A vital discipline for professionals who oversee custodial operations within healthcare buildings — including medical and dental offices, hospitals, outpatient and dialysis centers, and long-term care facilities — is infection prevention and control (IPC); an essential aspect of healthcare quality as well as patient, visitor, and healthcare worker (HCW) safety. IPC precautions put into place within these facilities work towards preventing healthcare-acquired infections (HAIs) and reducing antimicrobial resistance (AMR), and are critical to protecting against the spread of pathogens. 

HAIs are caused by microorganisms “which are common in the general population, in whom they cause no or milder disease than among hospital patients (Staphylococcus aureus, coagulase-negative staphylococci, enterococci, Enterobacteriaceae),” according to the World Health Organization (WHO). Factors that can influence the development of HAIs include contaminated instruments, objects, and substances; patient/healthcare worker contact; contaminated air conditioning systems; congested facilities (beds near one other); and improper sterilization and disinfection practices. 

The Impact of HAIs 

The Centers for Disease Control and Prevention (CDC) estimates that on any given day, one in 31 hospital patients and one in 43 nursing home residents in the United States has an HAI. From a global perspective, the WHO estimates that out of every 100 patients in acute-care hospitals, seven patients in high-income countries and 15 patients in low- and middle-income countries will acquire at least one HAI during their hospital stay. On average, one in every 10 affected patients will die from their HAI.  

HAIs negatively impact patient physical, mental/emotional and financial health, and are a growing threat in the United States and worldwide. HAIs also result in billions of dollars in added expenses to the healthcare systems overall. 

Throughout the last decade, viral outbreaks such as those due to Ebola, the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and the SARS-CoV-2 (COVID-19) pandemic have demonstrated how epidemic-prone pathogens can spread rapidly through healthcare settings. In particular, “the COVID-19 pandemic has exposed many challenges and gaps in IPC in all regions and countries, including those which had the most advanced IPC programs,” says Dr. Tedros Adhanom Ghebreyesus, WHO director general, in a press release. “It has also provided an unprecedented opportunity to take stock of the situation and rapidly scale up outbreak readiness and response through IPC practices, as well as strengthening IPC programs across the health system.”  

Global Report on IPC 

Earlier this year, the WHO released the “Global Report on Infection Prevention and Control”, bringing together evidence from scientific literature, various reports and new data from WHO studies. The report provides the first-ever global situation analysis of how IPC programs are being implemented in 4,440 healthcare facilities in 81 countries across all six WHO regions and income levels around the world. The report includes regional and country focuses. While highlighting the harm to patients and healthcare workers caused by HAIs and AMR, the report also addresses the impact and cost-effectiveness of IPC programs and the strategies and resources available to improve them.   

The new report and its executive summary are provided primarily for those in charge of making decisions and developing IPC policies at the national, subnational and facility levels. Topics examined in-depth in the report include the problem of unsafe care resulting from HAIs and AMR; IPC implementation at the national level; IPC implementation at the healthcare facility level, including a focus on hand hygiene; the impact and the economic side of IPC; the WHO’s approaches to IPC improvement; and recommendations and minimum requirements for the core components of IPC programs at the national and healthcare-facility level. 

Specifically, the relevant results of the study concern IPC implementation and recommendations, as well as minimum requirements and core components of IPC programs at the facility level. The full report is available free on the WHO website. A link to the full WHO report is included at the end of the article. 

IPC Implementation 

In 2016, the WHO developed global recommendations on the core components of effective IPC programs. Six core components are recommended at the national level. The report indicates that these core components also apply at the facility level, along with two additional points. These components are:  

1) Creating/establishing an active IPC program; 

2) Developing guidelines; 

3) Providing education and training; 

4) Conducting HAI surveillance; 

5) Establishing multimodal strategies to meet program requirements; 

6) Monitoring, auditing and gathering feedback; 

7) A focus on workload, staffing and bed occupancy; and 

8) Supplying a satisfactory built environment and sufficient materials and equipment. 

The WHO report details challenges and gaps to these core components faced by healthcare facilities and providers. 

In creating/establishing active IPC programs, challenges identified include competing interests/programs and services; a lack of financial investments in IPC; a lack of institutionalization, leadership, and weak legal frameworks; and limited integration of IPC into other programs. Efforts to develop guidelines face a lack of existing recommendations and technical documents from which to build, the fact that developing IPC policies is a demanding process requiring specific expertise, and an existing lack of templates that can be employed for guideline development.  

Education and training in IPC face a shortage of experts and mentors; a lack of standardized curricula and in-service training, and few career pathways and options for development for IPC professionals.  

Challenges to HAI surveillance were identified as a lack of expertise among auditors and a need for increased financial investment. Multimodal strategies for implementing IPC practices faced work practices, behaviors and organization that did not conform to international standards, while monitoring, evaluation and feedback on programs are hampered by limited translating of plans into actions, as well as limited use of data for action.

In looking at the core components focused on the healthcare facility level, the WHO report found challenges globally that included a chronic general problem of poor staff/patient ratio (insufficient nurses, doctors and other professionals), a lack of human resources dedicated to IPC activities, and HAIs not being included within occupational health policies. 

Finally, at the building level and considering sufficient materials and equipment, the report found challenges that included inadequate supplies and infrastructure — including water, sanitation and hygiene (WASH) — and procurement and distribution difficulties. 

In determining directions and priorities for IPC at the national level, the WHO report indicates that there are at least five main reasons for investing adequate resources in IPC. These five reasons can also be integrated at the facility level for improving IPC practices. They are:  

1) Ensuring quality of care and patient and healthcare worker safety, which will directly improve key health outcomes and save lives; 

2) Reduce healthcare costs and out-of-pocket expenses; 

3) Demonstrate proven strategies supported by implementation aids; and  

4) Result in programs that are scalable and adaptable to the local context. 

IPC minimum requirements must be in place, according to the report, to provide minimum protection and safety to all building occupants. In order to develop a working IPC program, it is stressed that a good built environment is essential to support workers in performing and adhering to IPC best practices. 

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