Table 6.
The 2023 status of the gaps identified in the different components of the IPC programmes at the three tertiary hospitals in Freetown, Sierra Leone in 2021.
| Core Components | Components of Hospitals IPC Programmes | |
|---|---|---|
| Gaps in 2021 * | Status in 2023 | |
| IPC program | No dedicated budget for the IPC programme | The gap still existed |
| IPC guideline | No written guidelines for Outbreak management and preparedness. Prevention of the different types of HAI |
Available guidelines for the prevention of the different types of HAI were in the updated national IPC guidelines. However, there were no written guidelines for outbreak management and preparedness |
| IPC education and training | No regular IPC training was conducted for healthcare workers and administrative staff IPC training was not integrated into clinical practice, as well as the training of specialists No IPC training for patients or family members to minimise HAI No certified continuous professional development courses for IPC focal persons |
Three out of the four gaps existed as only health education had been conducted for patients and family members to minimise HAI |
| HAI surveillance | No information technology support to conduct surveillance activities No HAI surveillance was being conducted by hospitals except for PCMH conducting SSI surveillance No analysis of antimicrobial drug resistance data, due to a lack of microbiology capacity |
Two out of the three gaps still existed as there was available information technology support to conduct surveillance activities in all the hospitals |
| Multimodal strategies | Safety climate and culture change were not included in the multimodal strategy A multidisciplinary team was not used to implement the multimodal strategies |
A multidisciplinary team was used to implement the multimodal strategy. However, there was still a need for safety climate and culture change to be included in the multimodal strategy |
| Monitoring/audit of IPC practice | No defined monitoring plan with clear goals, targets, and activities No hospitals monitored: Intravascular catheter insertion and/or care; wound dressing drainage; and consumption of alcohol-based hand rub |
Only one (PCMH) out of the three hospitals had a defined monitoring plan with clear goals, targets, and activities. Intravascular catheter insertion and/or care; wound dressing drainage; and consumption of alcohol-based hand rub were not monitored in all three hospitals |
| Workload, staffing and bed occupancy | Staffing levels were not assessed according to patient workload and there was no agreed healthcare-worker-to-patient ratio across the hospitals No system in place to assess and respond when bed capacity was exceeded Inadequate bed spacing in certain departments across all the hospitals |
All the gaps still existed |
| Built environment, materials and equipment | No reliable safe drinking water always available for staff, patients, and family members and in all locations No single-patient rooms for grouping patients with similar pathogens The constructed burning pit/waste dump in the hospitals had insufficient dimensions Non-functional incinerators in the hospitals Disposable items, such as examination gloves, facemasks, and aprons, were not continuously available |
Only Connaught Hospital had a functional incinerator |
* Source [13]. IPC—Infection Prevention Control; IPCAF—Infection Prevention and Control Assessment Framework at the hospital level. Maximum IPCAF score was 800: 0–200 Inadequate; 201–400 Basic; 401–600 Intermediate; and 601–800 Advanced. In this study, a gap was assigned to those scoring below 25 in any core component.