Core Component 1: IPC programme
|
Need an approach to maintain “continuous” advocacy (n = 15)
|
Set up regular meetings with senior leadership/managers
|
10
|
IPC should be a part of routine meetings, presentations, or rounds
|
5
|
May first need external technical assistance (n = 13)
|
National level should first support selected professionals to receive external IPC training and these professionals can then act as trainers in-country
|
9
|
External IPC experts should first review initial materials to ensure they meet IPC standards
|
4
|
Use a stepwise approach to build required resources (n = 10)
|
Start with a small group of committed staff in addition to link nurses and regional staff
|
6
|
Need at least a small budget in the beginning for recognition
|
4
|
Use specific activities or opportunities as “catalysts” for advocacy (n = 6)
|
Use of data (process or outcome measures) can help convince leadership of IPC’s importance, i.e. avoid "no data, no problem"
|
3
|
Publicize starting examples, e.g. hand hygiene, surgical site infections
|
3
|
Promote linkages with health system (n = 6)
|
Link IPC personnel and team with the quality management team
|
3
|
Link IPC personnel and team with AMR team
|
3
|
National IPC association can drive IPC improvement (n = 6)
|
National IPC association can be active in providing expert input and assisting with local adaption of materials
|
6
|
May need normative actions to convince stakeholders (n = 4)
|
Need legislation for recognition
|
4
|
Core Component 2: IPC guidelines
|
Consider specific approaches to operationalize guidelines (n = 16)
|
Link guidelines directly to training and workshops
|
6
|
Link guidelines directly to monitoring indicators
|
4
|
Set guideline dissemination plan early during planning
|
3
|
Designate dedicated multidisciplinary guideline implementation leads
|
3
|
Use specific strategies for adaption of guidelines (n = 15)
|
Schedule ongoing meetings to review guidelines and regularly update them based on current evidence and practice
|
5
|
National IPC association can drive guidance development and adaption
|
4
|
Meet with other public health programmes (e.g. maternal and child health, HIV, tuberculosis) and identify joint guideline themes and actions
|
3
|
Develop a plan to collect local evidence to inform guidelines
|
3
|
May first need external technical assistance (n = 12)
|
Hire external IPC expert for initial development and then locally adapt
|
8
|
Adapt international standard guidelines, e.g. WHO, ECDC, US CDC
|
4
|
Core Component 3: IPC education and training
|
Consider specific training methods (n = 19)
|
Select 1–2 master trainers to first receive IPC expert training outside of the country
|
5
|
Consider multidisciplinary training, i.e. different staff together, to remove hierarchy
|
4
|
Use a train-the-trainers structure
|
4
|
May need initial IPC expert technical consultant and then can locally adapt training
|
3
|
Ensure regular in-service workshops
|
3
|
Promote linkages with health system and sustainability (n = 9)
|
Create an IPC career path, e.g. accreditation
|
5
|
Harmonize trainings across programmes, e.g. maternal and child health, HIV, tuberculosis
|
4
|
Foster local IPC leadership during trainings (n = 7)
|
Require mandatory trained IPC hospital leads who can play an integral role in trainings
|
4
|
Identify local champion trainers and trainees at the facility level
|
3
|
Core Component 4: HAI surveillance
|
Prioritise feasible but high-impact starting points or pilots (n = 30)
|
Start with surgical site infection (e.g. post caesarean-section, 30-day follow-up) pilot
|
8
|
Start with device-associated infection, e.g. urinary or bloodstream, pilot
|
5
|
Start with severe acute respiratory infection pilot
|
5
|
Use a stepwise fashion to slowly scale-up surveillance in a careful way
|
5
|
Can start with paper-based system but develop transition plan for electronic surveillance
|
4
|
Start with pilot in intensive care units
|
3
|
Ensure multidisciplinary collaboration, mentorship (n = 26)
|
Conduct regular surveillance training and feedback, e.g. yearly seminars
|
6
|
Conduct site support visits, e.g. assessment of case finding, forms, denominator data
|
5
|
Advocate for integration of HAI surveillance with AMR and stewardship efforts
|
4
|
Create a technical working group on surveillance in National IPC or AMR committees
|
4
|
Ensure that one hospital is effectively trained in surveillance and can provide leadership to other hospitals
|
4
|
Promote frequent informal mentorship
|
3
|
Carefully consider definitions and data quality processes (n = 22)
|
Conduct a careful structured discussion on adaption of case definitions, maintaining standards, consistency and predictive value
|
7
|
Reference US National Healthcare Safety Network (NHSN) definitions
|
7
|
First identify who can collect, clean, and analyse data, i.e. invest in statisticians
|
4
|
Decide early on how to regularly evaluate data quality
|
4
|
Promote “data for action” (n = 7)
|
Leverage quality improvement programme/activities
|
7
|
Core Component 5: Multidmodal strategies for implementation of IPC interventions
|
Promote activities to clearly communicate and advocate for multimodal strategies (n = 16)
|
Need leadership buy-in to obtain resources, e.g. awareness workshop, regular meetings
|
7
|
Many cannot explain what multimodal strategies so communicate a clear definition
|
6
|
Identify multidisciplinary champions for multimodal strategies
|
3
|
Put focus on certain elements of multimodal strategies (n = 16)
|
Monitoring, audit, feedback, scoring and accountability mechanisms are key elements
|
8
|
Guidelines and training are key elements
|
4
|
Promotion of safety culture is a key element, e.g. organizational culture questionnaire, team communication mechanisms, mentorship activities
|
4
|
Prioritise feasible but high-impact starting points or pilots (n = 14)
|
Start with hand hygiene pilot
|
8
|
Start with device-associated infections, e.g. urinary or bloodstream, pilot
|
3
|
Start with surgical site infection pilot
|
3
|
Core Component 6: Monitoring/audit of IPC practices and feedback
|
Promote “data for action” (n = 17)
|
Present at IPC committee meetings, during hospital workshops, and in staff emails to build political will for change
|
6
|
Recognize performance with incentives, e.g. centre of excellence, ward/personnel awards
|
6
|
Publish scores for staff, e.g. device-associated infection-free days, hand hygiene practices
|
5
|
Prioritise feasible but high-impact starting points or pilots (n = 12)
|
Monitoring/audit and feedback should be part of IPC implementation from the beginning
|
5
|
Start with hand hygiene pilot
|
4
|
Start small to show “the problem”
|
3
|
Put focus on certain methods (n = 6)
|
Communicate positive audit and feedback culture, i.e. not punitive
|
3
|
Integrate with national health monitoring and information systems (HMIS)
|
3
|
Core Component 7: Workload, staffing and bed occupancy
|
Need the participation of national level actors (n = 11)
|
National level actors should set standards, e.g. for nurse-patient ratio
|
6
|
Long-term advocacy with national level actors is essential
|
5
|
Put focus on certain methods (n = 3)
|
Need to show data and local research to set staffing and bed occupancy standards
|
3
|
Core Component 8: Built environment, materials and equipment for IPC
|
IPC professionals should be actively involved in facility construction (n = 8)
|
Conduct regular meetings between construction and IPC teams to ensure that facility design, construction, modifications and renovations meet IPC standards
|
8
|
Put focus on certain elements of a multimodal strategy (n = 5)
|
Start with procuring equipment for hand hygiene
|
5
|
Promote long-term advocacy and integration with health system (n = 3)
|
Long-term WASH advocacy is needed for leadership buy-in and need phased in approach
|
3
|