Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

The Who Guidelines Development Group ,Julie Storr,Nizam Damani,Matthias Egger,Benedetta Allegranzi,Edward Kelley,Walter Zingg,Anthony Twyman,Lesley Price,Claire Kilpatrick,Jacqui Reilly,M Lindsay Grayson

doi:10.1186/s13756-016-0149-9

Abstract

Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

Highlights

Infection prevention and control (IPC) is a universally relevant component of all health systems and affects the health and safety of both people who use health services and those who provide them
One qualitative study explored the importance of surveillance and feedback to stakeholders and found that they were very influential in the implementation of an IPC programme targeting ventilator-associated pneumonia [51]
Evaluation of the evidence from 44 studies (13 noncontrolled before-after [22, 37, 54,55,56,57,58,59,60,61,62,63,64], eight noncontrolled cohort trials [65,66,67,68,69,70,71,72], ten interrupted time series [18, 25, 27, 29, 50, 73,74,75,76,77], four qualitative [31, 78,79,80], three randomized controlled trials [81,82,83], two controlled before-after [35, 84], two mixed methods [38, 85], one non-controlled interrupted time series [86] and one stepped wedge [87]) showed that implementing IPC activities at facility level using multimodal strategies is effective to improve IPC practices and reduce Health care-associated infections (HAI). This was relevant for hand hygiene compliance, central line-associated bloodstream infection, ventilatorassociated pneumonia and infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile

Summary

Introduction

Infection prevention and control (IPC) is a universally relevant component of all health systems and affects the health and safety of both people who use health services and those who provide them. The current review of the International Health Regulations and the Global Action Plan to combat antimicrobial resistance (AMR) [5,6,7,8,9] called for strengthening IPC across nations. This will contribute to achieve strategic goal 5 of the WHO Framework on integrated people-centred health services and the United Nations Sustainable Development Goals - in particular, those related to universal access to water and sanitation and hygiene (WASH), quality health service delivery in the context of universal health coverage, and the reduction of neonatal and maternal mortality

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Results

Conclusion