Table 1.
Frequent (≥ 3 occurrences) themes concerning IPC implementation lessons learned in low-resource settings according to each WHO core component
| Theme | Sub-themes | N* |
|---|---|---|
| Core Component 1: IPC programme | ||
| Need an approach to maintain “continuous” advocacy (n = 15) | Set up regular meetings with senior leadership/managers | 10 |
| IPC should be a part of routine meetings, presentations, or rounds | 5 | |
| May first need external technical assistance (n = 13) | National level should first support selected professionals to receive external IPC training and these professionals can then act as trainers in-country | 9 |
| External IPC experts should first review initial materials to ensure they meet IPC standards | 4 | |
| Use a stepwise approach to build required resources (n = 10) | Start with a small group of committed staff in addition to link nurses and regional staff | 6 |
| Need at least a small budget in the beginning for recognition | 4 | |
| Use specific activities or opportunities as “catalysts” for advocacy (n = 6) | Use of data (process or outcome measures) can help convince leadership of IPC’s importance, i.e. avoid "no data, no problem" | 3 |
| Publicize starting examples, e.g. hand hygiene, surgical site infections | 3 | |
| Promote linkages with health system (n = 6) | Link IPC personnel and team with the quality management team | 3 |
| Link IPC personnel and team with AMR team | 3 | |
| National IPC association can drive IPC improvement (n = 6) | National IPC association can be active in providing expert input and assisting with local adaption of materials | 6 |
| May need normative actions to convince stakeholders (n = 4) | Need legislation for recognition | 4 |
| Core Component 2: IPC guidelines | ||
| Consider specific approaches to operationalize guidelines (n = 16) | Link guidelines directly to training and workshops | 6 |
| Link guidelines directly to monitoring indicators | 4 | |
| Set guideline dissemination plan early during planning | 3 | |
| Designate dedicated multidisciplinary guideline implementation leads | 3 | |
| Use specific strategies for adaption of guidelines (n = 15) | Schedule ongoing meetings to review guidelines and regularly update them based on current evidence and practice | 5 |
| National IPC association can drive guidance development and adaption | 4 | |
| Meet with other public health programmes (e.g. maternal and child health, HIV, tuberculosis) and identify joint guideline themes and actions | 3 | |
| Develop a plan to collect local evidence to inform guidelines | 3 | |
| May first need external technical assistance (n = 12) | Hire external IPC expert for initial development and then locally adapt | 8 |
| Adapt international standard guidelines, e.g. WHO, ECDC, US CDC | 4 | |
| Core Component 3: IPC education and training | ||
| Consider specific training methods (n = 19) | Select 1–2 master trainers to first receive IPC expert training outside of the country | 5 |
| Consider multidisciplinary training, i.e. different staff together, to remove hierarchy | 4 | |
| Use a train-the-trainers structure | 4 | |
| May need initial IPC expert technical consultant and then can locally adapt training | 3 | |
| Ensure regular in-service workshops | 3 | |
| Promote linkages with health system and sustainability (n = 9) | Create an IPC career path, e.g. accreditation | 5 |
| Harmonize trainings across programmes, e.g. maternal and child health, HIV, tuberculosis | 4 | |
| Foster local IPC leadership during trainings (n = 7) | Require mandatory trained IPC hospital leads who can play an integral role in trainings | 4 |
| Identify local champion trainers and trainees at the facility level | 3 | |
| Core Component 4: HAI surveillance | ||
| Prioritise feasible but high-impact starting points or pilots (n = 30) | Start with surgical site infection (e.g. post caesarean-section, 30-day follow-up) pilot | 8 |
| Start with device-associated infection, e.g. urinary or bloodstream, pilot | 5 | |
| Start with severe acute respiratory infection pilot | 5 | |
| Use a stepwise fashion to slowly scale-up surveillance in a careful way | 5 | |
| Can start with paper-based system but develop transition plan for electronic surveillance | 4 | |
| Start with pilot in intensive care units | 3 | |
| Ensure multidisciplinary collaboration, mentorship (n = 26) | Conduct regular surveillance training and feedback, e.g. yearly seminars | 6 |
| Conduct site support visits, e.g. assessment of case finding, forms, denominator data | 5 | |
| Advocate for integration of HAI surveillance with AMR and stewardship efforts | 4 | |
| Create a technical working group on surveillance in National IPC or AMR committees | 4 | |
| Ensure that one hospital is effectively trained in surveillance and can provide leadership to other hospitals | 4 | |
| Promote frequent informal mentorship | 3 | |
| Carefully consider definitions and data quality processes (n = 22) | Conduct a careful structured discussion on adaption of case definitions, maintaining standards, consistency and predictive value | 7 |
| Reference US National Healthcare Safety Network (NHSN) definitions | 7 | |
| First identify who can collect, clean, and analyse data, i.e. invest in statisticians | 4 | |
| Decide early on how to regularly evaluate data quality | 4 | |
| Promote “data for action” (n = 7) | Leverage quality improvement programme/activities | 7 |
| Core Component 5: Multidmodal strategies for implementation of IPC interventions | ||
| Promote activities to clearly communicate and advocate for multimodal strategies (n = 16) | Need leadership buy-in to obtain resources, e.g. awareness workshop, regular meetings | 7 |
| Many cannot explain what multimodal strategies so communicate a clear definition | 6 | |
| Identify multidisciplinary champions for multimodal strategies | 3 | |
| Put focus on certain elements of multimodal strategies (n = 16) | Monitoring, audit, feedback, scoring and accountability mechanisms are key elements | 8 |
| Guidelines and training are key elements | 4 | |
| Promotion of safety culture is a key element, e.g. organizational culture questionnaire, team communication mechanisms, mentorship activities | 4 | |
| Prioritise feasible but high-impact starting points or pilots (n = 14) | Start with hand hygiene pilot | 8 |
| Start with device-associated infections, e.g. urinary or bloodstream, pilot | 3 | |
| Start with surgical site infection pilot | 3 | |
| Core Component 6: Monitoring/audit of IPC practices and feedback | ||
| Promote “data for action” (n = 17) | Present at IPC committee meetings, during hospital workshops, and in staff emails to build political will for change | 6 |
| Recognize performance with incentives, e.g. centre of excellence, ward/personnel awards | 6 | |
| Publish scores for staff, e.g. device-associated infection-free days, hand hygiene practices | 5 | |
| Prioritise feasible but high-impact starting points or pilots (n = 12) | Monitoring/audit and feedback should be part of IPC implementation from the beginning | 5 |
| Start with hand hygiene pilot | 4 | |
| Start small to show “the problem” | 3 | |
| Put focus on certain methods (n = 6) | Communicate positive audit and feedback culture, i.e. not punitive | 3 |
| Integrate with national health monitoring and information systems (HMIS) | 3 | |
| Core Component 7: Workload, staffing and bed occupancy | ||
| Need the participation of national level actors (n = 11) | National level actors should set standards, e.g. for nurse-patient ratio | 6 |
| Long-term advocacy with national level actors is essential | 5 | |
| Put focus on certain methods (n = 3) | Need to show data and local research to set staffing and bed occupancy standards | 3 |
| Core Component 8: Built environment, materials and equipment for IPC | ||
| IPC professionals should be actively involved in facility construction (n = 8) | Conduct regular meetings between construction and IPC teams to ensure that facility design, construction, modifications and renovations meet IPC standards | 8 |
| Put focus on certain elements of a multimodal strategy (n = 5) | Start with procuring equipment for hand hygiene | 5 |
| Promote long-term advocacy and integration with health system (n = 3) | Long-term WASH advocacy is needed for leadership buy-in and need phased in approach | 3 |
*Themes and sub-themes are listed in order of decreasing frequency for each WHO core component of IPC programmes
**AMR (Antimicrobial Resistance), ECDC (European Centre for Disease Prevention and Control), HAI (Health Care-Associated Infections), HIV (Human Immunodeficiency Virus), IPC (Infection Prevention and Control), NHSN (National Healthcare Safety Network), US CDC (United States Centers for Disease Control and Prevention), WASH (Water Sanitation and Hygiene), WHO (World Health Organization)