Abstract
Quality challengeThe Sierra Leone (SL) Ministry of Health and Sanitation’s National Infection Prevention and Control Unit (NIPCU) launched National Infection and Prevention Control (IPC) Policy and Guidelines in 2015, but a 2017 assessment found suboptimal compliance with standards on environmental cleanliness (EC), waste disposal (WD) and personal protective equipment (PPE) use.MethodsICAP at Columbia University (ICAP), NIPCU and the Centers for Disease Control and Prevention (CDC) designed and implemented a Rapid Improvement Model (RIM) quality improvement (QI) initiative with a compressed timeframe of 6 months to improve EC, WD and PPE at eight purposively selected health facilities (HFs). Targets were collaboratively developed, and a 37-item checklist was designed to monitor performance. HF teams received QI training and weekly coaching and convened monthly to review progress and exchange best practices. At the final learning session, a “harvest package” of the most effective ideas and tools was developed for use at additional HFs.ResultsThe RIM resulted in marked improvement in WD and EC performance and modest improvement in PPE. Aggregate compliance for the 37 indicators increased from 67 to 96% over the course of 4 months, with all HFs showing improvement. Average PPE compliance improved from 85 to 89%, WD from 63 to 99% and EC from 51 to 99%.Lessons learnedThe RIM QIC approach is feasible and effective in SL’s austere health system and led to marked improvement in IPC performance. The best practices are being scaled up and the RIM QIC methodology is being applied to other domains.
Highlights
Health care-associated infections (HAIs) are a worldwide public health threat, confronting wealthy and poor countries alike and resulting in significant morbidity, mortality and cost [1]
The Rapid Improvement Model (RIM)-Quality Improvement Collaborative (QIC) approach led to rapid improvement in Infection prevention and control (IPC) performance at the eight health facilities (HFs), driven largely by improvement in the waste disposal (WD) and environmental cleanliness (EC) domains
Learning sessions equipped the teams with knowledge, skills and tools to scale up the successful change ideas to additional wards
Summary
Health care-associated infections (HAIs) are a worldwide public health threat, confronting wealthy and poor countries alike and resulting in significant morbidity, mortality and cost [1]. Many IPC interventions are challenging in low- and middle-income countries (LMIC), leading to preventable adverse health outcomes. HAI are two to 20 times more common in LMIC than in high-income countries; for device-associated infections, the risk is 19 times higher. A WHO/UNICEF 2015 global review reported that, globally, nearly 40% of health facilities (HF) lack adequate water, 19% are without sanitation and 35% do not have any hand hygiene materials. As part of the global initiative to achieve universal health coverage, WHO, UNICEF and stakeholders from around the globe committed to the vision that by 2030, every HF in every setting should have safely managed reliable water, sanitation and hygiene facilities and IPC practices that meet standards and patient needs [4]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call