6 results
Supporting Healthcare-Associated Infection (HAI) Surveillance in Resource-Limited Settings: Lessons Learned, 2015–2019
- Matthew Westercamp, Paul Malpiedi, Amber Vasquez, Danica Gomes, Carmen Hazim, Benjamin J. Park, Rachel Smith
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s395-s396
- Print publication:
- October 2020
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Background: Since 2015, the CDC has supported the development and implementation of healthcare-associated infection (HAI) surveillance in resource-limited settings through technical support of case definitions and methods that are feasible with existing surveillance capacity and integration with clinical care to maximize sustainability and data use for action. Methods: Surveillance initiatives included facility-level implementation programs in Kenya, Sierra Leone, Thailand, and Georgia; larger national or regional network-level projects in India and Vietnam were also supported. For assessment and planning, surveillance capacities were grouped into 3 domains: staff, informatics, and diagnostic capacities. Based on these capacities, simplified case definitions surveillance methodologies were devised to balance resources and effort with the anticipated value and use of findings. Results: There was broad understanding of the importance of HAI surveillance; however, the required resources and other challenges (eg, training, staffing, quality of available data) were underappreciated. Staff capacities were often influenced by a lack of dedicated surveillance staff and limited experience in systematic data collection and analysis. Informatics capacities were generally limited by the lack of digital data management, nonstandardized clinical data collection and storage, and the inability to assign and maintain unique patient identifiers. We found that capacity for diagnostics, a critical component of traditional HAI surveillance systems, was limited by its availability, frequency of use, and inconsistent rationale in clinical care. We found that successful surveillance strategies were generally simple, matched existing capacities, and targeted specific HAI priorities identified by clinical teams. For example, in Kenya and Sierra Leone, participating facilities established, with minimal external support, simplified SSI surveillance among post–caesarean-delivery patients. These initiatives improved integration of surveillance with clinical care through encouraging participation of the clinical team in surveillance and planning. Furthermore, these models directly linked surveillance activities to improved patient care (eg, combined clinical checklists with surveillance data collection forms). Discussion: In resource-limited settings, the local cost and effort required to establish and sustain the necessary infrastructure for HAI surveillance can be substantial. Establishing actionable and sustainable HAI surveillance can be achieved through simplifying HAI surveillance to match existing capacities and can result in valuable surveillance programs, even in very resource-limited settings.
Funding: None
Disclosures: None
Improving Confirmatory Testing for the Antimicrobial Resistance Surveillance Network in Ethiopia
- Ashutosh Wadhwa, Michele Parsons, Degefu Beyene, Dawit Assefa, Gebrie Alebachew, Carmen Hazim, Matthew Westercamp, Theresa Kanter, Elizabeth Thomas, Surafel Fentaw Dinku, Kibra Hailu, Aynalem Mohamed, Mequanit Mitiku, Michael Omondi, Kathleen Gallagher, Amare Berhanu, Alison Halpin, Susan Bollinger
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s287-s288
- Print publication:
- October 2020
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Background: In July 2017, the Ethiopian Public Health Institute (EPHI) launched an antimicrobial resistance (AMR) surveillance network at 4 sentinel laboratories. The National Clinical Bacteriology and Mycology Laboratory (NRL) at EPHI performs monthly confirmatory testing on a subset of isolates submitted by these sites. We assessed the existing confirmatory testing program to identify gaps and develop solutions, including a monitoring and evaluation (M&E) system. Methods: We assembled a technical working group (TWG) of key stakeholders. Laboratory site visits included workflow observation, process mapping, document review, and technologist interviews. Proposed solutions to observed gaps were drafted in formats consistent with their intended application. Feedback from the TWG was incorporated into final drafts. Available AMR network staff members were trained remotely, and they will train remaining staff. Results: Table 1 describes major gaps and solutions identified. Conclusions: Confirmatory testing provides a mechanism to evaluate laboratory testing proficiency, target improvements, and estimate surveillance data quality, yet standardized methods were lacking. Our efforts highlight key components of confirmatory testing programs and provide a model for use in laboratories with similar needs.
Funding: None
Disclosures: None
Incorporating Telementorship Into Laboratory Capacity Building Initiatives for Improved AMR Surveillance in Ethiopia
- Martin Evans, Rajiha Abubeker, Surafel Fentaw Dinku, Thuria Adem, Abera Abdeta, Amete Teshale, Dawit Assefa, Gebrie Alebachew, Mequanit Mitiku, Estifanos Tsige, Maritza Urrego, Amare Berhanu, Carmen Hazim, Daniel VanderEnde, Theresa Kanter, Michele Parsons, Michael Omondi
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s41-s42
- Print publication:
- October 2020
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Background: In July 2017, recognizing the threat that antimicrobial resistance poses to the population, the Ethiopian Public Health Institute (EPHI) launched the Ethiopia AMR Surveillance Network at 4 sentinel laboratories. Simultaneously, laboratory capacity building was initiated to ensure the reporting of quality laboratory data to the surveillance system. One initiative, Project ECHO (Extension for Community Healthcare Outcomes) was used to virtually connect subject matter experts with participating laboratories in remote settings to provide ongoing education and telementoring and to foster peer-to-peer learning and problem solving in microbiology. The 10-month project was supported by the Centers for Disease Control and Prevention (CDC) and the American Society for Microbiology (ASM).
Methods: Biweekly 1-hour sessions were held by ASM for 2 sentinel sites, Tikur Anbessa Specialized Hospital and the EPHI Clinical Microbiology and Mycology Laboratory, using a videoconferencing platform. Each virtual session consisted of a didactic session, a case presentation by a participating laboratory, open discussion and feedback. Case presentations focused on technical challenges and problems encountered in the preanalytical, analytical, and postanalytical phases of microbiology testing. Experts from CDC and ASM provided feedback along with a summation of key learning objectives. Sessions were recorded and post session reports were shared with participants. To assess participants’ baseline knowledge, a comprehensive pretest was administered prior to the first session. The same instrument was administered as a posttest 2 weeks after the final session. Unstructured interviews were also conducted to assess participants’ perceptions of the value of ECHO to their work. Results: Mean pretest scores were 69.25% and the posttest scores were 71.04%, a difference of 1.79% (P = NS). Participant interviews revealed perceived benefits of ECHO participation to include enhanced critical thinking and problem resolution in microbiology, increased communication and improved working relationships between participating sites, and improved understanding and application of CLSI standards. As a result of Ethiopia’s participation in Project ECHO, 23 case presentations have been added to ECHO Box, a resource bank and web portal, which allows members of the ECHO community to share and access didactics, documents, and learning materials. Conclusions: Despite minimal difference between pretest and posttest scores, the Project ECHO experience of virtual case-based learning and collaborative problem solving has encouraged critical thinking, peer-to-peer learning, networking among participants, and has provided microbiologists with the resources for improved bacterial isolation, identification, and antibiotic susceptibility testing. The lessons learned could be applied as this project is expanded to additional laboratories in the AMR Surveillance Network.
Funding: None
Disclosures: None
Infection Prevention and Control Capacity Building During 2018–2019 Democratic Republic of Congo Ebola Virus Disease Outbreak
- April Baller, Kevin Ousman, Maria Clara Padoveze, Charles Basilubo, Rodrigue Bobwa, Antoine Engrand, Bienvenu Houndjo, Landry Cihambanya, Jonathan Lotemo, Samuel Mangala, Patrick Mirindi, Jude Tatabod, Deye Niang, Awa Ndir, Michel Yao, Bryan Christensen, Ibrahima Fall, Danica Gomes, Abdou Gueye, Carmen Hazim, Paul Malpiedi, Jonas Nsenda Nsenda, Molly Patrick, Nathalie tremblay, Vasquez Amber, Matthew Westercamp, Katie Wilson, Remegie Nzeyimana, Lucia Saenz, Benedetta Allegranzi
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s300
- Print publication:
- October 2020
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Background: As of July 1, 2019, ~18% of all cases in the Ebola virus disease (EVD) outbreak in the Democratic Republic of Congo (DRC) were healthcare-associated (ie, nosocomial) infections (HAIs) and healthcare worker (HCW) infections. Although progress has been achieved, gaps remained in infection prevention and control (IPC), specifically, a need to reinforce standardized, evidence-based IPC practices to effectively address HAIs. The Ministry of Health (MOH), in collaboration with partners, developed an IPC tool kit consisting of >70 documents (ie, terms of reference, standard operating procedures, training modules, etc) to improve HCW IPC knowledge and practices at healthcare facilities among staff. The tool kit incorporated international IPC standards, DRC-specific experiences, and best practices. Thus, it serves as a technical and operational package, covering general guidance (standard precautions) and EVD specific issues. Methods: A decentralized rollout approach was used to disseminate the tool kit content at the various health-system levels over several months. Initially, national-level training of trainers was held, followed by subnational-level training of IPC supervisors and key IPC implementers, and lastly, training of healthcare facility (HCF) IPC focal persons. The 5-day training adhered to the MOH standard of 60% theory and 40% practice. Participants completed evaluations before and after training; changes in knowledge between the pre- and posttraining tests were analyzed and the results of the statistical tests were reported (P < .05 was considered statistically significant). Results: In total, 294 IPC supervisors were trained across 7 subnational commissions. Data were analyzed for 138 participants. Participants were 60.9% IPC supervisors, 8% WASH supervisors, and 31% others. MOH representation was 52.9% The average results before the test were 66% (19.8 of 30), the average posttest results were 72% (21.6 of 30)—a significant improvement. The worst-performing pretest IPC domain was IPC approach, and facility closure was the worst performing for posttest. As of November 11, 15.7% of all cases were HAIs. Conclusions: The IPC training program initiated during an outbreak can increase knowledge and potentially improve practices and confidence. An association with the downward HAI trend is yet to be validated. The MOH anticipates that this tool kit will be the go-to resource for future Ebola outbreaks and that it will be incorporated into the preservice medical curriculum to ensure a resilient heath system.
Funding: None
Disclosures: None
Development of a Skills-Based IPC Supervisor Course During the 2018-19 DRC Ebola Virus Disease Outbreak
- Katie Wilson, Danica Gomes, Samuel Mangala, Hanako Osuka, Erica Tindall Umeakunne, Carmen Hazim, Molly Patrick, Cori Dennison, Carolyn Herzig, April Baller, Landry Cihambanya, Maria Clara Padoveze, Charles Basilubo, Rodrigue Bobwa, Jonathan Lotemo, Lina Elbadawi, Patrick Mirindi, Jude Tatabod, Kevin Ousman, Deye Niang, Steve Ahuka
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s188
- Print publication:
- October 2020
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Background: With >3,000 cases and 2,000 deaths, the current outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) is the second-largest reported EVD outbreak in history. Healthcare-associated transmission of EVD has been a persistent amplifier of transmission due, in part, to fragility of the healthcare system, lack of basic infection prevention and control (IPC) infrastructure, and large number of healthcare facilities (HCFs). A central component of the strategy to rapidly strengthen IPC in HCFs is the provision of IPC supervisors to oversee standardized risk assessments and improvements and provide mentorship to HCF staff. To support these activities, we designed skills based training for IPC supervisors. Methods: Staff recruited by the Ministry of Health (MoH) to strengthen IPC are part of an outbreak-specific cadre known as IPC supervisors. IPC supervisors, who originally lacked technical knowledge and mentoring experience, were trained to provide technical support and mentorship to staff at HCFs, with the objective of improving IPC-related processes and behaviors. A competency-based training course was designed by conducting informal assessments of IPC supervisors during daily tasks to identify areas for performance improvement. We developed competencies based on activities designated for IPC supervisors according to MoH guidelines. We planned an iterative training rollout to allow for continuous, real-time modifications based on lessons learned throughout the implementation phase. Results: Although IPC supervisors displayed technical knowledge of IPC recommendations, we observed large gaps in implementation. IPC supervisors frequently failed to recognize behaviors that are high-risk for infection transmission. In addition, IPC supervisors lacked the ability to develop prioritized action plans and to implement interventions aimed at rapidly improving IPC practices. The course, designed as an interactive, skills-based training, is rooted in instructional design principles and addresses 4 key competencies: risk recognition and prioritization, IPC assessment completion, action plan development, and effective leadership and communication. The course will be pilot tested in the DRC to an audience of 25 IPC supervisors. Conclusions: In an outbreak setting, strong mentorship and problem-solving skills are needed to support effective implementation of IPC quality improvement. Trainings that are informed by field experiences and teach problem-solving, coaching, and communication skills are critical and can be developed rapidly. The strategy employed by the Ministry of Health to rapidly achieve IPC capacitation at HCFs might be adapted for use in future outbreaks.
Funding: None
Disclosures: None
Training to Improve Clinical Specimen Collection and Antimicrobial Resistance (AMR) Diagnostics and Surveillance in Ethiopia
- Kurt Stevenson, Joan-Miquel Balada-Llasat, Jennifer Kue, Ashley Bersani, Getnet Yimer, Shu-Hua Wang, Wondwossen Gebreyes, Gebrie Alebachew, Surafel Fentaw Dinku, Rajiha Abubeker, Eyasu Seyoum, Carmen Hazim, Michael Omondi, Denise Kirley, Amare Berhanu, Theresa Kanter, Kathleen Gallagher, Elizabeth Bancroft, Daniel VanderEnde, Benjamin J. Park
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s414
- Print publication:
- October 2020
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Background: Antimicrobial resistance (AMR) is an increasingly critical global public health challenge. An initial step in prevention is the understanding of resistance patterns with accurate surveillance. To improve accurate surveillance and good clinical care, we developed training materials to improve the appropriate collection of clinical culture samples in Ethiopia. Methods: Specimen-collection training materials were initially developed by a team of infectious diseases physicians, a clinical microbiologist, and a monitoring and evaluation specialist using a training of trainers (ToT) platform. Revisions after each training session were provided by Ethiopian attendees including the addition of regional and culturally relevant material. The training format involved didactic presentations, interactive practice sessions with participants providing feedback and training to each other and the entire group as well as assessments of all training activities. Results: Overall, 4 rounds of training were conducted from August 2017 to September 2019. The first 2 rounds of training were conducted by The Ohio State University (OSU) staff, and Ethiopian trainers conducted the last 2 rounds. Initial training was primarily in lecture format outlining use of microbiology laboratory findings in clinical practice and steps for collecting specimens correctly. Appropriate specimen collection was demonstrated and practiced. Essential feedback from this early audience provided input for the final development of the training manual and visual aids. The ToT for master trainers took place in July 2018 and was conducted by OSU staff. In sessions held in February and August 2019, these master trainers provided training to facility trainers, who provide training to personnel directly responsible for specimen collection. In total, 144 healthcare personnel (including physicians, nurses, and laboratory staff), from 12 representative Ethiopian public and academic hospitals participated in the trainings. Participants were satisfied with the quality of the training (typically ranked >4.5 of 5.0) and strongly agreed that the objectives were clearly defined and that the information was relevant to their work. Posttraining scores increased by 23%. Conclusions: Training materials for clinical specimen collection have been developed for use in low- and middle-resource settings and with initial pilot testing and adoption in Ethiopia. The trainings were well accepted, and Ethiopian personnel were able to successfully lead the trainings and improve their knowledge and skills regarding specimen collection. The materials are being finalized in an online format for easier open access dissemination. Further studies are planned to determine the effectiveness of the trainings in improving the quality of clinical specimen submissions to the microbiology laboratory.
Funding: None
Disclosures: None