Gaps were identified in the lack of detailing on organisation and management of IPC, education and training activities, and targets of surveillance such as central line-associated bloodstream infections, ventilator associated pneumonia, catheter-associated urinary tract infections, and Clostridium difficile infections. Information was available on adoption and implementation of 7 out of the 10 ECDC key components, and 7 out of the 8 WHO core components.ConclusionTo variable degrees, there is evidence on implementation of all NHCPRC areas and of most of the ECDC key components and the WHO core components in acute care hospitals in Mainland China. The results are encouraging, but gaps in effective IPC were identified that may be used to guide future national policy-making in Mainland China.Electronic supplementary materialThe online version of this article (10.1186/s13756-019-0481-y) contains supplementary material, which is available to authorized users.

Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China

“…Globally, until 28 th February 2020 there have been reported 83,774 confirmed cases and 2,867 deaths [2]. During the periods of outbreak of COVID-19 or other infectious diseases, implementations of infection prevention and control (IPC) becomes a great importance in healthcare settings [3], particularly the great importance of personal protection of healthcare workers [4]. In order to contain the outbreak of COVID-19 in Mainland China, National Health Commission of the People's Republic of China (NHCPRC) have so far dispatched medical support teams (41,600 healthcare workers from 30 provinces and municipalities) to support the medical treatment in Wuhan and Hubei province [5].…”

Prevenção relacionada à exposição ocupacional do profissional de saúde no cenário de COVID-19 [Prevention related to the occupational exposure of health professionals workers in the COVID-19 scenario] [Prevención relacionada cone la exposición ocupacional de profesionales de la salud en el escenario COVID-19]

“…No contexto de pandemia de COVID-19, mas também considerando outras doenças infecciosas, a implementação de medidas de prevenção e controle de contaminação ocupacional é de extrema relevância nos serviços de saúde, especialmente pela necessidade de proteção individual dos profissionais que possam ser infectados 19 .…”

Will the status of infection prevention and control (IPC) professionals be improved in the context of COVID-19?

“…Before the emergency outbreak of COVID-19, most IPC professionals faced structural/hierarchical challenges, including but not limited to power struggles in influencing the IPC practices in the clinical departments. 5 Also, in the hospital management level, IPC services (ie, routine IPC measures, emergency preparedness, and responses) have not been considered as important as clinical and nursing services. Therefore, IPC professionals had to undertake greater accountability of risks and pressures for implementing IPC outbreak management strategies.…”

“…In fact, IPC nurses are traditionally still the key players, and this makes other professionals reluctant to be assigned to an IPC position by hospital management. 5 Also, in the national level, few medical sources were invested for cultivating interdisciplinary talents in the field of IPC. Therefore, expert panel of Steering Committee for fighting against COVID-19 in Mainland China highly recommended that IPC education and training (especially emergency preparedness and responses) should be initiated and made compulsory in all medical undergraduate courses.…”