P166
Improving evidence for infection prevention policy and practice– the role of capacity building in health services research
Lisa Hall, Emily Bailey, Nick Graves
QUEENSLAND UNIVERSITY OF TECHNOLOGY, Kelvin Grove, Brisbane, Australia
Correspondence:Lisa Hall
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P166
Introduction:To continually improve infection prevention policy and practice we need to provide good quality, relevant evidence for deci- sion makers. One strategy to improve the quality, utility and imple- mentation of evidence is to build capacity for targeted, policy-driven health services research.
Objectives:To improve evidence for infection prevention policy and practice through establishment of a capacity building health services research centre.
Methods: Through a large, competitive, national capacity building grant we established the Centre of Research Excellence in Reducing Healthcare Associated Infection (CRE-RHAI) in Brisbane, Australia. Over 6 years we trained 10 PhD students, and 5 post docs in health services research, with projects relevant to infection prevention and control. Research topics were driven by gaps in the infection preven- tion literature and stakeholder priorities on topics such as antimicro- bial stewardship, surveillance, environmental cleaning, decision- making, and cost-effectiveness of infection prevention strategies. A key focus was on the integrated use of diverse range of methods in- cluding epidemiology, health economics, qualitative research and mathematical modelling. A cohort model of student development was established, enabling peer-to-peer feedback and collaboration along with a structured set of activities to develop generic, transfer- able, research skills.
Results:The CRE-RHAI successfully generated a large amount of con- temporary, useful evidence for infection prevention and control alongside training the next generation of health services researchers. A number of the projects are already influencing policy, and several have provided the groundwork for larger research studies. We propose that the combined output and impact of the CRE-RHAI far exceeds what would have resulted from these researchers working in isolation.
Conclusion:Focused investment of research funds by major funding agencies into targeted, capacity building schemes is a valuable use of resources. Aligning research capacity building centres with stake- holder priorities can facilitate the development of useful and relevant research, and aid translation of evidence into improved policy and practice.
Disclosure of Interest
None Declared
P167
Ease of implementation assessment of infection prevention and control core components in low-resource settings
Sara Tomczyk1, Walter Zingg2, Julie Storr1, Claire Kilpatrick1, Benedetta
Allegranzi1
1World Health Organization;2University of Geneva Hospitals, Geneva,
Switzerland, Geneva, Switzerland
Correspondence:Sara Tomczyk
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P167
Introduction:Guidelines on the core components (CCs) for infection prevention and control (IPC) programmes were recently issued by the World Health Organization. Uptake of the guidelines in low- resource settings is critical but effective implementation may require adaptation and prioritization.
Objectives:We assessed predetermined ease of implementation cri- teria in low-resource settings for each CC at the national and facility level.
Methods:Based on existing models and expert consensus, criteria in- cluded financial and human resources; equipment, materials and in- frastructure; capacity for communication and local adaptation; and interconnectedness with other priorities. Focus group discussions were held with international experts using a semi-structured ques- tionnaire. The results were validated by a follow-up survey with indi- vidual participants. We summarized common implementation gaps (defined as average availability of criteria ratinglessthan perceived need) and opportunities (defined as average availability of criteria ratinggreaterthan perceived need).
Results: Four focus groups were held and 26 (84%) experts responded to the survey. The first CC recommends that an IPC programme should be established at the national and facility level. Experts commonly reported that interconnectedness with other pri- orities, human resources, and communication capacity present large gaps in the implementation of this component, whereas capacity for local adaption and equipment availability present opportunities. Similar findings were reported for CCs on evidence-based guidelines, education and training, multimodal strategies, and monitoring, audit and feedback. Financial resources were reported as a large gap for the implementation of CCs on healthcare-associated infection surveil- lance and adequate workload, staffing and bed occupancy. Equip- ment, materials and infrastructure were reported as a large gap for the CC on built environment.
Conclusion: These findings suggest common patterns concerning the perceived ease of implementation of each IPC CC in low-resource settings. The results could be useful for implementers at the national and facility level when considering the necessary adaptation and prioritization of WHO IPC CCs.
Disclosure of Interest
None Declared
P168
Implementation of infection prevention and control (IPC) in low- resource settings: a qualitative analysis
Sara Tomczyk, Julie Storr, Claire Kilpatrick, Benedetta Allegranzi World Health Organization, Geneva, Switzerland
Correspondence:Sara Tomczyk
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P168
Introduction: Robust evidence on the implementation of infection prevention and control (IPC) interventions in low-resource settings is limited.
Objectives:We aimed to qualitatively identify examples of IPC imple- mentation in these settings and summarize key learned lessons.
Methods: From December 2016–March 2017, we conducted semi- structured interviews with IPC professionals from low-resource settings and analysed the results using a qualitative inductive thematic
approach. IPC implementation examples within the data items were coded, collated into broader themes, and reviewed to ensure validity. Themes were defined as patterned elements across data capturing key IPC implementation lessons; these were summarized descriptively.
Results:Twenty-nine interviews were analyzed. Common IPC imple- mentation themes (appearing≥4 times) were as follows: To develop an IPC programme, key elements include advocacy with managers, the driving role of national IPC associations, identification of cham- pions, integration with antimicrobial resistance (AMR) and quality programmes, and legislation. To develop guidelines, key elements in- clude securing initial technical assistance which can be followed by local adaptation, identification of common guideline areas with other programmes, and an early focus on guideline implementation (e.g. link to training, monitoring, other tools). For training, the develop- ment of an IPC career path and multidisciplinary approaches are im- portant elements. To implement surveillance, stakeholders should carefully address case definitions, consider step-wise pilots, integrate activities with AMR efforts, and emphasize the use of data for im- provement. To implement multimodal strategies, key elements in- clude monitoring as well as raising awareness of the approach. For monitoring, it is critical to identify the feedback process early includ- ing presentation of data to leaders and linkage of results to incen- tives and improvement plans. Long-term advocacy is needed for staffing and bed occupancy standards and IPC professionals should be included in the facility construction and renovation process to promote improvement of the built environment.
Conclusion:Key themes of IPC implementation examples were iden- tified. They offer important qualitative evidence for IPC professionals to consider.
Disclosure of Interest
None Declared
P169
Implementation of infection prevention and control program at national level in Brazil: a systematic approach
Magda M. Costa1, Fabiana C. Sousa1, Maria Dolores S. Nogueira1, Cleide
F. Ribeiro1, Diogo P. Soares1, Maria Clara Padoveze2on behalf of The National Committee for Prevention and Control of Healthcare- Associated Infection
1Anvisa- Agência Nacional de Vigilância Sanitária, Brasilia;2SCHOOL OF
NURSING OF UNIVERSITY OF SÃO PAULO, São Paulo, Brazil
Correspondence:Maria Clara Padoveze
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P169
Introduction: The implementation of an Infection Prevention and Control Programme (IPCP) at national level is challenging for devel- oping countries. In Brazil, despite many progress, no written national program was developed up to 2012.
Objectives:To describe the implementation process of the national IPCP in Brazil.
Methods: A first evaluation was performed in 2012 by using the infection prevention and control core components assessment tools (IPCAT) according to the World Health Organization (WHO). Members of the National Committee for Prevention and Control of HAI (NCPC-HAI) performed an individual preliminary assess- ment of the conformity of IPCP at national level. Individual data were compiled to identify the level of agreement among NCPC- HAI members. A face-to-face meeting was carried out to achieve a consensus and to identify the main gaps to be addressed in the first IPCP (2013 to 2015). On January 2016 another cycle of IPCAT application and further development of national IPCP (2016 to 2020) was performed.
Results: The first national IPCP included detailed goals and stra- tegic actions to achieve the following objectives: a) reduction of primary blood stream and surgical site infections; b) establish mechanisms of control of antimicrobial resistance in healthcare settings; d) improve the conformity of national IPCP. From 2012 to 2015 the conformity to the core components at national level raised from, respectively: organization of IPCP- 19% to 67%;
technical guidelines- 23% to 50%; surveillance of HAI- 59% to 77%; microbiology laboratory support-7% to 43%; environment- 13% to 50%; monitoring and evaluation- 0 to 67%; and links with public health and other services- 0 to 5%; but no change in the human resources conformity (16%) in the studied period. The next IPCP was supported by these results and included periodic assessment to monitor the progress of the national IPCP.
Conclusion:The use of IPCAT favored a systematic assessment and implementation of national IPCP and allowed to address relevant gaps to promote improvements.
Disclosure of Interest
None Declared
P170
Performance of programs for prevention of healthcare-associated infection in small hospitals: a regional study in São Paulo, Brazil
Rubia A. L. Baroni, Pryscilla L. C. Santos, MARIA CLARA PADOVEZE NURSING SCHOOL, UNIVERSITY OF SÃO PAULO, SÃO PAULO, Brazil
Correspondence:Rubia A. L. Baroni
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P170
Introduction: The occurrences of Healthcare-Associated Infection- s(HAI) can be reduced by an effective Program of Prevention and Control(PPCHAI). However, small hospitals may lack resources to es- tablish a full-compliant PPCHAI.
Objectives: To describe the structure for HAI prevention and to evaluate PPCHAIs of small hospitals in a coastal region of the state of São Paulo, Brazil.
Methods: Prospective cross-sectional study, performed between 2015 and 2016 in 14 small hospitals (52.0% of the eligible institu- tions). An evaluation tool previously validated was applied through direct observation, documental analysis and interviews. The Conform- ity Index(CI) of the PPCHAI included elements of both structure and process regarding four indicators: 1) Technical-Operational-TO; 2) Guidelines-GD; 3) Surveillance System-SS; 4) Prevention Activities-PA.
Results:The overall CI of PPCHAIs was 69.5% (DP = 12.3). This result was lower than other studies that included larger hospitals in others regions of Brazil. The mean values of each indicator were: TO = 61.0%(DP = 20.3); GD = 84.5%(DP = 18.7); SS = 57.9%(DP = 39.5); PA = 74.5%(DP = 24.1). Only three hospitals evaluated had an Intensive Care Unit. Availability of specific isolation rooms were found in four hospitals; only one with Negative Pressure and High Efficiency Par- ticulate Air System. Hand hygiene resources and sharps disposal were available in all hospitals; however, in three hospitals the sharps disposal were inappropriate.
Conclusion:These small hospitals showed low CI regarding PPCHAI and insufficient resources to isolation precautions, which may affect the patient safety. These findings point out to the need of public pol- icies addressed to this type of healthcare settings in the Brazilian healthcare system.
Disclosure of Interest
None Declared
P171
Performance of infections relating the medical care prevention and control program, in Manaus City, Amazonas State, Brazil
Rubia A. L. Baroni1, HADELANDIA M. OLIVEIRA2
1NURSING SCHOOL, UNIVERSITY OF SÃO PAULO, SANTOS;2NURSING
SCHOOL, UNIVERSIDADE FEDERAL DO AMAZONAS, SÃO PAULO, Brazil
Correspondence:Rubia A. L. Baroni
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P171
Abstract video clip: Performance of programs for prevention of healthcare-associated infection, in Manaus City, Amazonas State, Brazil.
Introduction:Performance of programs for prevention of healthcare- associated infection(PPCHAI) are not well recognized in North Region
of Brazil.Objective:The scope was to evaluate these programs in hos- pitals of Manaus City, Brazilian North Region.Method:Assessment trans- versal study in 2015 with 25 hospitals, 89.3% of the totality, above 50 beds. Four indicators were applied for the data collection: Technical- Operational-TO; Guidelines-GD; Surveillance System-SS; Prevention Activities-PA.Results:The overall performance was 69%. This result was similar than other with small hospitals in a Brazilian coastal region. The mean values of each indicator were: TO = 81,9%; SS = 73,2%; GD = 72,3%; PA = 48,6%. There were associations between hospital character- istics and PPCHAI performance. The better evaluation was related to private, accredited/certified hospitals; PPCHAI comprised of nurses and physicians; nurse and physician labor entailment duly institutionalized; exclusive hour charge for the nurses(over 6 hours) and physicians (over 4 hous); the skill period of the nurses acting is as of five years and that of the physicians lies between five and ten years; control and preven- tion capacitation in the admission(excepting the SS).Conclusion:The study allowed recognize the weaknesses and opportunities of these programs at North Region, aimed to increasing the possibility of im- provements in the quality of health services provided to that popula- tion. The application of these indicators is an important tool for the knowledge of IRMCPC throughout the Brazilian territory.
Descriptors: Health Assessment; Hospital Infection; Health Care Indicators
Disclosure of Interest
None Declared
P172
Implementation of an infection prevention and control (ipc) programme in a rural province in Zimbabwe: the successes and challenges
Admire S. Murongazvombo, Wilfred Moyo, Epiphania Chaitezvi, Pepetua Munjoma
MoHCC, Mashonaland Central Province, Zimbabwe
Correspondence:Admire S. Murongazvombo
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P172
Introduction: The Ministry of Health and Child Care (MoHCC) Zimbabwe has strengthened the National IPC programme through the five-year Zimbabwe Infection Prevention and Control Project(ZIP- COP).The programme operates in an environment with a high bur- den of infectious diseases including Human Immunodeficiency Virus(HIV) and Tuberculosis(TB).
Objectives:This study sought to assess the successes and challenges in the implementation of a MoHCC run IPC programme in a rural province in Zimbabwe.
Methods:A provincial team of National Certified IPC trainers conducted Site Support Visits(SSVs) to 14 health facilities in the province. The team used a colour-coded checklist to assess IPC from 2015 to 2016, followed by feedback at each site. IPC practices were scored as: 2.appropriate intervention in place; 1.intervention in progress; 0.intervention not in place; or N/A if the domain is not applicable. The final score was cate- gorized into four classes, S1:≥75%; S2:65-74%; S3:50-64%; S4: <50%.
Results:Seventy-nine percent of sites (11/14) showed progress from baseline with 54.5%(6/11) improving by two classes, 45.5%(5/11) im- proving to the next class, while 21%(3/14)maintained their S1 and S2 baseline classes resulting in six S1, six S2, two S3 sites. Strengths were consistently noted in the following domains: collection and submission of blood and body fluids exposure statistics(14/14,100%), having a trained IPC focal person(13/14, 92.9%), conducting IPC sur- veillance(12/14, 85.7%) and administrative TB controls in place(12/ 14,85.6%). Weaknesses were noted in TB healthcare-worker (HW) screening(6/14, 42.9%), having personal protective equipment pol- icy(6/14, 42.9%) and functional incinerators(7/14, 50%).
Conclusion:Site support and mentoring by the MoHCC Provincial IPC team, building on gains made by ZIPCOP, has resulted in a marked improvement in IPC practices in the sites in Mashonaland Central Province, Zimbabwe. This approach has yielded success in low-cost interventions such as administrative TB infection controls
and IPC surveillance. The domains that posed a challenge include TB HW screening and incinerators. The study demonstrated the value of SSVs and the colour-coded checklist in improving IPC programmes.
Disclosure of Interest
None Declared
P173
Past, present and future: the evolution of the infection prevention and control programme in Georgia
David Tsereteli1, Giorgi Chakhunashvili1, Ekaterine Jabidze1, Ana Paula
Coutinho Rehse2
1Communicable Disease, National Center for Disease Control and Public
Health, Tbilisi, Georgia;2Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
Correspondence:David Tsereteli
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P173
Introduction:For many years the infection prevention and control (IPC) programme in Georgia was based on punitive administrative measures.
Objectives:Assessment of evaluation IPC programme in Georgia.
Methods: Descriptive study about the improvements of IPC programme in Georgia overtime.
Results: From the Soviet period and up to the 20th century, spite of case definitions of healthcare associated infections (HCAIs) were avail- able and reporting of HCAIs was considered mandatory, only passive surveillance of HCAIs was conducted in hospitals. For decades the na- tional prevalence of HCAIs was never higher than 1%, and data describ- ing antimicrobial resistance (AMR) rates in hospitals was unavailable. Later in 2005, the Georgian National Medical Center in collaboration with Minnesota Department of Health and University of Minnesota, USA, im- plemented the first successful IPC programme. The National IPC guide- line was then developed and published for the first time in 2009. During the past few years, a number of projects aiming to further improve and strength Georgia national IPC and AMR capacities were implemented in collaboration with WHO and other international partners. Among those projects, a national strategy to combat AMR was approved, the national AMR committee was created and empowered, legislation on IPC renewed, an IPC post-graduation training curricula developed, awareness on HCAIs and AMR increased and knowledge on IPC among healthcare workers improved. Georgia joined the Central Asian and Eastern Euro- pean Surveillance of AMR network, established the National Microbiol- ogy laboratory network, EUCAST standards were implemented in laboratories, and more recently the pilot proof-of-principle study was carried out. The following activities are planned for next years: strength- ening IPC programmes in hospitals, surveillance of the antibiotic use, promotion of antibiotic stewardship, update National IPC guideline and development of IPC standard operation procedures.
Conclusion: Mandatory notification of HCAIs is not an indicator of effective IPC programme. Political commitment, international support and availability of technical expertise at national level were crucial to instigate a fundamental change in the Georgian IPC programme.
Disclosure of Interest
None Declared
P174
Accelerating implementation of the ipc policy in Kenya
RACHEL KAMAU
Health Standards Quality Assurance and Regulations, Ministry of Health, Nairobi, Kenya
Correspondence:RACHEL KAMAU
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P174
Abstract video clip: ACCELERATING IMPLEMENTATION OF THE IPC POLICY IN KENYA
The importance of maintaining high standards of infection preven- tion and control (IPC) practices in health care facilities is a matter of national concern for the Ministry of Health (MoH) in Kenya. In 2010, the MoH developed its first IPC Policy that recommended the estab- lishment of a cohesive, comprehensive IPC program in the Depart- ment of Health Standards Quality Assurance and Regulations. In 2013 an IPC unit was established within the Ministry.
Method
This paper describes the achievements of the IPC program since 2013
Achievements
Following the establishment of the IPC unit, the National IPC Advisory Committee was appointed and its first task was to conduct a rapid situ- ation assessment of IPC practices in Kenya to support the development of the national IPC strategic plan (2014-2018). The recommendations from the situation assessment to revise the national IPC policy and to update the national IPC guidelines was done in 2015. IPC training mod-