The first WHO global survey on infection prevention and control in health-care facilities

Abstract

Background: WHO core components for infection prevention and control (IPC) are important building blocks for effective IPC programmes. To our knowledge, we did the first WHO global survey to assess implementation of these programmes in health-care facilities.

Methods: In this cross-sectional survey, IPC professionals were invited through global outreach and national coordinated efforts to complete the online WHO IPC assessment framework (IPCAF). The survey was created in English and was then translated into ten languages: Arabic, Chinese, English, French, German, Italian, Japanese, Russian, Spanish, and Thai. Post-stratification weighting was applied and countries with low response rates were excluded to improve representativeness. Weighted median scores and IQRs as well as weighted proportions (Nw) meeting defined IPCAF minimum requirements were reported. Indicators associated with the IPCAF score were assessed using a generalised estimating equation.

Findings: From Jan 16 to Dec 31, 2019, 4440 responses were received from 81 countries. The overall weighted IPCAF median score indicated an advanced level of implementation (605, IQR 450·4-705·0), but significantly lower scores were found in low-income (385, 279·7-442·9) and lower-middle-income countries (500·4, 345·0-657·5), and public facilities (515, 385-637·8). Core component 8 (built environment; 90·0, IQR 75·0-100·0) and core component 2 (guidelines; 87·5, 70·0-97·5) scored the highest, and core component 7 (workload, staffing, and bed occupancy; 70·0, 50-90) and core component 3 (education and training; 70 ·0, 50·0-85·0) scored the lowest. Overall, only 15·2% (Nw: 588 of 3873) of facilities met all IPCAF minimum requirements, ranging from 0% (0 of 417) in low-income countries to 25·6% (278 of 1087) in primary facilities, 9% (24 of 268) in secondary facilities, and 19% (18 of 95) in tertiary facilities in high-income countries.

Interpretation: Despite an overall high IPCAF score globally, important gaps in IPC facility implementation and core components across income levels hinder IPC progress. Increased support for more effective and sustainable IPC programmes is crucial to reduce risks posed by outbreaks to global health security and to ensure patient and health worker safety.

Funding: WHO and the Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine.

Translations: For the French and Spanish translations of the abstract see Supplementary Materials section.

Figure 1

Country participation in the Infection Prevention and Control Assessment Framework global survey 2019, after application of the minimal response threshold Total number of countries=81. Total number with nationally coordinated data collection=37. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Published with permission of the WHO GIS Centre for Health, DNA/DDI.

Figure 2

Weighted IPCAF overall and core component-specific scores by income level (A) Weighted overall scores, only includes complete surveys (n=4192). (B) Core-component-specific scores, includes per component all health-care facilities that completed corresponding survey section. The boxes represent the IQR, including the median which is represented by the middle horizontal line. The whiskers represent the full range and the dots represent the outliers. IPCAF=Infection Prevention and Control Assessment Framework. Core component 1=IPC programme. Core component 2=IPC guidelines. Core component 3=IPC education and training. Core component 4=health-care-associated infection surveillance. Core component 5=multimodal strategies. Core component 6=monitoring, audit of IPC practices and feedback. Core component 7=workload, staffing, and bed occupancy. Core component 8=built environment, materials, and equipment for IPC.

Figure 3

Correlation between weighted median scores for the 2019 HHSAF survey and the IPCAF survey, stratified by World Bank income categories Only includes complete survey responses from health-care facilities that responded to both surveys overall and for the relevant core components. (A) Correlation between IPCAF and HHSAF total scores (n=2437). (B) Correlation between IPCAF multimodal strategies and HHSAF total scores (n=2543). (C) Correlation between IPCAF monitoring, audit, and feedback and HHSAF evaluation and feedback scores (n=2618). (D) Correlation between IPCAF built environment and HHSAF system scores (n=2593). The size of the coloured dots represent the respective weight. HHSAF=Hand Hygiene Self-Assessment Framework. IPCAF=Infection Prevention and Control Assessment Framework.