2 results
The Design and Implementation of an IPC Certificate Course: Experiences From Sierra Leone
- Jamine Weiss, Amy Kolwaite, Meghan Lyman, Getachew Kassa, Miriam Rabkin, Anna Maruta, Marita Murrman, Hassan Benya, Christiana Conteh
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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. s498
- Print publication:
- October 2020
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Background: Trained infection prevention and control (IPC) practitioners are critical to reducing healthcare-associated infections (HAI) and improving patient safety. Despite having HAI rates 3 times higher than high-income countries, many low- and middle-income countries (LMICs) lack trained IPC professionals. During the 2014–2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS) recognized this need and appointed and trained IPC focal persons at all district hospitals. Following the outbreak, MoHS requested assistance from the US CDC to develop and implement a comprehensive IPC training program for IPC specialists. Methods: The CDC, alongside its partners, convened a multidisciplinary team to develop an IPC certificate course. ICAP led the curriculum development process using a “backwards design” approach, starting with development of competencies and learning objectives, then designing an evaluation framework and learning strategies, and finally, identifying course content. The curriculum was based on existing resources, primarily designed for high-income countries, which were adapted to the Sierra Leone context and aligned with national IPC policies and guidelines. Additionally, an IPC steering committee, led by MoHS, was established to provide national leadership and oversight and make country-level decisions regarding accreditation and career pathways for IPC specialists. Results: The course includes three 2-week workshops over 6 months consisting of classroom didactics and hands-on activities. Topics include standard and transmission-based precautions, microbiology, laboratory, HAI, quality improvement, leadership, and scientific writing. Between sessions, participants conduct IPC activities at their work site and share results during subsequent workshops. Participants receive electronic tablets, which contain course content, assessment tools, and references, to upload their work into a cloud-based storage system for facilitators to provide feedback. They also receive in-person mentorship and connect with peers through a group messaging platform to share lessons learned. Participants’ knowledge and skills are assessed using a before-and-after test and observing them perform IPC practices using standardized checklists. The first cohort of 25 participants will complete the course in November 2019. Conclusions: The IPC certificate course is the first comprehensive, competency-based IPC training in Sierra Leone. Successes, challenges, sustainability, and lessons learned remain to be determined; however, based on similar models, the course has the potential to significantly improve IPC in Sierra Leone. Additionally, it is a model that can be replicated in other resource-limited settings.
Funding: None
Disclosure:None
Feasible Surgical Site Infection Surveillance in Resource-Limited Settings: A Pilot in Sierra Leone
- Matthew Westercamp, Aqueelah Barrie, Christiana Conteh, Danica Gomes, Hassan Benya, Jamine Weiss, Anna Maruta, 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, p. s38
- Print publication:
- October 2020
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Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). SSI surveillance can be challenging and resource-intensive to implement in LMICs. To support feasible LMIC SSI surveillance, we piloted a multisite SSI surveillance protocol using simplified case definitions and methodology in Sierra Leone. Methods: A standardized evaluation tool was used to assess SSI surveillance knowledge, capacity, and attitudes at 5 proposed facilities. We used simplified case definitions restricted to objective, observable criteria (eg, wound purulence or intentional reopening) without considering the depth of infection. Surveillance was limited to post-cesarean delivery patients to control variability of patient-level infection risk and to decrease data collection requirements. Phone-based patient interviews at 30-days facilitated postdischarge case finding. Surveillance activities utilized existing clinical staff without monetary incentives. The Ministry of Health provided training and support for data management and analysis. Results: Three facilities were selected for initial implementation. At all facilities, administration and surgical staff described most, or all, infections as “preventable” and all considered SSIs an “important problem” at their facility. However, capacity assessments revealed limited staff availability to support surveillance activities, limited experience in systematic data collection, nonstandardized patient records as the basis for data collection, lack of unique and consistent patient identifiers to link patient encounters, and no quality-assured microbiology services. To limit system demands and to maximize usefulness, our surveillance data collection elements were built into a newly developed clinical surgical safety checklist that was designed to support surgeons’ clinical decision making. Following implementation and 2 months of SSI surveillance activities, 77% (392 of 509) of post-cesarean delivery patients had a checklist completed within the surveillance system. Only 145 of 392 patients (37%) under surveillance were contacted for final 30-day phone interview. Combined SSI rate for the initial 2-months of data collection in Sierra Leone was 8% (32 of 392) with 31% (10 of 32) identified through postdischarge case finding. Discussion: The surveillance strategy piloted in Sierra Leone represents a departure from established HAI strategies in the use of simplified case definitions and implementation methods that prioritize current feasibility in a resource-limited setting. However, our pilot implementation results suggest that even these simplified SSI surveillance methods may lack sustainability without additional resources, especially in postdischarge case finding. However, even limited phone-based patient interviews identified a substantial number of infections in this population. Although it was not addressed in this pilot study, feasible laboratory capacity building to support HAI surveillance efforts and promote appropriate treatment should be explored.
Funding: None
Disclosures: None