WHO Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Health Care Facility Level Web Appendix III Summary of an inventory of available guidance from countries and WHO regional offices Introduction To inform the development of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level, a methodology was developed to identify existing documents outside of the academic literature, existing at the WHO regional and national level. The inventory of regional and national documents (including strategies, plans, reports and recommendations) presented in this report is the conclusion of this work. The inventory was developed primarily using existing WHO regional networks. Purpose of the inventory The development of an inventory of national and regional IPC action plans and strategic documents complements the two systematic reviews described in web appendices I and II of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. The inventory provided a mechanism for collating regional and national documents that describe what could be considered the core elements of Infection Prevention and Control (IPC) programmes. Information collected was analyzed and synthesized in parallel to the systematic reviews and fed into the development of the Guidelines. Methods A methodology and data capture approach was developed to identify, record and analyse regional and national documents that in some way address the key components of IPC programmes. The approach covered all WHO regions: WHO African Region (AFR), the WHO Pan American Health Organization (PAHO), WHO Eastern Mediterranean Region (EMR), WHO European Region (EUR), WHO South-East Asia Region (SEAR) and WHO Western Pacific Region (WPR). The scope of the work was developed through internal and external meetings with the WHO Antimicrobial Resistance Secretariat and WHO Regional Focal Points (RFPs) starting in October 2015, informed by an existing repository of AMR national action plans (NAPs) and strategies. Furthermore, a short online survey mainly targeting national IPC focal points and aimed at retrieving information on existing IPC national programmes and documents was undertaken from 20 January to 13 May 2016. The main fields within which data were captured related to the eight core components listed in a 2009 WHO meeting report (1) and the key components of the Systematic review and evidence-based guidance on organization of hospital infection control programmes (SIGHT) report (2) resulting in 9 categories (annex 1). Four information sources were used to collect information: the online survey; AMR NAPs 1
repository; RFPs for IPC/Patient Safety; WHO websites and a review of WHO s Country Cooperation Unit Country Visit Reports. Technical guidelines and standards for IPC and global documents/scientific reports issued by WHO headquarters solely addressing diseases or narrow aspects of IPC (e.g. TB, injection safety, AIDS) were excluded. Results From the 136 responses to the survey, 44 documents were retrieved from 49 countries. In total, 81 documents were collected across all information sources. Seventy three documents were national whereas eight were regional. One document was developed by the South East Asian and Western Pacific Regions collaboratively and was logged twice within each region (Table 1). 39 documents were in English, 42 in other languages (Albanian, Arabic, French, Georgian, Greek, Lithuanian, Portuguese, Russian and Spanish). WHO Region Documents (n ) African Region 8 Region of the Americas 27 Eastern Mediterranean Region 10 European Region 21 South-East Asia Region 7 (1 pan-regional) Western Pacific Region 9 (1 pan-regional) Total 82 by region (81 by document) Table 1: Breakdown of documents by region The type of documents reviewed included 27 AMR NAPs, three regional documents on AMR, five regional IPC documents and 56 national IPC documents. Documents were retrieved from a total of 41 Member States. On average across all regions Core Components one, three, four and seven (organization of IPC programmes [92%], human resources [90%], surveillance and assessment [91%], and programme monitoring and evaluation [78%]) are the most frequently addressed. The least frequently addressed is Component six (environment and equipment [65%]). Components two (technical guidelines), five (microbiology laboratory), and eight (links with public health and other services) are addressed in 77%, 66% and 68% of documents, respectively. A more detailed summary by component is presented below. Core component 1: organization of IPC programmes All regions address the need for IPC structures within existing documents, however there are gaps in relation to the need for adequate budgets for IPC programmes. Core component 2: technical guidelines Each region is addressing development, dissemination or implementation of guidelines to some extent, this being most evident in the South-East Asian Region and less so in the American Region based on available documentation. Core component 3: human resources Noticeable gaps are evident across all regions in relation to adequate IPC staff and measures to prevent biological risks. Training emerges as the strongest area of focus. Core component 4: surveillance 2
The majority of reviewed documents contain guidance relating to the establishment of priorities for surveillance, with some regional variation. Multiple cross-regional gaps exist in terms of recommending surveillance in the context of outbreak response and detection. Core component 5: microbiology laboratory There are noticeable gaps from all regions relating to the standardization of microbiology laboratory techniques and the promotion of the interaction between IPC activities and the microbiology laboratory. This includes the use of microbiology data for surveillance and IPC activities. Profound gaps exist in relation to addressing laboratory biosafety standards. Core component 6: environment and equipment There are noticeable gaps relating to identification of the minimum requirements for IPC including clean water, ventilation, hand hygiene facilities, patient placement and isolation facilities, storage of sterile supply and conditions for building and/or renovation within available documents. This is most noticeable in terms of specific direction on bed occupancy and availability and access to equipment. Core component 7: programme monitoring and evaluation Need for routine reporting is mentioned in most documents across all regions. In terms of promoting reporting in a non-punitive culture, significant gaps are evident in all documents across all regions. Core component 8: links with public health/other services With the exception of stakeholder coordination, noticeable gaps are identified across all available documents and across all other regions in relation to linkages between IPC and broader public health services. Component 9: other components Component nine includes any other components of IPC programmes not previously categorized. Most documents from the African region noted the importance of other components such as research and around half of the documents in all other regions included a range of other components including community engagement, patient education, interactions with the private sector and the role of partnerships in IPC. Discussion and conclusion The high level analysis provides useful information that acts as a baseline of current and previous regional and national efforts to address the core components of IPC programmes. It is clear that there are key strengths in a number of areas across all regions. In particular, there appears to be some clarity and direction on IPC structures, roles and responsibilities, including addressing policies and strategies across all Member States. This is likely to be influenced by the previous WHO work in support of Member States (1). Other key strengths identified include instruction on the general development, dissemination and implementation of technical, evidence-based guidelines, priority setting and routine reporting. There is less evidence in terms of the requisite qualified and dedicated staff with defined roles and responsibilities. There is also a serious gap relating to identifying the need for adequate dedicated budget as a condition for enabling programme activities. Lack of direction on the 3
minimum requirements for IPC including clean water, hand hygiene facilities, ventilation, patient placement and isolation facilities, storage of sterile supply and conditions for building and/or renovation, and bed occupancy also emerged. In summary, this exercise to gather intelligence on the extent of global, regional and national documents addressing the core elements of IPC programmes has revealed valuable insights into the current situation across all regions. 4
Annex 1: Survey structure Component CC1 CC2 CC3 CC4 CC5 CC6 CC7 CC8 CC9 Category Organisation of IPC Programmes Technical Guidelines Human Resources Surveillance and Assessment Microbiology Laboratory Environment & Equipment Programme Monitoring and Evaluation Links with Public Health/Other services Other CC: core components; IPC: infection prevention and control. 5
REFERENCES: 1. Core components for infection prevention and control programmes. Geneva: World Health Organization; 2009. 2. Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, et al. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis 2015:15:212-224. 6