Title : Achieving minimum standards for infection prevention and control in Sierra Leone urgent need for a Quantum leap in progress in the COVID-19 Era!
Introduction: Infection prevention and control is a clinical and public health speciality that is based on a scientific approach, providing practical solutions grounded in infectious diseases, healthcare epidemiology, social and implementation science, and health systems strengthening. It is designed to prevent harm caused by avoidable infection to patients, health workers and visitors in health care settings and of recent, in communities.
Good Infection prevention and control (IPC) practice is vital for tackling antimicrobial resistance (AMR) and limiting health care-associated infections (HAI). The recent revelation of five million annual global AMR deaths also re-emphasizes the importance of IPC. The notion that ‘every infection prevented is an antibiotic treatment avoided, and possibly a death averted’ is now more relevant, particularly to Western sub-Saharan African countries like Sierra Leone, which have a higher risk of AMR deaths. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. Methods: Cross-sectional assessments using standardized World Health Organizations IPC checklists for assessment of IPC standards at the national IPC unit (IPCAT), and at health facilities (IPCAF). They are developed based on the WHO guideline on core components of Infection Prevention and Control at the National and Acute Health Care Facility Levels. IPC performance scores were graded as inadequate=0-25%, basic=25.1-50%, intermediate=50.1-75%, and advanced=75.1-100%. Results: Overall performance improved from ‘basic’ to ‘intermediate’ at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained ‘basic’ at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included poor HAI surveillance, no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined IPC monitoring system. Conclusion: Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pan-demic and endemic infectious disease outbreaks in Sierra Leone, a more rapid pace of progress is needed in IPC implementation. There is an urgent need to mobilize political will, leadership and resources and make a quantum leap forward.