Infection Prevention And Control Policies Research Articles

Mind the gap: knowledge, attitudes and perceptions on antimicrobial resistance, antimicrobial stewardship and infection prevention and control in long-term care facilities for people with disabilities in the Netherlands

BackgroundAntimicrobial resistance (AMR) has become one of the major public health threats worldwide, emphasizing the necessity of preventing the development and transmission of drug resistant microorganisms. This is particularly important for people with vulnerable health conditions, such as people with intellectual disabilities (ID) and long-term care residents. This study aimed to assess the current status of AMR, antimicrobial stewardship (AMS) and infection prevention and control (IPC) in Dutch long-term care facilities for people with intellectual disabilities (ID-LTCFs).MethodsA web-based cross-sectional survey distributed between July and November 2023, targeting (both nonmedically and medically trained) healthcare professionals working in ID-LTCFs in The Netherlands, to study knowledge, attitudes and perceptions regarding AMR, AMS and IPC.ResultsIn total, 109 participants working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. The knowledge levels of AMR and IPC among nonmedically trained professionals (e.g., social care professionals) were lower than those among medically trained professionals (p = 0.026). In particular regarding the perceived protective value of glove use, insufficient knowledge levels were found. Furthermore, there was a lack of easy-read resources and useful information regarding IPC and AMR, for both healthcare professionals as well as people with disabilities. The majority of the participants (> 90%) reported that AMR and IPC need more attention within the disability care sector, but paradoxically, only 38.5% mentioned that they would like to receive additional information and training about IPC, and 72.5% would like to receive additional information and training about AMR.ConclusionAlthough the importance of AMR and IPC is acknowledged by professionals working in ID-LTCFs, there is room for improvement in regards to appropriate glove use and setting-specific IPC and hygiene policies. As nonmedically trained professionals comprise most of the workforce within ID-LTCFs, it is also important to evaluate their needs. This can have a substantial impact on developing and implementing AMR, AMS and/or IPC guidelines and policies in ID-LTCFs.

Implementatie van de Infectierisicoscan in een ziekenhuisnetwerk door het Hospital Outbreak Support Team

Implementation of the Infection Risk Scan in a hospital network by the Hospital Outbreak Support Team The Infection Risk Scan (IRIS) assesses the quality of infection prevention and control (IPC) and antimicrobial stewardship (AMS) in a hospital ward by the standardized measurement of a broad range of quality indicators. IRIS was implemented in the geriatric wards of the 4 hospitals of the Plexus healthcare network ‘Oost-Vlaams-Brabant’ (Belgium). The goal was to compare the IPC and AMS policies of the hospitals in order to define common improvement strategies within the Hospital Outbreak Support Team (HOST), a federal project concerning IPC and AMS. In the first part of IRIS, the risk profile of the patient population is determined by a point prevalence measurement of 4 variables. In the second part, the improvement plot is created based on the measurement of 7 quality indicators. Improvement actions can be deduced from quality indicators with higher improvement potentials. The risk profiles of the 4 hospitals were highly comparable and the improvement plots showed an intermediate to high improvement potential for the use of AMT and hand hygiene compliance. There were important differences in the appropriate use of transurethral and intravascular catheters, with 2 hospitals having a low and 2 hospitals having a high improvement potential. IRIS was a useful tool in the early phase of the HOST project to benchmark the IPC and AMT policies between the Plexus hospitals and to decide what future projects could be collaborated on. As a result of IRIS, it was decided to define common care bundles for the prevention of catheter-associated urinary tract and blood stream infections and to determine hospital-specific actions with regard to the optimisation of AMS.

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.

Antibiotic resistance in Sudan: assessing the knowledge and practices of healthcare workers in Khartoum.

Antibiotic resistance (ABR) is a major public health issue, associated with increased patient morbidity and mortality globally, with significantly higher rates in low- and middle-income countries (LMICs). Assessment of contextual factors, such as information, education, infrastructure and regulations are important for developing local solutions against ABR. To determine the knowledge and practices of healthcare workers (HCWs) towards ABR in hospitals in Sudan. A survey was conducted in three different hospitals in Khartoum, Sudan from February to December 2020. HCWs of different specialties and expertise were invited to participate. Data were descriptively analysed using Statistical Package for Social Sciences (SPSS). ABR was identified as a big challenge by 89% of 345 HCWs who participated. The results show that 79% of doctors don't rely on the clinical microbiology laboratory (CML) results for antibiotic prescription or clinical decision-making. Sixty percent of HCWs agreed there are infection prevention and control (IPC) guidelines in their hospital, but 74% of them don't have access to them, and infrequently receive relevant IPC training. Furthermore, HCWs obtain ABR information from other colleagues informally, not through local data or reports. Despite adequate knowledge of ABR locally, there are significant contextual technical challenges facing HCWs in Sudan, such as availability of policies and accurate data from CMLs. The results indicate a poor link between HCWs and the CMLs for infection management and it is essential to improve communication between the different hospital departments with regard to ABR transmission, and ensure the effectiveness of local IPC policies based on locally available data.

Implementing a continuous quality-improvement framework for tuberculosis infection prevention and control in healthcare facilities in China, 2017-2019.

Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019. Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics. Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services. TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.

Exploring factors influencing the compliance of patients and family carers with infection prevention and control recommendations across Bangladesh, Indonesia, and South Korea.

Poor compliance with infection prevention and control (IPC) measures has been a longstanding issue globally. To date, healthcare workers (HCWs) have been the primary target for policy and strategy revisions. Recent studies exploring the contributing factors to the spread of COVID-19 across countries in Asia have suggested that the scope of focus should be extended to family carers who provide patient care activities. This study aimed to explore factors affecting patients' and their family carers' IPC compliance in hospitals in Bangladesh, Indonesia, and South Korea. A qualitative study incorporating 57 semi-structured interviews was conducted in five tertiary-level hospitals across the three focus countries between July 2019 and February 2020. Interviews were undertaken with: (1) patients, family carers and private carers; and (2) healthcare workers, including nurses, doctors, and hospital managers. Drawing upon the principles of grounded theory, data were inductively analyzed using thematic analysis. A total of three main themes and eight subthemes are identified. Key themes focused on the assumptions made by healthcare workers regarding the family/private carers' level of understanding about IPC and training received; uncertainty and miscommunication regarding the roles of family/private carers; variations in carer knowledge toward IPC and healthcare-associated infections, and the impact of cultural values and social norms. This exploratory study offers novel findings regarding the factors influencing IPC compliance among patients and their family/private carers across various cultural settings, irrespective of resource availability. The role of cultural values and social norms and their impact on IPC compliance must be acknowledged when updating or revising IPC policies and guidelines.

Infection prevention and control policies in hospitals and prevalence of highly resistant microorganisms: an international comparative study

BackgroundThere are differences in infection prevention and control (IPC) policies to prevent transmission of highly resistant microorganisms (HRMO). The aim of this study is to give an overview of the IPC policy of six European hospitals and their HRMO prevalence, to compare the IPC policies of these hospitals with international guidelines, and to investigate the hospitals’ adherence to their own IPC policy.MethodsThe participating hospitals were located in Salzburg (Austria), Vienna (Austria), Kayseri (Turkey), Piraeus (Greece), Rome (Italy) and Rotterdam (The Netherlands). Data were collected via an online survey. Questions were aimed at prevalence rates in the years 2014, 2015, 2016 of carbapenemase-producing Klebsiella pneumoniae (CPK), carbapenemase-producing Pseudomonas aeruginosa (CPPA), vancomycin-resistant Enterococcus faecium (VRE) and hospitals’ IPC policies of 2017. Implemented IPC measures (i.e. with a self-reported adherence of > 90%) were counted (26 points maximal).ResultsThe self-reported prevalence of CPK per year was low in the Austrian and Dutch hospitals and high in the Turkish and Greek hospitals. CPPA was highly prevalent in the Turkish hospital only, while the prevalence of VRE in four hospitals, except the Austrian hospitals which reported lower prevalence numbers, was more evenly distributed. The Dutch hospital had implemented the most IPC measures (n = 21), the Turkish and Greek hospitals the least (n = 14 and 7, respectively).ConclusionHospitals with the highest self-reported prevalence of CPK and CPPA reported the least implemented IPC measures. Also, hospitals with a higher prevalence often reported a lower adherence to own IPC policy.

Status of infection prevention and control capacity in Korean hospitals: implications for disaster response and pandemic preparedness

ObjectivesThis study aims to explore the association of hospital infection prevention and control (IPC) structure (i.e. a dedicated IPC team and/or IPC committee) and IPC capacity in Korean hospitals, as well as its implications in the response and preparedness to COVID-19. Study designThis was a cross-sectional study using data collected through a nationwide survey. MethodsParticipating hospitals completed an online questionnaire. Participation was voluntary. The survey questionnaire was developed by the government in consultation with IPC experts. The questionnaire was distributed to 2108 hospitals, including both acute and long-term care hospitals. The independent variables were the presence of an IPC team and/or IPC committee. The dependent variables were IPC activities and capacity measures, which were based on the World Health Organisation (WHO) recommendations on the core components in IPC. ResultsA total of 1442 hospitals completed the survey. Hospitals with IPC structures conducted significantly more IPC activities in all outcome measures compared with hospitals without IPC structures, with the exceptions of monitoring hand hygiene and screening for infectious diseases that showed non-significant differences. Hospitals with IPC structures showed a significant difference in performance in IPC risk assessment, operating outbreak response teams and appraisal of hospital IPC policies compared with hospitals without IPC structures. ConclusionsThe presence of a dedicated IPC team and IPC committee was associated with increased IPC activities and IPC capacity. Hospitals with IPC teams and IPC committees showed strong implementation of planning, appraisal, resource management and outbreak response, indicating that strengthening IPC structures within hospitals is the key to more effective IPC and disaster response.

What is needed to sustain improvements in hospital practices post-COVID-19? a qualitative study of interprofessional dissonance in hospital infection prevention and control

BackgroundHospital infection prevention and control (IPC) depends on consistent practice to achieve its purpose. Standard precautions are embedded in modern healthcare policies, but not uniformly observed by all clinicians. Well-documented differences in attitudes to IPC, between doctors and nurses, contribute to suboptimal IPC practices and persistence of preventable healthcare-associated infections. The COVID-19 pandemic has seriously affected healthcare professionals’ work-practices, lives and health and increased awareness and observance of IPC. Successful transition of health services to a ‘post-COVID-19’ future, will depend on sustainable integration of lessons learnt into routine practice.MethodsThe aim of this pre-COVID-19 qualitative study was to investigate factors influencing doctors’ IPC attitudes and practices, whether they differ from those of nurses and, if so, how this affects interprofessional relationships. We hypothesised that better understanding would guide new strategies to achieve more effective IPC. We interviewed 26 senior clinicians (16 doctors and 10 nurses) from a range of specialties, at a large Australian tertiary hospital. Interview transcripts were reviewed iteratively, and themes identified inductively, using reflexive thematic analysis.ResultsParticipants from both professions painted clichéd portraits of ‘typical’ doctors and nurses and recounted unflattering anecdotes of their IPC behaviours. Doctors were described as self-directed and often unaware or disdainful of IPC rules; while nurses were portrayed as slavishly following rules, ostensibly to protect patients, irrespective of risk or evidence. Many participants believed that doctors object to being reminded of IPC requirements by nurses, despite many senior doctors having limited knowledge of correct IPC practice. Overall, participants’ comments suggested that the ‘doctor-nurse game’—described in the 1960s, to exemplify the complex power disparity between professions—is still in play, despite changes in both professions, in the interim.ConclusionsThe results suggest that interprofessional differences and inconsistencies constrain IPC practice improvement. IPC inconsistencies and failures can be catastrophic, but the common threat of COVID-19 has promoted focus and unity. Appropriate implementation of IPC policies should be context-specific and respect the needs and expertise of all stakeholders. We propose an ethical framework to guide interprofessional collaboration in establishing a path towards sustained improvements in IPC and bio-preparedness.

Infection prevention and control practice among home‐care nursing agencies in Japan: Secondary analysis of a nationwide cross‐sectional survey

AimWe describe the nationwide situation of infection prevention and control (IPC) practices among home‐visit nursing agencies and compare them by agency size to explore whether these practices are associated with the occurrence of infection.MethodsWe conducted a secondary analysis using data from a cross‐sectional nationwide survey inspecting patient safety and IPC practices among nationwide home‐visit nursing agencies, from March to April 2020. Among 9978 agencies, 580 responded and 370 were incorporated in the analysis. The self‐administered questionnaire inquired about the IPC policy and administrative structure, education and training, adherence to standard precautions, and employee health programs. We described the adherence to IPC practice at the agency level and compared them by agency size using chi‐squared tests. Logistic regression analysis was performed to explore the associations between IPC practices and incidence of infection.ResultsAdherence to IPC practices ranged from 19.2% to 92.4% and varied according to agency size. Less than 20% of agencies had instituted a committee for IPC and strictly used disposable aprons when changing patients' diapers. Instituting a committee for IPC (odds ratio 2.19, 95% confidence interval 1.11–4.34, P < 0.05) and training staff for infection prevention (odds ratio 1.67, 95% confidence interval 1.02–2.72, P < 0.01) were significantly associated with the incidence of infection, after adjusting for covariates.ConclusionsThere are challenges in establishing IPC policies and administrative structures and adhering to standard precautions. Well‐organized agencies were found to be more likely to detect infections occurring over the past 3 months. Geriatr Gerontol Int 2021; 21: 913–918.

Ghana beyond the epi-curve: initial lessons learned from the implementation of infection prevention and control measures in the COVID-19 response.

Infection prevention and control (IPC) measures remain crucial to breaking transmission of the virus in the wake of inconclusive efforts underway to find an effective vaccine and treatment. While acknowledging that many lessons evolve as the pandemic unfolds, an initial understanding and recognition of the complexities that surround IPC policy implementation and adherence is vital for effective control of on-going pandemic in particular and to inform national IPC policies beyond the epi-curve. This short communication therefore seeks to unravel initial thoughts, themes and concepts that have unfolded in the implementation of IPC policies and guidelines in the context of the ongoing outbreak response in Ghana. A rapid desk review was done. Reflexive journals, field notes, observations and workshop experiences were compiled and overlapped with authors’ experience as a member of the COVID-19 national response team for Infection Prevention and Control (IPC). Thematic content analysis was then used to categorize the lessons into common themes. While aligning with global strategies, the concept of ‘looking within’ for initial solutions and strengths have proven useful for a public health emergency response in Ghana. Future IPC policies must inculcate perspectives from the politics and economics of IPC practices and employ varieties of multidisciplinary approaches required to broaden the scope of IPC practice.

Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana.

Healthcare-associated infections (HAIs) remain a serious threat to patient safety worldwide, particularly in low- and middle-income countries. Reducing the burden of HAIs through the observation and enforcement of infection prevention and control (IPC) practices remains a priority. Despite growing emphasis on HAI prevention in low- and middle-income countries, limited evidence is available to improve IPC practices to reduce HAIs. This study examined the perspectives of healthcare providers (HPs) and mothers in the neonatal intensive care unit on HAIs and determined the major barriers and facilitators to promoting standard IPC practices. This study draws on data from an ethnographic study using 38 in-depth interviews, four focus group discussions and participant observation conducted among HPs and mothers in neonatal intensive care units of a secondary- and tertiary-level hospital in Ghana. The qualitative data were analysed using a grounded theory approach, and NVivo 12 to facilitate coding. HPs and mothers demonstrated a modest level of understanding about HAIs. Personal, interpersonal, community, organizational and policy-level factors interacted in complex ways to influence IPC practices. HPs sometimes considered HAI concerns to be secondary in the face of a heavy clinical workload, a lack of structured systems and the quest to protect professional authority. The positive attitudes of some HPs, and peer interactions promoted standard IPC practices. Mothers expressed interest in participation in IPC activities. It however requires systematic efforts by HPs to partner with mothers in IPC. Training and capacity building of HPs, provision of adequate resources and improving communication between HPs and mothers were recommended to improve standard IPC practices. We conclude that there is a need for institutionalizing IPC policies and strengthening strategies that acknowledge and value mothers’ roles as caregivers and partners in IPC. To ensure this, HPs should be better equipped to prioritize communication and collaboration with mothers to reduce the burden of HAIs.

Home Health Staff Perspectives on Infection Prevention and Control: Implications for Coronavirus Disease 2019

ObjectivesThe role of home healthcare (HHC) services in providing care to vulnerable, often frail individuals with chronic conditions is critical. Effective infection prevention and control (IPC) in HHC is essential to keeping both healthcare workers and patients safe, especially in the event of an emerging infectious disease outbreak. Prior to the coronavirus disease 2019 pandemic, we explored successes and challenges with IPC from the perspectives of HHC staff. DesignQualitative descriptive study. Setting and ParticipantsFrom May to November 2018, we conducted in-depth telephone interviews with 41 staff from 13 agencies across the nation. MethodsTranscripts were coded by a multidisciplinary coding team, and several primary and subcategories were identified using directed content analysis. ResultsFour primary categories were generated including (1) uniqueness of HHC; (2) IPC as a priority; (3) importance of education; and (4) keys to success and innovation. Participants perceived that IPC plays a big part in patient safety and reducing rehospitalizations, and protection of patients and staff was a major motivator for compliance with IPC. The identified challenges included the unpredictability of the home environment, patient/family dynamics, the intermittent nature of HHC, and staffing issues. Education was seen as a tool to improve staff, patient, caregiver and families' compliance with IPC. Keys to success and innovation included a leadership focus on quality, using agency infection data to improve quality, and a coordinated approach to patient care. Conclusions and ImplicationsThis qualitative work identified barriers to effective IPC in HHC, as well as important facilitators that HHC agencies can use to implement policies and procedures to improve patient care and keep staff safe. Leadership prioritization of IPC is key to implementing appropriate IPC policies and may be especially important in midst of a crisis such as coronavirus disease 2019.

COVID-19 in Shanghai: IPC Policy Exploration in Support of Work Resumption Through System Dynamics Modeling.

PurposeIt is unclear how and to what extent various infection prevention and control (IPC) policies affect the spread of an epidemic during work resumption. In order to assess the impact of IPC policies, this research addresses the results of a policy simulation in Shanghai, China, which estimates the transmission dynamics of COVID-19 under various IPC policies and offers evidence-based outcomes of work resumption policies for the world.Materials and MethodsThis simulation research is based on a system dynamics (SD) model that integrates IPC work resumption policies implemented in Shanghai into the classical susceptible-exposed-infected-removed (SEIR) epidemiological model. Input data were obtained from official websites, the Baidu migration index and published literature. The SD model was validated by comparing results with real-world data.ResultsThe simulations show that a non-quarantined and non-staged approach to work resumption (Policy 1) would bring a small secondary outbreak of COVID-19. The quarantined but non-staged approach (Policy 2) and the non-quarantined but staged approach (Policy 3) would not bring a secondary outbreak of COVID-19. However, they both would generate more newly confirmed cases than the staged and quarantined approach (Policy 4). Moreover, the 14-day quarantine policy alone appears to be more effective in reducing transmission risk than the staged work resumption policy alone. The combined staged and quarantined IPC policy led to the fewest confirmed cases caused by work resumption in Shanghai, and the spread of COVID-19 stopped (ie, the number of newly confirmed cases reduced to zero) at the earliest date.ConclusionConservative IPC policies can prevent a second outbreak of COVID-19 during work resumption. The dynamic systems model designed in this study can serve as a tool to test various IPC work resumption policies, facilitating decision-making in responses to combating the COVID-19 pandemic.

Challenges and Facilitators to Effective Infection Prevention in Home Health Care: Results From Qualitative Interviews of Home Health Care Services

Background: As the population of older Americans with chronic conditions continues to grow, the role of home health care (HHC) services in improving care transitions between acute care and independent living has become a national priority. Infection prevention and control (IPC) is often a focus of quality improvement initiatives at HHC agencies. In this study, we investigated barriers and facilitators of effective IPC in HHC. Methods: In 2018, we conducted in-depth, telephone interviews with 41 staff from 13 agencies across the United States including administrators, IPC and quality improvement personnel, registered nurses and HHC aides. Interview transcripts were coded in NVivo v 12 software (QSR International), and themes were identified using content analysis. Results: We identified 4 themes: (1) IPC as a priority, (2) uniqueness of home health care, (3) importance of education, and (4) keys to success and innovation. When discussing the top priorities in the agency, participants described IPC as a big part of patient safety and as playing a major role in reducing rates of rehospitalization. Protection of patients and staff was described as a major motivator for compliance with IPC policies and procedures, and agencies placed specific focus on improving hand hygiene, bag technique, and disinfection of equipment. Almost all participants described the uniqueness of providing health care in a patient’s home, which was often talked about as an unpredictable environment due to lack of cleanliness, presence of pets and/or pests, and family dynamics. Furthermore, the intermittent nature of HHC was described as affecting effective implementation of IPC procedures. Education was seen as a tool to improve and overcome patient, caregiver, and families’ lack of compliance with IPC procedures. However, to be effective educators and role models, participants stated that they themselves needed to be properly educated on IPC policies and procedures. Several keys to success and innovation were discussed including (1) agency reputation as a key driver of quality; (2) agency focus on quality and patient satisfaction; (3) using agency infection data to improve the quality of patient care; (4) utilizing all available resources within and outside of the agency, and (5) a coordinated approach to patient care with direct, multimodal communication among all clinical disciplines. Conclusions: This qualitative work identified barriers to effective infection prevention and control in HHC and important facilitators that HHC agencies can use to improve implementation of policies and procedures to improve patient care.Funding: NoneDisclosures: None

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

The Design and Implementation of an IPC Certificate Course: Experiences From Sierra Leone

Background: Trained infection prevention and control (IPC) practitioners are critical to reducing healthcare-associated infections (HAI) and improving patient safety. Despite having HAI rates 3 times higher than high-income countries, many low- and middle-income countries (LMICs) lack trained IPC professionals. During the 2014–2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS) recognized this need and appointed and trained IPC focal persons at all district hospitals. Following the outbreak, MoHS requested assistance from the US CDC to develop and implement a comprehensive IPC training program for IPC specialists. Methods: The CDC, alongside its partners, convened a multidisciplinary team to develop an IPC certificate course. ICAP led the curriculum development process using a “backwards design” approach, starting with development of competencies and learning objectives, then designing an evaluation framework and learning strategies, and finally, identifying course content. The curriculum was based on existing resources, primarily designed for high-income countries, which were adapted to the Sierra Leone context and aligned with national IPC policies and guidelines. Additionally, an IPC steering committee, led by MoHS, was established to provide national leadership and oversight and make country-level decisions regarding accreditation and career pathways for IPC specialists. Results: The course includes three 2-week workshops over 6 months consisting of classroom didactics and hands-on activities. Topics include standard and transmission-based precautions, microbiology, laboratory, HAI, quality improvement, leadership, and scientific writing. Between sessions, participants conduct IPC activities at their work site and share results during subsequent workshops. Participants receive electronic tablets, which contain course content, assessment tools, and references, to upload their work into a cloud-based storage system for facilitators to provide feedback. They also receive in-person mentorship and connect with peers through a group messaging platform to share lessons learned. Participants’ knowledge and skills are assessed using a before-and-after test and observing them perform IPC practices using standardized checklists. The first cohort of 25 participants will complete the course in November 2019. Conclusions: The IPC certificate course is the first comprehensive, competency-based IPC training in Sierra Leone. Successes, challenges, sustainability, and lessons learned remain to be determined; however, based on similar models, the course has the potential to significantly improve IPC in Sierra Leone. Additionally, it is a model that can be replicated in other resource-limited settings.Funding: NoneDisclosure:None

Responding to “Covid-19”Pandemic: Quality Management and Preventive Strategies of a Hospital

The newly emerged public health crisis threatening the world with emergence or spread of a novelcoronavirus named SARS - CoV-2 associated with higher infection rates and deaths especially elderlypeople and people with Hypertension, Diabetes Mellitus, Cerebrovascular and Cardiovascular diseasesthroughout the world. As of 17thJune 2020, 216 countries were affected with 83,26,825 confirmed casesincluding 4,48,081 total deaths. India has reported around 3.6 lakh confirmed cases with more than 12thousand total deaths. To respond this pandemic, India needs to set-up an adequate, well equipped anddedicated health care facility to contain the spread of infection and manage the infected patients as wellas providing protection to the healthcare workers (HCW). Quality management and preventive strategiesof a hospital plays very important role for this purpose. Quality management is the fundamental featureof a hospital to establish customer satisfactions and desired outcomes. High quality care health servicesinvolve doing the right things, for the right patient, at the right time, in the right way to minimise the harmand resource waste. Preventive strategies especially infrastructure development &amp; Infection prevention andcontrol policies (IPC) are very crucial. The effective, safe, people centred, timely, equitable, integratedand efficient heath care delivery improvement with appropriate quality management system and preventivestrategies will be helpful to combat with “COVID-19”. This study highlights the “Quality management andPreventive Strategies of a Hospital responding to COVID-19” for providing better healthcare services inIndian healthcare management system.

State of Infection Prevention and Control in Home Healthcare Agencies

<h3>Background</h3> Home healthcare (HHC) is becoming a leading source of post-acute services. Currently, most HHC patients have multiple chronic conditions, thereby increasing their risk of infections and rehospitalizations. With a nationally-representative survey, we aimed to better understand the current state of infection prevention and control (IPC) at HHC agencies. <h3>Methods</h3> A national survey, directed at administrators and clinical managers, was conducted from October 2018 to November 2019. Agencies were recruited from a national HHC conference, and a national random sample of 1,505 agencies stratified by census region, ownership status and rural/urban location. Questions were asked about IPC staffing, IPC compliance and training, and current IPC policies and procedures. Descriptive statistics were computed using Stata 13. <h3>Results</h3> 575 HHC agencies (35% response rate) responded; 63% had for-profit ownership. At responding agencies, 35.4 % of staff members in charge of IPC had received no specific IPC training, and 5.6% reported that they currently did not have a staff member in charge of IPC. Over 60% of agencies provided staff training on IPC topics either annually or at new employee orientation. 82.3% reported measuring adherence to hand hygiene policies; policy adherence was measured by shadowing (84.9%) and knowledge assessments (71.8%). Most HHC agencies (87.6%) reported collecting and reviewing infection data to identify trends. Overall, only 31% of agencies required staff influenza vaccination; however, a majority (61.4%) offered free influenza vaccinations to their staff. During the past influenza season, 62.7% of agencies had 75% or more of their employees vaccinated for influenza, and 9% reported not tracking that data. <h3>Conclusions</h3> This national study examining the current state of IPC in HHC can be used as a benchmark for quality improvement initiatives. Particularly, we learned that staff training around IPC and policies and procedures related to staff vaccination are currently inadequate.

Emerging Challenges and Threats for Dental Health Care Sector Attributable to COVID-19: Tale of a Developing Country.

Prevention and control of infection in dentistry is an essential matter that has gained immense attention in recent years. There exist a lack of scientific data about the cross-transmission and its associated risk, especially in the dental health care setting of Pakistan. This article will evaluate the emerging challenges and threats for the dental community in Pakistan attributable to the COVID-19 outbreak. There is a significant knowledge gap regarding the state- and institutional-level of infection prevention and control (IPC) policies and practices. In addition, not much is known about the development, implementation, and monitoring of IPC policies and its challenges.