Implementation of the WHO Core Components of an Infection Prevention and Control Programme in two Sub-Saharan African Acute Health-Care Facilities: a Mixed Methods Study

Abstract

Background The coronavirus pandemic again highlighted the need for robust health care facility infection prevention and control (IPC) programmes. WHO guidelines on the core components (CCs) of IPC programmes provides guidance for facilities, but their implementation can be difficult to achieve in resource-limited settings. We aimed to gather evidence on an initial WHO IPC implementation experience using a mixed methods approach. Methods A five-day training on the WHO IPC CCs was conducted at two reference acute health care facilities in the Democratic Republic of Congo and Burkina Faso. This was accompanied by a three-part mixed-methods evaluation consisting of a: 1) baseline and follow-up survey of participants’ knowledge, attitudes and practices (KAP), 2) qualitative assessment of plenary discussion transcripts and 3) deployment of the WHO IPC assessment framework (IPCAF) tool. Results were analysed descriptively and with a qualitative inductive thematic approach. Results Twenty-two and twenty-four participants were trained at each facility, respectively. Baseline and follow-up KAP results suggested increases in knowledge related to the necessity of a dedicated IPC focal person and annual evaluations of IPC training although lack of recognition on the importance of including hospital leadership in IPC training and hand hygiene monitoring recommendations remained. Most participants reported rarely attending IPC meetings or participating in IPC action planning although attitudes shifted towards stronger agreement with the feeling of IPC responsibility and importance of an IPC team. A reocurring theme in plenary discussions was related to limited resources as a barrier to IPC implementation, namely lack of reliable water access. However, participants recognised the importance of IPC improvement efforts such as practical IPC training methods or the use of data data to improve quality of care. The facilities’ IPCAF scores reflected a ‘basic/intermediate’ IPC implementation level. Conclusions The training and mixed-methods evaluation revealed initial IPC implementation experiences that could be used to inform stepwise approaches to facility IPC improvement in resource-limited settings. Implementation strategies should consider both global standards such as the WHO IPC CCs and specific local contexts. The early involvement of all relevant stakeholders and parallel efforts to advocate for sufficient resources and health system infrastructure are critical.

Global burden of fungal skin diseases: An update from the Global Burden of Diseases Study 2019

“…33 This susceptibility is compounded by potentially higher environmental exposure to infections, crowded living conditions, and improper hygiene practices, which collectively accelerate the spread and development of fungal skin diseases. [34][35][36] Elderly individuals are more prone to infection due to compromised skin integrity and diminished immune responses, leading to significantly increased incidence rates and YLD rates. 37 The higher number of elderly patients in highincome countries is attributed to their demographic composition.…”

“…Children and adolescents have immature immune systems, making them more susceptible to fungal pathogens 33 . This susceptibility is compounded by potentially higher environmental exposure to infections, crowded living conditions, and improper hygiene practices, which collectively accelerate the spread and development of fungal skin diseases 34–36 . Elderly individuals are more prone to infection due to compromised skin integrity and diminished immune responses, leading to significantly increased incidence rates and YLD rates 37 .…”