The first WHO global survey on infection prevention and control in health-care facilities

Sara Tomczyk,Anthony Twyman,Marlieke E A De Kraker,Ana Paula Coutinho Rehse,Ermira Tartari,João Paulo Toledo,Alessandro Cassini,Didier Pittet,Benedetta Allegranzi

doi:10.1016/s1473-3099(21)00809-4

Abstract

SummaryBackgroundWHO core components for infection prevention and control (IPC) are important building blocks for effective IPC programmes. To our knowledge, we did the first WHO global survey to assess implementation of these programmes in health-care facilities.MethodsIn this cross-sectional survey, IPC professionals were invited through global outreach and national coordinated efforts to complete the online WHO IPC assessment framework (IPCAF). The survey was created in English and was then translated into ten languages: Arabic, Chinese, English, French, German, Italian, Japanese, Russian, Spanish, and Thai. Post-stratification weighting was applied and countries with low response rates were excluded to improve representativeness. Weighted median scores and IQRs as well as weighted proportions (Nw) meeting defined IPCAF minimum requirements were reported. Indicators associated with the IPCAF score were assessed using a generalised estimating equation.FindingsFrom Jan 16 to Dec 31, 2019, 4440 responses were received from 81 countries. The overall weighted IPCAF median score indicated an advanced level of implementation (605, IQR 450·4–705·0), but significantly lower scores were found in low-income (385, 279·7–442·9) and lower-middle-income countries (500·4, 345·0–657·5), and public facilities (515, 385–637·8). Core component 8 (built environment; 90·0, IQR 75·0–100·0) and core component 2 (guidelines; 87·5, 70·0–97·5) scored the highest, and core component 7 (workload, staffing, and bed occupancy; 70·0, 50–90) and core component 3 (education and training; 70 ·0, 50·0–85·0) scored the lowest. Overall, only 15·2% (Nw: 588 of 3873) of facilities met all IPCAF minimum requirements, ranging from 0% (0 of 417) in low-income countries to 25·6% (278 of 1087) in primary facilities, 9% (24 of 268) in secondary facilities, and 19% (18 of 95) in tertiary facilities in high-income countries.InterpretationDespite an overall high IPCAF score globally, important gaps in IPC facility implementation and core components across income levels hinder IPC progress. Increased support for more effective and sustainable IPC programmes is crucial to reduce risks posed by outbreaks to global health security and to ensure patient and health worker safety.FundingWHO and the Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine.TranslationsFor the French and Spanish translations of the abstract see Supplementary Materials section.

Highlights

The COVID-19 pandemic has emphasised the crucial role of infection prevention and control (IPC) pro grammes and practices to ensure the safety of patients and health workers through preparedness and response to outbreaks
Effective IPC programmes are the foundation for reducing endemic health-care-associated infections (HAIs), the spread of antimicrobial resistance (AMR), and for the containment of emerging pathogens, contributing to quality of care as an essential component of universal health coverage
Added value of this study This study reports findings from the first WHO global survey assessing IPC programme implementation at the facility level using IPC assessment framework (IPCAF), a validated and standardised tool to assess the WHO IPC core components, which represent the global gold standard, evidence-based, recommendations for IPC at the national and health-care facility level

Summary

Introduction

The COVID-19 pandemic has emphasised the crucial role of infection prevention and control (IPC) pro grammes and practices to ensure the safety of patients and health workers through preparedness and response to outbreaks. It has shown that even advanced health systems have deficiencies in their implementation of IPC practices and preparedness to outbreaks.. Effective IPC programmes are the foundation for reducing endemic health-care-associated infections (HAIs), the spread of antimicrobial resistance (AMR), and for the containment of emerging pathogens, contributing to quality of care as an essential component of universal health coverage.. WHO and other international agencies have demonstrated the global burden of HAIs and AMR, with an urgent call to action to improve IPC.. Evidence-based IPC interventions have been shown to be effective in preventing at least Unprepared health systems are unable to withstand the shock of an outbreak, as shown by the west African 2014–16 Ebola outbreak and the COVID-19 pandemic. Importantly, evidence-based IPC interventions have been shown to be effective in preventing at least

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