Infection Prevention And Control Education Research Articles

Infection prevention and control programs in Armenian Psychoneurological Hospitals

Aim of the study: to characterize the integration and implementation of the main components of infection prevention and control (IPC), defined by the World Health Organization (WHO), in psychoneurological hospitals in Armenia. Materials and methods. The study was conducted over the period from 2019 to 2022 in all 8 psychoneurological hospitals in Armenia. The research tool was based on using the IPCAF (Infection Prevention and Control Assessment Framework) questionnaire translated into Armenian, consisting of 8 sections. In accordance with the WHO scoring methodology, each possible answer to the question was scored. The maximum total score for each core component could be 100 points, and the final score — 800. Descriptive epidemiology was used during the study. Results. The average final score for all IPCAF components for all neuropsychiatric hospitals in Armenia over the entire study period was increased by 1.46 times (from 345.0±10.7 points in 2019 to 502.5±32.5 in 2022; р 0.01) and in 2022 was characterized as an “intermediate level”. Analysis by individual IPC core components (CC) found that the highest average scores in 2022 were obtained for components CC2 (IPC guidelines) — 81.6 points, CC8 (Built environment, materials and equipment for IPC at the facility level) — 72.8 points, and CC5 (Multimodal strategies) — 70.0 points. The lowest average scores were obtained for the key components: CC4 (Health care-associated infection (HAI) surveillance) — 45.0 points, and for CC3 (IPC education and training) — 56.3 points and CC7 (Workload, staffing and bed occupancy) — 56.9 points. Conclusion. Our study demonstrated for the first time an opportunity for using the IPCAF questionnaire to evaluate IPC programs in neuropsychiatric hospitals and identify gaps in various areas of IPC. Information was received regarding the state of key IPC component implementation in psychoneurological hospitals in Armenia. Analysis by individual core components identified gaps that need to be addressed. It is recommended to implement continuous monitoring of compliance with various aspects of IPC in order to prevent weakening of control and deterioration of epidemiological situation.

Educational needs of community visiting nurses for infection prevention and control: Application of the Borich needs assessment and the Locus for Focus models.

This study aimed to assess the educational needs and analyze the priorities of infection prevention and control (IPC) for community-visiting nurses. This is a cross-sectional descriptive study. This study was conducted with 144 visiting nurses working in public health centers and long-term care facilities in South Korea. A total of 23 questions in five subcategories were used to measure the current knowledge and perceived importance of IPC in community-visiting nursing. Data were collected from June 23 to October 30, 2021, during the COVID-19 pandemic. Data were analyzed paired t-test, the Borich needs assessment, and the Locus for Focus models. Top-priority content was defined as content belonging to two models, the first 10 contents of Borich needs assessment and the contents located in the Quadrant I of the Locus for Focus models. "Reporting in case of infection-related accidents," "Mandatory vaccination for visiting nurses," "Standard precaution," "Airborne precaution," "Contact precautions," "Respiratory infection control," and "Post-visit management." This study suggests that it is necessary to provide visiting nurses with more opportunities for IPC education and to develop standardized IPC programs that consider educational priorities.

Key lessons from the establishment of a nurse-led infection prevention and control program for COVID-19 in an Australian hotel quarantine and isolation service

BackgroundA key aspect of Australia's response to the COVID-19 pandemic was to control transmission through legislated quarantine and isolation of overseas returning travellers and potentially infectious community members. In New South Wales, Special Health Accommodation (SHA) was rapidly established as a comprehensive health service for individuals that were at risk of having COVID-19, were confirmed to have COVID-19 or for those with complex health needs that were deemed inappropriate for management in Police managed Quarantine Hotels. SHA services were later expanded to care for community members who were COVID-19 positive and unable to effectively isolate, or contacts of individuals who were unable to quarantine effectively in their homes. SHA's unique nurse-led Infection Prevention and Control (IPC) program offers key lessons that may impact future programs. MethodsA reflection on the experience of leading an Infection Prevention and Control program in SHA was undertaken. This was supported by a review of SHA admission, workforce and transmission data and data obtained from a cross-sectional questionnaire aimed to better understand the experiences of a novel population of health workers (HW) in a comprehensive health-led quarantine and isolation service. ResultsSHA program data demonstrates how its IPC program implementation prevented transmission of COVID-19 to SHA staff and patients. Responses from the questionnaire suggested staff felt safe and well-prepared through the IPC education they received. They also gained transferrable knowledge and skills, which they intend to use in future healthcare roles. ConclusionThe SHA nurse-led IPC program offered successful quarantine and isolation for COVID-19 in non-purpose-built facilities. A review of IPC strategies and key lessons from the establishment of the SHA IPC program are of critical importance to planning and management of current and future pandemics.

Perceived barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: a cross-sectional study

BackgroundAdequate implementation of infection prevention and control (IPC) in residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDDs) is crucial to safeguarding this vulnerable population. Studies in this field are scarce. This study aimed to identify perceived barriers to and facilitators of IPC among professionals working in these settings, along with recommendations to improve IPC, to inform the development of targeted interventions.MethodsWe administered an online questionnaire to 319 professionals from 16 Dutch RCFs for people with IDDs (March 2021-March 2022). Perceived multilevel barriers and facilitators (guideline, client, interpersonal, organisational, care sector, and policy level) were measured on a 5-point Likert scale (totally disagree-totally agree). Recommendations were assessed using a 5-point Likert scale (not at all helpful-extremely helpful), supplemented by an open-ended question. Barriers, facilitators, and recommendations were analysed by descriptive statistics. Open answers to recommendations were analysed through thematic coding.ResultsBarriers to IPC implementation included the client group (e.g., lack of hygiene awareness) (63%), competing values between IPC and the home-like environment (42%), high work pressure (39%), and the overwhelming quantity of IPC guidelines/protocols (33%). Facilitators included perceived social support on IPC between professionals and from supervisors (90% and 80%, respectively), procedural clarity of IPC guidelines/protocols (83%), and the sense of urgency for IPC in the organisation (74%). Main recommendations included the implementation of clear IPC policies and regulations (86%), the development of a practical IPC guideline (84%), and the introduction of structural IPC education and training programmes (for new staff members) (85%). Professionals also emphasised the need for IPC improvement efforts to be tailored to the local care context, and to involve clients and their relatives.ConclusionsTo improve IPC in disability care settings, multifaceted strategies should be adopted. Initial efforts should involve clients (and relatives), develop a practical and context-specific IPC guideline, encourage social support among colleagues through interprofessional coaching, reduce workload, and foster an IPC culture including shared responsibility within the organisation.

Infection prevention and control in CT Part 1: An Australian study of roles, responsibilities and practices

IntroductionThe computed tomography (CT) suite presents Infection Prevention and Control (IPC) risks for staff and patients. This is the first of a two-part series on IPC in the CT setting and reports on Australian baseline data related to intravenous contrast media administration and the use of power injectors in the CT suite, including knowledge sources related to the delivery of contrast media. The second part provides insights into CT staff's perceptions of high-risk scenarios for non-adherence to standard or transmission-based precautions. MethodsThe study employed an online survey design, directed at radiographers and radiology nurses working in Australia. The survey included questions relating to CT workplace staffing and equipment, contrast media use and occupational roles, and knowledge sources used for infection control and contrast injectors. ResultsOverall, 160 study participants completed the survey (radiographers: n = 138, 86.3%; nurses: n = 22, 13.7%). Differences were identified between public and private practice. Public hospitals completed more contrast-enhanced scans, and with dual injecting systems, operated and cleaned by radiographers and nurses. Private clinics generally used single-system, power injectors. Radiographers and nurses relied heavily on their colleagues and product guidelines for IPC information. IPC teams were uncommon in private clinics, very common in public departments and 50% of respondents had undertaken IPC training in the last 12 months. ConclusionInsights into use and duties of professionals delivering intravenous contrast media administration using power injectors in the CT suite will help to inform decision-making processes on IPC education strategies and map risk. Implication for practiceFuture research should focus on how radiology workers in CT perceive IPC risk and/or might vary from best practice, which has direct clinical implications for safety if contamination, or incorrect information is routinely applied.

Management and control of an outbreak of NDM-producing Klebsiella pneumoniae in a teaching hospital

Abstract Background Outbreaks caused by New Delhi metallo-β-lactamase (NDM)-producing Enterobacteriaceae are a major public health threat. We report an outbreak caused by NDM-producing Klebsiella pneumoniae (KP) in an Italian teaching hospital and describe the composite management approach that led to a successful containment. Methods On August 12 2022, a 39-year old Ukrainian patient with known colonization (rectal swab) by NDM-producing KP was admitted to the Hematology Unit of the University Hospital of Verona, Italy. Six days after, a second patient tested positive for carbapenem-resistant (CR) KP from rectal swab and 2 additional cases (rectal and pharyngeal swab respectively) were identified in the following 2 weeks. The 4 cases were identical strains. Results A multidisciplinary team coordinated the response actions. Isolation measures were ordered for positive patients, including use of dedicated instruments. Screening at admission and every 7 days was placed for all the ward patients. On-site inspections and microbiological screening of ward surfaces and devices were carried out. Infection prevention and control (IPC) measures were strengthened among personnel. Environmental cleaning was implemented by deep treatment of critical points (e.g. toilets) and reinforcement of routine cleaning. The Risk Manager developed an original checklist based on literature to review the implementation of IPC practices for CR Enterobacteriaceae. No new cases were identified from screening in the following weeks and the Unit returned to standard IPC measures. Given that environmental samples were negative and the cases had overlapping personnel, the hypothesis of contact transmission through caregivers was the most plausible. Reinforcement of training on hand hygiene and transmission-based precautions was planned. Conclusions It was possible to contain the hospital outbreak through rapid and diversified reaction capacity. Continuous IPC education is an essential control measure. Key messages • The spread of NDM-producing Enterobacteriaceae in the hospital setting must be countered with enhanced prevention and, in case of outbreak, rapid control. • Effective containment involves a mix of established measures (screening, hygiene, environmental controls) and innovative approaches (e.g. literature-based checklists).

Psychosocial determinants associated with healthcare workers’ self-reported compliance with infection prevention and control during the COVID-19 pandemic: a cross-sectional study in Dutch residential care facilities for people with intellectual and developmental disabilities

BackgroundHealthcare workers’ (HCWs) compliance with infection prevention and control (IPC) is crucial to reduce the infection transmission risk. However, HCWs’ compliance with IPC in residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDDs) is known to be suboptimal. Therefore, this study examined sociodemographic and psychosocial determinants associated with IPC non-compliance in this setting, to inform IPC policy and promotion programmes for adequate IPC behaviour.MethodsAn online questionnaire was administered to 285 HCWs from 16 RCFs between March 2021 and March 2022. Determinants associated with IPC non-compliance were assessed using logistic regression analyses.ResultsBeing a woman (OR: 3.57; 1.73–7.37), and being a non-medical professional were associated with increased odds of non-compliance (social workers, OR: 2.83; 1.65–4.85; behavioural specialists, OR: 6.09; 1.98–18.72). Perceived inadequate education/training (aOR: 1.62; 1.15–2.27) and perceived time constraints/competing priorities (aOR: 1.43; 1.03–1.98) were also associated with increased odds of non-compliance, independent of sociodemographic variables. In contrast, the belief that the supervisor complies with IPC (descriptive norm supervisor) was associated with decreased odds of non-compliance (aOR: 0.60; 0.41–0.88).ConclusionsTo improve IPC in disability care settings, the implementation of tailored and structural IPC education and training programmes (e.g., on-the-job training) is recommended to increase HCWs’ capabilities and bridge the IPC compliance gap between medical and non-medical professionals. In addition, role models, particularly supervisors, are crucial for promoting IPC behaviour. Facilities should create a culture of IPC compliance by norm setting, acting on, and modelling IPC behaviours at all levels of the organisation (management, medical, and non-medical staff).

Mapping of infection prevention and control education and training in some countries of the World Health Organization’s Eastern Mediterranean Region: current situation and future needs

BackgroundA strong understanding of infection prevention and control (IPC) procedures and comprehensive training among healthcare workers is essential for effective IPC programs. These elements play a crucial role in breaking the chain of nosocomial infections by preventing the transmission of resistant organisms to patients and staff members. This study mapped the components of IPC education and training across various member states of the World Health Organization (WHO) in the Eastern Mediterranean Region (EMR) at national, academic, and healthcare institutional levels.MethodsA self-administered structured online questionnaire based on the WHO “Core Component 3” of IPC programs at the national and acute healthcare facility levels (IPC education and training) was given to national IPC focal persons in each of the WHO’s EMR countries between February and March 2023.ResultsFrom 14 of the 22 countries,15 IPC persons participated in the survey. Most countries have scattered nonhomogeneous IPC education programs in human health undergraduate majors without considering it a standalone module. Academic institutions are rarely involved, and elaborate and predefined undergraduate IPC education programs provided by universities are present in 21.4% of the countries. In 71.4% of these countries, postgraduate training targeting IPC professionals is provided by national IPC teams, primarily based on national IPC guidelines developed with the aid of the WHO. Generally, healthcare worker training relies heavily on healthcare facilities in 92.9% of the countries, rather than on a national training program. In 42.9% of the countries, practicing IPC physicians are not necessarily specialists of infectious disease or medical microbiologists and IPC nurses are not required to specialize in IPC. However, nonspecialized IPC professionals are expected to undergo training upon employment and before beginning practice. Nongovernmental organizations such as the WHO play a significant role in IPC education and in supporting national IPC authorities in establishing national IPC guidelines, as it is the case in 78.6% of these countries.ConclusionClear disparities exist in IPC education and training across different countries in the WHO’s EMR. Establishing a regional scientific network specializing in IPC would help bridge the existing gaps and standardize this education within individual countries and across countries in the region. This region needs to establish IPC certification standards and standardized education curricula.

Public health infection prevention: An analysis of existing training during the COVID-19 pandemic

ObjectivesIn response to the COVID-19 pandemic, agencies and organizations required trainings to support the needs of the public health workforce. To better understand the training resources available, this study identified, organized, and classified infection prevention and control (IPC) training and educational opportunities. Study designEnvironmental scan. MethodsA total of 306 IPC training resources were compiled between January and April 2021. Key themes and topics were identified and compared to the Healthcare Infection Control Practices Advisory Committee's (HICPAC) core IPC practices. ResultsThree hundred and six training resources, including webinars, fact sheets, module-based learning activities, infographics, and professional practice guidance materials, were identified. Common themes included proper use of personal protective equipment (e.g., masks, gloves), community reopening guidance, and mass vaccination resources. A large proportion (74.9%) of trainings were under 60 min. Using the HICPAC framework, the most frequently addressed content included standard precautions (40%), leadership support (31.6%), and transmission-based precautions (25.8%). Few trainings addressed performance monitoring and feedback (17.1%). ConclusionsA wide range of organizations developed IPC-specific content during the pandemic. However, these resources did not address the breadth of knowledge required to implement IPC concepts effectively. The creation of universally applicable IPC core competencies and the development of high-quality IPC education and trainings for public health and the overall responder workforces should be prioritized. Accessible high-quality online and just-in-time trainings are critical for future pandemic and disaster preparedness.

Screening medical students for SARS-CoV-2 to facilitate face-to-face clinical teaching and prevent onward spread to patients

Screening medical students for SARS-CoV-2 to facilitate face-to-face clinical teaching and prevent onward spread to patients

Assessing implementation of prevention and infection control programs in armenian hospitals during the COVID-19 pandemic

Aim of the study was to assess the current state of implementating key aspects of infection prevention and control (IPC) in Armenian hospitals, defined by the main WHO components, using the survey tool IPCAF (Infection Prevention and Control Assessment Framework). Materials and methods. 113 hospitals were involved in the study. All participants filled out the IPCAF questionnaire, consisting of 8 sections (each rated up to 100 points) devoted to various IPC aspects. Depending on the total final score, IPC programs were divided into the following categories: advanced (601800 points), intermediate (401600 points), basic (201400 points) and inadequate (0200 points). The study conducted a descriptive analysis of the overall IPCAF score as well as score evaluation of the relevant core components and some selected questions of particular interest. Results. The 2021 total average score for all IPCAF components for all hospitals in Armenia is 578.07.9 points, which is currently regarded as an intermediate level. At the same time, 47 (41.6%) hospitals were assigned to the advanced category, 63 (55.7%) to the average category and 3 (2.7%) to the basic category. Analysis of the main IPC components (CC, Core component) revealed that the maximum average scores were obtained for the components CC2 (IPC Guidelines) 80.8 points, CC8 (Creating a safe environment in medical premises, as well as materials and equipment for IPC) 75.5 points and CC7 (Workload, staffing and number of beds) 75.2 points. The lowest average scores were obtained for the key components: CC4 (Surveillance for healthcare-associated infections) with 54.7 points and CC3 (IPC education and training) with 59.5 points. Conclusion. Legislative and practical changes implemented in the real world during the novel coronavirus infection (COVID-19) pandemic have significantly contributed to improved scores for many key components of IPC programs. The study found that the IPCAF is a useful tool for assessing IPC standards and identifying gaps, regardless of a country economic development level. In our opinion, the re-use of IPCAF in all medical institutions should be encouraged, which is important for monitoring changes and trends in IPC, as well as proposing individual strategies in the development and improvement of IPC.

1203. Assessment of Infection Prevention and Control Programs in Acute Care Facilities in Central and South America

Abstract Background Little is known about the development of Infection Prevention and Control (IPC) programs in Latin American hospitals despite alarming rates of multidrug resistant healthcare-associated infections (HAIs) in the region. The aim of this study was to identify gaps in implementation of hospital IPC programs in Latin America. Methods We conducted a cross-sectional survey using a self-assessment tool (Spanish version) adapted from the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) in March 2022. The survey was deployed to 40 hospitals in Panama, Guatemala, Ecuador, and Argentina through a regional research network. The instrument has 8 components (score 0-100), with 800 as maximum overall score. Facility IPC program implementation is categorized into four levels based on the final score: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Median scores, overall and by component, were calculated. Additionally, for each question, we estimated the proportion of hospitals that met criteria stratified by private and public hospitals. Results Thirty five hospitals (14 private and 21 public) completed the evaluation (88% response rate), 83% were academic, and 14% were < 110 bed-hospitals. Overall, 57% of hospitals fell in the “Advanced” category (percentile [p]10: 518; p 50 614; p90 744). The median score for each component is shown in the Figure. IPC education and training, and workload, staffing and bed occupancy had the lowest median scores (Figure). In general, public hospitals had lower scores than private hospitals (Figure). Most hospitals performed surveillance for HAIs and hand hygiene, although fewer monitored compliance with adherence to prevention bundles or communicate these data to front-line workers. Additional gaps were identified, principally between private and public hospitals (Table). Figure: Median score for individual IPCAF component for all hospitals, private and public heathcare facilities. Conclusion While most participating hospitals were considered “advanced” based on the IPCAF score, several gaps were identified, which differed between public and private hospitals. Insufficient IPC education and training, workload, staffing and bed occupancy, multimodal strategies and lack of leadership support may be barriers to effective IPC programs in the region. Disclosures All Authors: No reported disclosures.

The Implementation of Infection Prevention and Control at the Lubuklinggau City Community Health Center: An Observational Study

<p><strong>Introduction:</strong> Implementation of Infection Prevention and Control (IPC) is one of the characteristics of the quality of Health Care Services. Health care facilities must do the surveillance, IPC education and training. This aims to describe the implementation of IPC at the Lubuklinggau City Community Health Center (CHC).</p><p><strong>Methods:</strong> Descriptive qualitative study with a participant observation approach used.</p><p><strong>Result: </strong>The results showed that the priority problem was the ineffectiveness of the IPC team in implementing the IPC at the Lubuklinggau City CHC.</p><p><strong>Discussion:</strong> The preparation stage consists of socialization of IPC technical guidelines at CHC, assistance in implementing management and organization, assistance in disseminating policies, guidelines, SOPs, IPC, and IPC indicators, IPC implementation and reporting at the Primary Healthcare Facilities level, and IPC education and information at the level of health cadres and community leaders in every Health Center. The stages of monitoring and supervision are starting from the planning, implementation, and reporting stages. Evaluation is carried out with indicators of success in the form of accuracy and completeness of the report. Reporting is done at the end of the activity. Internal constraints that may occur are constraints on organizational culture, human resources, and funds, while external constraints include regional characteristics, reinforcing factors, and changing/accelerating factors. From these possible obstacles, strategies are made to overcome them.</p><p><strong>Conclusion:</strong> In this study, in order to further increase the effectiveness of the implementation of IPC at the Lubuklinggau City CHC, it is necessary to carry out continuous upgrading of the competence of health workers and IPC data at CHC.</p>

Serology suggests adequate safety measures to protect healthcare workers from COVID-19 in Shiga Prefecture, Japan

Healthcare workers (HCWs), especially frontline workers against coronavirus disease 2019 (COVID-19), are considered to be risky because of occupational exposure to infected patients. This study evaluated the correlation between seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies among HCWs and the implementation of personal protective equipment (PPE) & infection prevention and control (IPC). We recruited 1237 HCWs from nine public COVID-19-designated hospitals in Shiga Prefecture, central Japan, between 15-26 February 2021. All participants answered a self-administered questionnaire and provided blood samples to evaluate SARS-CoV-2 antibodies. A total of 22 cases (1·78%) were seropositive among the 1237 study participants. An unavoidable outbreak of SARS-CoV-2 had occurred at the terminal care unit of one hospital, before identifying and securely isolating this cluster of cases. Excluding with this cluster, 0·68% of HCWs were suspected to have had previous SARS-CoV-2 infections. Binomial logistic regression from individual questionnaires and seropositivity predicted a significant correlation with N95 mask implementation under aerosol conditions (p = 8.63e-06, aOR = 2.47) and work duration in a red zone (p = 2.61e-04, aOR = 1.99). The institutional questionnaire suggested that IPC education was correlated with reduced seropositivity at hospitals. Seroprevalence and questionnaire analyses among HCWs indicated that secure implementation of PPE and re-education of IPC are essential to prevent SARS-CoV-2 infection within healthcare facilities. Occupational infections from SARS-CoV-2 in healthcare settings could be prevented by adhering to adequate measures and appropriate use of PPE. With these measures securely implemented, HCWs should not be considered against as significantly risky or dirty by local communities.

Barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: A theory-informed qualitative study.

BackgroundCare institutions are recognised to be a high-risk setting for the emergence and spread of infections and antimicrobial-resistant organisms, which stresses the importance of infection prevention and control (IPC). Accurate implementation is crucial for optimal IPC practice. Despite the wide promotion of IPC and research thereof in the hospital and nursing home setting, similar efforts are lacking in disability care settings. Therefore, this study aimed to assess perceived barriers and facilitators to IPC among professionals working at residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDD), as well as to identify professional-reported recommendations to improve IPC.MethodsThis qualitative study involved semi-structured interviews (before COVID-19) with twelve professionals from five Dutch RCFs for people with IDD. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis using inductive and deductive approaches was conducted. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.ResultsOur findings revealed barriers and facilitators at the guideline, client, professional, professional interaction, professional client interaction, client interaction, organisational, community, and societal level. Six main themes covering multiple barriers and facilitators were identified: (1) guidelines’ applicability to (work)setting; (2) professionals’ cognitions and attitude towards IPC (related to educational background); (3) organisational support and priority; (4) educational system; (5) time availability and staff capacity; and (6) task division and change coaches. The main professional-reported recommendations were the introduction of tailored and practical IPC guidelines, structural IPC education and training among all professionals, and client participation.ConclusionsTo promote IPC, multifaceted and multilevel strategies should be implemented, with a preliminary need for improvements on the guideline, professional, and organisational level. Given the heterogeneous character, i.e., different professionals, clients and care needs, there is a need for a tailored approach to implement IPC and sustain it successfully in disability care. Our findings can inform future IPC practice improvements.

Serology Suggests Adequate Safety Measures to Protect Healthcare Workers From COVID-19 in Shiga Prefecture, Japan

Background: Healthcare workers (HCWs), especially frontline workers against coronavirus disease 2019 (COVID-19), are considered to be at increased risk of infection because of occupational exposure to infected patients. This study evaluated the correlation between seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies among HCWs and the implementation of personal protective equipment (PPE) & infection prevention and control (IPC). Methods: We prospectively recruited 1237 HCWs from nine public COVID-19-designated hospitals in Shiga Prefecture, central Japan, between 15–26 February 2021. All participants answered a self-administered questionnaire and provided blood samples to evaluate SARS-CoV-2 antibodies. Findings: A total of 22 cases (1·78%) were seropositive among the 1237 study participants. Half of the participants (n=500; 48·8%) had worked in red zones designated for COVID-19, where high exposure to SARS-CoV-2 was suspected in the past months. Seven (7/1025; 0·68%) HCWs were suspected to have had previous SARS-CoV-2 infections. From these, binomial logistic regression from individual questionnaires and seropositivity predicted a significant correlation with N95 mask usage under aerosol conditions and work duration in a red zone. The institutional questionnaire suggested that IPC education was correlated with reduced seropositivity at hospitals. Interpretation: Seroprevalence and questionnaire analyses among HCWs indicated that secure implementation of PPE and re-education of IPC are essential to prevent SARS-CoV-2 infection within healthcare facilities. Occupational infections from SARS-CoV-2 in healthcare settings can be prevented by adhering to adequate measures and appropriate use of PPE. With these measures securely implemented, HCWs should not be discriminated against as risky or dirty by local communities. Funding Information: Shiga Prefecture and Shiga University of Medical Science Hospital funded the administrative costs of this study.Declaration of Interests: No authors have conflicts of interest to declare.Ethics Approval Statement: This study was approved as an administrative investigation of Shiga Prefecture by the Research Review Board of Shiga University of Medical Science (No. RRB20-032). Written informed consent and self-administered questionnaires were obtained from all study participants.

A scope review on home-based care practices for COVID-19: What Nigeria can learn from other countries

Introduction: Home-based care (HBC) services associated with COVID-19 pandemic are inevitable due to rising number of cases, the need for patients to self-isolate and curb the spread of infection. We reviewed the practices of HBC for COVID-19, identified possible challenges and suggested solutions for its optimization in Nigeria.Methods: We adopted the scope review methodology. We conducted an extensive search of published articles on three databases; MedLine, PubMed, and PLOS ONE focusing on home management for COVID-19 and screened them for eligibility.Results: Our findings revealed HBC decongests health facilities, makes room for health workers to focus on critically ill patients, and enhances recuperation of ill persons at a low cost. However, when self-isolation and infection prevention and control are not strictly adhered to, HBC increases the risk of transmission of COVID-19 among family members and further community transmission. Similarly, the existence of the perception of ‘imprisonment’ and difficulty in adherence to safety measures could be key challenges to optimizing HBC.Conclusion: Strict infection prevention and control (IPC) measures could reduce the transmission of COVID-19 during HBC. We recommend HBC training sessions, and IPC education for community members regarding home care of COVID-19 patients. Patients who are less likely to adhere to HBC should be isolated in health facilities where available. Organized trainings need to be scheduled for community-based volunteer healthcare workers to undertake visitations to household where COVID-19-infected persons are being isolated. A periodic review of HBC is needed to identify its challenges and proffer prompt solutions.

Infection prevention and control (IPC) at a Lassa fever treatment center before and after the implementation of an intensive IPC program

Background: Infection prevention and control (IPC) programs are important to control the Lassa Fever (LF) outbreak. We reported IPC's status at the Federal Medical Centre, Owo, southwest Nigeria, before and after implementing the IPC program during a surge in the LF outbreak.
 Methods: We conducted a longitudinal observational study among five health care professionals at the Federal Medical Centre, Owo, between February 2019 and May 2019 using the IPC Assessment Framework (IPCAF). The tool has eight core components with a score of 0-100 per component and provided a baseline assessment of the IPC program and evaluation after three months. We interviewed relevant unit heads and IPC committee members in the first phase. In the second phase, we designed and implemented the IPC program, and in the third phase, we conducted a repeat interview similar to the first phase. The program initiated included training healthcare workers and providing relevant IPC items according to identified gaps and available funding.
 Results: We interviewed five health care professionals, two female nurses, and three male doctors responsible for organizing and implementing IPC activities at the Federal Medical Centre, Owo, with an in-depth understanding of IPC activities. The overall IPC level score increased from 318.5 at baseline to 545 at three months later. IPC improvements were reported in all the components, with IPC education and training [baseline (20), final (70)], IPC guidelines [baseline (50), final (92.5)] and monitoring/audits of IPC practices and feedback [baseline (40), final (82.5)] recording the highest improvements. Healthcare-associated infection [baseline (10), final (25)], and built environment, materials, and equipment for IPC [baseline (43.5), final (55)] had the least improvement. Poor motivation to adopt recommended changes among hospital staff were major issues preventing improvements.
 Conclusion: Promotion of IPC program and activities should be implemented at the Federal Medical Centre, Owo.
 
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Site Visits Reveal Common Gaps in Instrument Reprocessing and Sterilization at Philadelphia Dental Clinics

Background: Most dental clinics lack resources and oversight related to infection prevention and control (IPC) practices. Few dental clinics undergo inspections by regulatory authorities unless the state licensing authorities receive a specific complaint. Many states, including Pennsylvania, do not have continuing IPC education requirements for dental providers. In 2018–2019, the Philadelphia Department of Public Health (PDPH) received and responded to multiple complaints and concerns related to IPC practices at dental clinics. Complaints were investigated in collaboration with the Pennsylvania Department of State (PADOS). Methods: Unannounced site visits were conducted at 7 Philadelphia dental clinics from December 2018 through September 2019 as part of the public health responses. Clinic evaluations and observations by PDPH certified infection preventionists focused on (1) IPC policies and procedures, (2) staff IPC training, (3) hand hygiene, (4) personal protective equipment, (5) instrument reprocessing and sterilization, (6) injection safety, and (7) environmental cleaning and disinfection. The CDC and the Organization of Safety, Antisepsis and Prevention (OSAP) checklists were adapted for this purpose. Results: Most dental practices we visited were small, unaffiliated, owner-operated clinics. The most common gaps we identified were associated with instrument reprocessing and sterilization practices, including inadequate separation between clean and dirty work areas, limited space and availability of sinks, inappropriate use of glutaraldehyde products for instrument cleaning (n = 3, 43%), extended reuse of cleaning brushes (n = 5, 71%), sterilization or storage of sterilized instruments without appropriate packaging (n = 2, 29%), lack of spore testing or reviewing results (n = 2, 29%), and lack of documentation of sterilizer run cycles and maintenance (n = 7, 100%). Additionally, most clinics did not have well-developed IPC policies and procedures, and staff IPC trainings were neither documented nor conducted annually. Alcohol-based hand sanitizer was often not available at the point of use. Conclusions: In Philadelphia, dental clinics often lacked IPC support and oversight. Lapses across multiple key IPC domains were common. These findings suggest that public health may have a role in providing IPC support to unaffiliated dental clinics. Licensing entities can also serve a role in improving IPC practices by more widely mandating continuing IPC education as part of the dental license renewal process.Funding: NoneDisclosures: None

Examining the inclusion of patients and their family members in infection prevention and control policies and guidelines across Bangladesh, Indonesia, and South Korea

Although familial involvement during inpatient care is not uncommon in western countries, the types of caring activities that family members in Asian countries provide are significantly different. These activities may place the family member at risk from a health care-associated infection. This study aimed to examine whether the role of patients' families has been accounted for in the infection prevention and control (IPC) guidelines and policy, using examples from Bangladesh (low-income country), Indonesia (middle-income country), and South Korea (high-income country). The World Health Organization website and Institutional Repository for Information Sharing, Centers for Disease Control and Prevention website, Australian Government Web Archive, Open Grey, Grey Matters, World Bank, and advanced Google search, as well as the Health Department/Ministry of Health websites for each target country and 4 western countries (Australia, Canada, England, and the United States) were searched. Other databases, such as Embase, Medline, CINAHL, Global Health, ProQuest databases, Google scholar, Web of Science, and Scopus were also searched. This was to review the reflection of the cultural influence in IPC policies/guidelines by reviewing those from the global organizations, which are often used as a blueprint for policy development, as well as those from western countries, which hold different cultures in care arrangement. Search was conducted with attention to the key areas: definition and role of carer in the acute health care facility, involvement of patients/family members in IPC activities, patient and family member hand hygiene, and IPC education. Ninety-two articles were identified based on the criteria for the study. Only 6 acknowledged that care is provided to hospitalized patients by their family members, and only 1 recommended that family members receive the same level of training as health care workers on IPC precautions. Other guides recommended the provision of information on IPC measures as means of patient involvement in the IPC program. Recognition of family caregivers or inclusion of them in the IPC strategies was not included in the target countries' guidelines. Although health care workers are the primary actors when it comes to providing care in acute health care settings, it is important to expand the IPC guides by considering the role of other caregivers. Policies and guidelines should reflect the cultural influence over healthcare. This is especially true when cultural values strongly influence over healthcare arrangements and the healthcare accommodates these cultural influences in the practice. Further work needs to be undertaken on the level of training/education provided to family members in Bangladesh, Indonesia, and South Korea.