Adoption of an infection prevention and control programme (IPCP) in the Republic of Kiribati: a case study in diffusion of innovations theory

Abstract presented at the International Conference on Prevention & Infection Control (ICPIC 2011) Geneva, Switzerland. 29 June - 2 July 201

Towards a framework for a collaborative support model to assist infection prevention and control programmes in low- and middle-income countries: a scoping review

Background: Infection prevention and control (IPC) in low- and middle-income countries (LMIC) is reported to be poorly supported because of limits in financial, human and physical resources and competing priorities in health budgets. As a result, there is often a role for external agencies to assist in strengthening IPC. While there are reports of how these partnerships have been put into practice, there are no reported frameworks or guidance documents to support the development of such relationships. Aim: The aim of this study is to identify the core elements of a collaborative support framework to assist LMIC in strengthening IPC. Methods: To achieve this, a systematic scoping review of available literature was conducted based on the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020). The databases MEDLINE, CINAHL, Embase and Scopus were utilised. The search strategy included different combinations of Medical Subject Heading (MeSH) terms, Emtree and keywords that are relevant to IPC collaboration in LMIC. Literature was limited to that published between 2005 and 2020 in the English language only. Results: Six core elements of comprehensive IPC collaborative support were identified with five IPC programme areas as minimum requirements, namely: 1) Collaborative Projects, 2) Policies and Procedures, 3) Training and Professional Development, 4) Surveillance Systems and 5) Assessment and Feedback. The last element, 6) Partnerships, was identified as an enabling factor. Conclusion: These six core elements should be considered when building a collaborative support model to assist IPC in LMIC

Factors influencing health care workers' willingness to respond to duty during infectious disease outbreaks and bioterrorist events: an integrative review

Background: Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond. Aim: The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events. Methods: An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool. Results: A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics. Conclusions: By comprehensively identifying the facilitators and barriers to HCWs' WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety. Keywords: bioterrorism; health care workers; infectious disease emergency; infectious disease outbreak; willingness to respond

Barriers and facilitators to COVID-19 vaccine uptake among Australian health professional students during the pandemic: a nationwide study

Using a cross-sectional online survey we investigated knowledge, attitudes, and risk perception about COVID-19 vaccination and identified factors influencing vaccine uptake among Australian health professional students from October 2021 to January 2022. We analysed data from 1114 health professional students from 17 Australian universities. Most participants were enrolled in nursing programs (n = 958, 86.8%), and 91.6% (n = 858) of the participants received COVID-19 vaccination. Approximately 27% believed COVID-19 was no more serious than seasonal influenza and that they had a low risk of acquiring COVID-19. Nearly 20% disagreed that COVID-19 vaccines in Australia were safe and perceived they were at higher-risk of acquiring COVID infection than the general population. Higher-risk perception viewing vaccination as their professional responsibility, and vaccine mandate strongly predicted vaccination behaviour. Participants consider COVID-19 information from health professionals, government websites, and World Health Organization as the most trusted information sources. The findings highlight that healthcare decision-makers and university administrators need to monitor students’ hesitancy with vaccination to improve students’ promotion of the vaccination to the general population

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Innovation in the time of SARS: the Kiribati infection and control programme

Background A locally adapted comprehensive infection prevention and control programme (IPCP) is imperative to the management of healthcare associated infections. An IPCP is a technology cluster made up of a number of elements which are closely inter-related. IPCPs in high-income countries have demonstrated effective control of infection transmission in healthcare settings. Relative to the experience of high-income countries, low- and middle-income (LMI) countries have adopted IPCPs, or parts thereof, with varying degrees of success. The country of Kiribati has been most successful in adopting IPCP principles and practices. The ‘atypical’ case of Kiribati raises many questions, primarily ‘How and why did it change?’, ‘What has been the process of the change?’ and ‘Could other countries in the region benefit from the Kiribati experience?’ This study addresses the research questions: How can the success of IPCPs be enhanced in LMI country healthcare settings? Can the classic Diffusion of Innovations model be used to explain the level of success?’ Methods The adoption process of an IPCP in the Republic of Kiribati was investigated with the findings analysed within the framework of Diffusion of Innovations theory. The case study investigation involved: 1. Review and analysis of IPCP adoption literature to identify those studies that have both consciously and unconsciously followed classical Diffusion of Innovations theory processes. This was to find evidence to support the suggestion that the theoretical process of Diffusion of Innovations is a key framework within which to explore and understand the adoption of IPCP in LMI countries. 2. Evaluation of current IPCP status in Kiribati using adapted National Health Service (NHS) and World Health Organization (WHO) IPCP audit tools. 3. Survey of healthcare worker knowledge, application and confidence with infection prevention and control principles and practice using a previously validated tool. 4. Chronological and thematic analysis of Republic of Kiribati IPCP documentation (for example: infection control manuals, infection control committee minutes) and findings and recommendations of IPCP assessments performed by Republic of Kiribati staff and external agencies/consultants. 5. Semi-structured interviews with key informants in the Republic of Kiribati and external agencies (using snow-ball sampling) to explore the key elements that contributed to the adoption of IPCP. Findings The literature review revealed a scarcity of relevant literature examining the adoption of comprehensive IPCP or associated conceptual frameworks. Only one study was published which demonstrated the Diffusion of Innovations framework, and it is discussed in more detail. The healthcare worker survey and evaluation of the Kiribati IPCP indicated that the programme had been integrated into healthcare service delivery. The IPCP reached a level of 75% compliance in accordance with the scoring method of the tool. Two key activities of the organisational innovation process were identified from the interviews and the chronological and thematic analysis of the IPCP documentation. These were: initiation and implementation. The initiation activity included: 1) agenda-setting: preparations for severe acute respiratory syndrome (SARS) in 2003 stimulated the identification of organisational IPCP deficits, and 2) matching: deficits were identified and the decision to adopt an IPCP innovation package was made. Implementation included: a) redefining/restructuring: identification of the components of an IPCP and how they best fit within the local health structure, b) clarifying: integration of IPCP into the health services and defining an infection control role within the nursing division and, c) routinising: the IPCP became an ongoing element in health service delivery. Conclusions Exploration of the adoption of the Kiribati IPCP provided an important case study for other low- and middle-income countries in how they may overcome barriers to the establishment and integration of a programme into a health service. The outcome of the literature review identified a clear need for more research into IPCP adoption. The availability of relevant literature would be especially important to low resourced healthcare settings to assist their adoption of comprehensive IPCPs. Opportunities were identified for future expansion of the Kiribati IPCP through the healthcare worker survey and IPCP evaluation. The adoption of the Kiribati IPCP followed the classic Diffusion of Innovations process for Organisations. The Kiribati case study provides a relevant and useful example of an IPCP adoption model in low- and middle-income healthcare settings and suggests ways other LMI countries may utilise opportunities as they occur during an innovation. It is recommended that other LMI countries should enhance their adoption of IPCP through applying key components of the Diffusion of Innovations framework to their endeavours

Frameworks to assist adoption of infection prevention and control programs. Does the literature exist?

The importance of comprehensive infection prevention and control programs (IPCPs) to preventhealthcare associated infection is well reported in the literature. What is not as well reported are the conceptualframeworks that guide the adoption of these comprehensive programs. By reporting the catalysts and processesassociated with the successful adoption of IPCPs, a template for successful program implementation may bedeveloped that will assist others in recognising such opportunities, thus enabling replication. This paper providesstimulus for such adoption and implementation.A systematic review of the literature was undertaken to identify reports of comprehensive IPCP adoption andthe conceptual frameworks used in the process. The review revealed an absence of relevant literature examiningthe adoption of comprehensive IPCP or associated conceptual frameworks. Only one published study demonstratedthe Diffusion of Innovations framework, and is discussed in detail. The outcome of this literature review points toa clear need for more research into IPCP adoption. This is especially important as relevant literature would assistlow-resourced healthcare settings in their adoption of comprehensive IPCPs

Evaluating infection control: A review of implementation of an infection prevention and control program in a low-income country setting

Background This study was conducted to review the status of the comprehensive infection prevention and control program (IPCP) established in the Republic of Kiribati in 2005, and to identify opportunities to continue and expand the integration of the IPCP into health service delivery. Methods The review was conducted in 2010 using 2 empirical tools: a pilot IPCP evaluation (IPCPE) tool that evaluated the activities of the program and its implementation, and a previously validated self-administered survey that assessed health care worker (HCW) knowledge, application, and confidence in infection control principles and practice. The survey was given to all 186 clinicians at Tungaru Central Hospital; the response rate was 59.7%. Results The Kiribati IPCP demonstrated a minimum level of compliance (75%) with the activity standards set out in the IPCPE tool. The mean scores on the HCW survey were 62% for knowledge, 63% for application, and 79% for confidence. Significant correlations were found among knowledge, application, and confidence. Conclusions This evaluation of the Kiribati IPCP with our IPCPE tool provides valuable insight into the status of a recently adopted comprehensive program and how it has translated into the knowledge, application, and confidence of HCWs in their clinical practice. The HCW survey provides evidence that the IPCP has translated into confidence and ability in the application of infection prevention practices

Audit of essential infection prevention and control content provided within undergraduate/postgraduate public health programs across Australian and New Zealand universities

Background: To describe and analyse the infection prevention and control (IPC) curricula within Public Health degrees across Australian and New Zealand Universities and identify foundational IPC knowledge deficits. Methods: A cross-sectional study of public health and related programs across tertiary education institutions within Australia and New Zealand was conducted to comprehensively illustrate the current inclusion of IPC core and elective courses and identify areas of IPC content deficit. Results: Australian (n = 32) and New Zealand (n = 9) universities were audited, consisting of 217 public health/public health related degrees within Australia and 45 within New Zealand. Within Australia 41% of public health degrees and 49% in New Zealand did not offer any IPC content as core or elective subjects. Conclusions: Public health tertiary education in Australia and New Zealand is lacking in equipping and imbedding IPC skills and knowledge in public health graduates. This highlights the need for a framework guiding mandatory IPC content within Australian and New Zealand public health programs

Success in the South Pacific: a case study of successful diffusion of an infection prevention and control program

Introduction: The aim of this study was to explore the role of the Diffusion of Innovations framework in adopting an infection prevention and control program (IPCP) in a low and middle income (LMI) country, the Republic of Kiribati. Methods: Case-study methodology was used to examine and contextualise the analysis of the Republic of Kiribati\u27s adoption of the IPCP from 2003 to 2010. Data were collected from multiple sources including semi-structured interviews, IPCP documentation, program evaluation and a healthcare worker survey. Data were subjected to thematic analysis and descriptive statistics where relevant to the study design. Results: It was found that the self-initiated progression of activities and stimuli has resulted in the successful adoption of a comprehensive IPCP. The process followed the staged model of the classic Diffusion of Innovations process in organisations described by Everett Rogers. Conclusion: This case study provides an illustration of how a comprehensive IPCP can be adopted in a LMI country setting with little involvement from external agencies. It identifies key stimuli, opportunities and activities which could be similarly adopted and implemented by other LMI countries