Pillar 6. Infection Prevention and Control
Steps		Actions to Be Taken	Responses and Plans
1	1	Assess IPC capacity at all levels of the health care system, including public, private, traditional practices, and pharmacies. Minimum requirements include a functional triage system and isolation rooms, trained staff (for early detection and standard principles for IPC); and sufficient IPC materials, including PPE and WASH services/hand hygiene stations	The Governor’s Office, the Provincial Governor, the Municipality, and the Iranian Medical Council reported assessing IPC capacities but did not publish any reports by August 2020.
	2	Assess IPC capacity in public places and community spaces where the risk of community transmission is considered high	None
	3	Review and update existing national IPC guidance: health guidance should include a defined patient-referral pathway, including an IPC focal point, in collaboration with case management. Community guidance should include specific recommendations on IPC measures and referral systems for public places such as schools, markets, and public transport as well as community, household, and family practices	For COVID-19 prevention and control, the National Communicable Disease Office has created several guidelines and is constantly updating them. Also, 14 work-related guidelines and 7 dietary guidelines have been developed through August 2020.
	4	Develop and implement a plan for monitoring health care personnel exposed to confirmed cases of COVID‑19 for respiratory illness	Online self-declaration websites for staff were launched by regional deputies of treatment.
	5	Develop a national plan to manage PPE supply (stockpile, distribution) and identify IPC surge capacity (numbers and competence)	Governor’s Office, Provincial Governor, Municipality, Iranian Medical Council, and the MoHb deputy of food and drug reported daily planning
2	6	Engage trained staff with authority and technical expertise to implement IPC activities, prioritizing based on risk assessment and local care-seeking patterns	16-hour and 24-hour centers for COVID-19 received full available PPE from The deputy of food and drug.
	7	Record, report, and investigate all cases of healthcare-associated infections	Data gathered from observatories are presented in the MASK application through colors, representing required levels of alert and precautions in different provinces.
	8	Disseminate IPC guidance for home and community care providers	Guidelines for public use were available via the “1569” hotline in 9 categories since late March 2020.
	9	Implement triage, early detection, and infectious-source controls, administrative controls, and engineering controls; implement visual alerts (educational material in the appropriate language) for family members and patients to inform triage personnel of respiratory symptoms and to practice respiratory etiquette	Currently active in 16-hour primary health centers.
	10	Support access to water and sanitation for health (WASH) services in public places and community spaces most at risk	- As described in the first and second steps of COVID-19 reopening of business protocols, sanitary water and health products are mandatory for reopening. - Mandatory use of PPE and other guidelines were uploaded online and notifications were sent to all covered work units. - Implementation of guidelines was enforced through HSE officers of primary health centers.
3	11	Monitor IPC and WASH implementation in selected healthcare facilities and public spaces using the Infection Prevention and Control Assessment Framework, the Hand Hygiene Self-Assessment Framework, hand hygiene compliance observation tools, and the WASH Facilities Improvement Tool	- Water distribution systems are repeatedly inspected and water sanitation is controlled via chlorometry - Hospitals infections prevention and control units follow the second step of reopening guidelines, matching WHO guidelines.
	12	Provide prioritized tailored support to health facilities based on IPC risk assessment and local care-seeking patterns for supplies, human resources, and training	Health facility managers were notified based on guidelines.
	13	Carry out training to address any skills and performance deficits	None