SOCIETY FOR HEALTH ALLIED RESEARCH & EDUCATION INDIA (SHARE INDIA)

Infection Prevention and Control

Building systems capacity on Outbreaks Laboratory Surveillance Training Emergency response and


Infection Prevention Control and Anti-Microbial Resistance (BOLSTER)

Infection Prevention & Control (IPC)

India with a population of 1.3 billion is home to various infectious diseases with its vast and divergent geographical and ecological diversity. Over the years, there has been an increase in Healthcare Acquired Infections (HAI) among patients in India. Studies conducted on HAI in India, identified that HAIs results in prolonged hospital stay, long-term disability, increased resistance of microorganisms to antimicrobials, additional cost on health systems, high cost for patients and their family and preventable deaths. The COVID-19 pandemic has heightened existing concerns in the states and facilities that Infection Prevention and Control (IPC) and laboratory capacity is suboptimal. The lack of sufficiently trained staff with the ability to protect themselves and patients leads to preventable morbidity and mortality. Without adequate laboratory capacity the ability to detect healthcare associated infections is not available to healthcare workers or patients.

The Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) has introduced the National Patient Safety Implementation Framework (2018-2025) (NPSIF) and adopted the UN General Assembly declaration, to respond to antimicrobial resistance (AMR). In alignment with the NPSIF, National Guidelines for Infection Prevention and Control (IPC) in health care facilities was introduced in January 2020 to enhance the capacity of healthcare workers to prevent and control infections in hospitals. The National Guidelines on Clinical Management of COVID-19, March 2020, also puts greater emphasis on IPC in the care for COVID-19 patients. The Guidance on developing State Action Plans for Containment of antimicrobial Resistance (SAPCAR), MoHFW, July 2018 also points to the key strategic priorities (2 & 3) of IPC, Laboratory and surveillance. Along with that the National Health System Resource centre (NHSRC) provided information on the measures taken by Government of India (GoI) for ensuring Patient Safety especially in Public Hospitals and National Health Programmes and launched the National Quality Assurance Programme for Public Health Facilities to ensure quality services and infection prevention control as one of the key parameters for quality assurance.

The Centres for Disease Control and Prevention (CDC) collaborated with SHARE INDIA to support facility, state and national priorities and move towards SAPCAR, considering the pro-active healthcare system in the state of Andhra Pradesh (AP) to strengthen IPC since 2020.

Our Reach

Andhra Pradesh

Deliverables

  • Baseline assessment: To understand current IPC practices and gap finding; Conduct risk assessment to enhance IPC
  • Capacity building / training: Facilitate formation of IPC team; Development of training curriculum & facilitate virtual trainings of IPC team; Provide resources on IPC and COVID; Reconstitution of the existing HICC
  • Monitoring and mentoring: Onsite visits to monitor implementation of IPC; Quarterly review meetings – HICC; Periodic IPC assessments
  • Engagement of leadership and dissemination: Periodic updates to Govt; Monthly engagement with the state nodal officers for IPC from the offices of DME, APVVP and SQAC
  • Surveillance of health care associated infection: Technical assistance to link these hospitals to HAI Surveillance network

Objectives

The overall aim of project BOLSTER is to support an accelerated and evidence-based response to the multi-dimensional challenges and seamless achievement of GHSA goals, by supporting building core public health capacities in IPC AMR, HAI, Surveillance and outbreak response.

Specific objectives under IPC

  • Provide technical and logistical support to conduct baseline assessments of IPC programs in designated hospitals using standardized assessment tools.
  • Provide technical and logistical support to develop work plans to address IPC gaps in designated hospitals
  • Provide technical and logistical support to implement NCDC IPC guidelines in the designated healthcare facilities
  • Provide technical and logistical support for implementation of comprehensive IPC Programme activities using a quality improvement approach in designated hospitals
  • Provide technical and logistical support for in-person and virtual training and mentorship of designated hospital staff on topics related to IPC and HAIs.
  • Provide technical and logistical support for analysis and use of IPC program data to target IPC activities in designated hospitals.
  • Provide technical and logistical support for review meetings of key stakeholders
  • Provide technical and logistical support for reporting of IPC Programme outcome indicators to facility, state, and national stakeholders.
  • Involve and keep informed state level leadership in planning, implementation, and reporting activities throughout the project period.

Activities

1. Advocacy and Communication

The project is focused on conducting the following activities to strengthen Infection Prevention and Control (IPC) at designated healthcare facilities:

Baseline assessments for IPC in the project implementing sites

  • The project conducted IPC core component assessment at 21 HCFs using World Health Organization (WHO) – Infection Prevention and Control Assessment Framework (IPCAF) tool.
  • Conducted facility assessment at 21 facilities using the latest version of the NCDC tool for healthcare facility /hospital preparedness for COVID-19 isolation facilities
  • An action plan was prepared based on the baseline assessments and the project team facilitated in providing the following interventions towards COVID-19 response, general IPC practices, establishing a sustainable IPC strategy for the HCFs, hospital pandemic preparedness plan and aimed to prevent, detect and respond to healthcare associated transmission of SARS CoV 2 and other emerging infectious pathogens.

Facilitated training for Capacity building in IPC

  • The project team trained the hospital infection control committee (HICC) members of the project implementing facilities on IPC and hospital preparedness and IPC for COVID-19 in the state of Andhra Pradesh. The WHO-IPCAF tool and guidance document was used for assessing and implementing IPC core components in the facility.
  • Training was also provided to 72 Hospital Infection Control Nurse (HICN) at the facility and were mentored on:
  • Ensure Triage
    • Implement Standard precautions
    • Ensure that the HICC has access all the latest IPC guidance from MoHFW and encourage the use of national guidelines
    • Conduct risk assessments and ensure Transmission based precautions are being implemented
    • Address the gaps found from hospital preparedness assessments and IPACF assessments and help implement the action plans within the stipulated timelines
    • Coordinate with Health care facility for
      • Ensuring HCW safety, Staff Cohorting, passive / active screening
      • Personal protective equipment (PPE)
      • Hand Hygiene
      • Quality improvement plan for IPC

Intervention sites in Andhra Pradesh

2. Accomplishments

  • The project team assessed 21 healthcare facilities in AP using the standardized assessment checklists Capacity building of IPC personnel on carrying out IPC activities were done.
  • The gaps were addressed at the facility level by building the capacity of the HCFs personnel, designing work plans and maintaining timelines.
  • Training on COVID-19 hospital preparedness towards infection prevention and control activities was provided. The capacity building of the staff was done on the preparedness of the hospitals to respond to potential outbreaks.
  • Recommendations were made to the state health system and key stakeholders to address system level gaps and to ensure sustenance of the programme.