Technology supporting infection prevention and control training in Africa

Infection Control Network Africa (ICAN) is the largest infection prevention and control (IPC) organisation in Africa. It provides IPC education programs and actively supports IPC implementation to reduce healthcare-associated infections(HAIs), such as COVID-19, Ebola, etc. Good quality clinical hand hygiene is the foundation of IPC. Still, it is challenging to teach as it involves a new psychomotor skill and develops new hand hygiene habits appropriate to the clinical setting. In 2019 ICANTrain-The-Trainer (TTT) program began using the SureWashtechnology platform to support both in-person education and the cascade of training to other staff in the facility. This paper describes the need, the technology platform, program rollout before and during the COVID-19 outbreak, the impact and the lessons learned. We conclude by providing some observations on the future use of technology for infection control trainin

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

Technology supporting infection prevention and control training in Africa

Infection Control Network Africa (ICAN) is the largest infection prevention and control (IPC) organisation in Africa. It provides IPC education programs and actively supports IPC implementation to reduce healthcare-associated infections(HAIs), such as COVID-19, Ebola, etc. Good quality clinical hand hygiene is the foundation of IPC. Still, it is challenging to teach as it involves a new psychomotor skill and develops new hand hygiene habits appropriate to the clinical setting. In 2019 ICANTrain-The-Trainer (TTT) program began using the SureWashtechnology platform to support both in-person education and the cascade of training to other staff in the facility. This paper describes the need, the technology platform, program rollout before and during the COVID-19 outbreak, the impact and the lessons learned. We conclude by providing some observations on the future use of technology for infection control trainin

Scenario-based simulation training for the WHO hand hygiene self-assessment framework

Abstract The WHO SAVE LIVES: Clean Your Hands global hand hygiene campaign, launched in 2009 and celebrated annually on the 5th of May, features specific calls to action seeking to increase engagement from stakeholders’ collaborations in hand hygiene improvement. WHO calls on everyone to be inspired by the global movement towards universal health coverage (UHC). Infection prevention and control (IPC), including hand hygiene, is critical to achieve UHC as it has a direct impact on quality of care and patient safety across all levels of the health services. In the framework of UHC, the theme for 5 May 2019 is “Clean care for all – it’s in your hands”. In this context, the WHO has launched a global survey to assess the current level of progress of IPC programmes and hand hygiene activities in healthcare facilities (HCFs) worldwide. This involved the creation of two tools for healthcare facilities: the WHO Infection Prevention and Control Assessment Framework (IPCAF) and the WHO Hand Hygiene Self-Assessment Framework (HHSAF). The objective of this paper is to provide case scenario-based simulation for IPC specialists to simulate and fully assimilate the correct completion of the HHSAF framework in a standardized format. The three case scenarios have been tested and are proposed for the reader to assess the HHSAF of different HCFs in a variety of contexts, even in low-resouce settings. They were designed for simulation training purposes to achieve standardization and interactive learning. These scenarios are meant to be used by professionals in charge of implementing a hand hygiene improvement strategy within their HCF, as well as for simulation and standardized training purposes prior to completing and submitting data for the 2019 WHO Global Survey. Additionally, information provided by the use of the HHSAF can easily be translated into action plans to support the implementation and improvement related to specific indicators of hand hygiene promotion. We invite all HCFs to participate in the 2019 WHO global survey and monitor the level of progress of their IPC programme and hand hygiene activities

Building capacity for point of care alcohol based hand rub (ABHR) and hand hygiene compliance among healthcare workers in the rural maternity and surgical units of a hospital in Cameroon

BackgroundHand hygiene (HH) is challenging in healthcare, but particularly in resource-limited settings due to lack of training, resources and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among healthcare workers in a Cameroon hospital.MethodsIt was a three-stage before and after study. First stage involved baseline collection of ABHR utilisation and HH compliance data. Second stage included implementation of ABHR at the POC, supported by implementation strategy involving HH training, monitoring and feedback and HH champions. Third stage involved post-implementation data collection on ABHR use and HH compliance.Results5214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (p < 0.001) and to 87.2% (post-implementation stage) (p<0.001). Weekly ABHR usage increased significantly during implementation (5670 mL), compared to baseline, (1242.5 mL, p=0.001) and remained high in post-implementation (7740 mL).ConclusionsContinuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities