Infection control: Conditions for safe practice

"If ‘sustainability’ is anything more than a slogan or expression of emotion, it must amount to an injunction to preserve productive capacity for the indefinite future."
Robert Solow

Infection control encompasses much more than what we have focused on in our research project. As we developed our strategy for training health workers in West Africa on infection control practice, we grappled with the question of sustainability and whether the knowledge and techniques that we would teach would be able to thrive thereafter. Effective and sustained infection control practice in the healthcare environment is dependent on a multitude of factors, not limited to knowledge on infection control, access to necessary infection control related resources such as running water, personal protective equipment, appropriate waste disposal stations and an appropriate waste management system. Protocols on the appropriate use of the above are also necessary to guide health workers on universally acceptable methods for observing infection control measures. These protocols may vary by institution but should be guided by evidence-based recommendations. Another critical factor in infection control adherence is administrative support and effective communication between the hospital administration and health workers regarding the implementation of infection control protocols.

At the outset of the infection control training sessions we conducted in May/ June 2015, each participant at the primary training sites was administered a baseline survey to determine baseline practice and access to infection control practice resources.

These sites were as follows:
-Nigeria: University of Abuja Teaching Hospital, Gwagwalada and University of Nigeria, Enugu.
-Ghana: University of Tamale, Teaching Hospital, tamale, Northern Region.

Our findings:
Among all study participants (3 sites), 53.8% were nurses while 46.2% were physicians that ranged in expertise from intern to consultant (specialist physician). All health workers were recruited from different clinical units in the hospital. Approximately 36% of all participants had never received formal training in infection control and 39.8% had never participated in simulation based training prior to the program. Among 56 participants who had partaken in medical simulation training before, 12 (21.4%) had received training related to infection control, predominantly on hand washing and other hand hygiene techniques.

When asked about their access to personal protective equipment when required for clinical duties, 46.7% said they had access to gloves every time they needed it, 37% had consistent access to surgical face masks, and 3.6% reported similar access to eye goggles whenever they requested it. 5.4% reported constant availability of N-95 respirators which are recommended for airborne transmitted diseases such as tuberculosis and chickenpox, while 56.52% had never been able to access one at a time it was indicated.

These findings indicate the existence of insufficient availability of infection control materials such as personal protective equipment, which introduces a significant barrier to the practice of effective transmission based infection control at our study sites and similar health institutions. As we continue to review and share our findings with you, the scientific community and the world at large, we hope that our findings will assist hospitals in appraising their existing infection control systems and resources.

Please look for our updates on this blog to read more about our use of simulation to train health workers on preventative infection control measures. Please feel free to contact us with inquiries you may have by sending an email to Adaora M Chima, MBBS, MPH or Benjamin H Lee, MD, MPH.

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Top image: JHU trainer observing local trainer teaching a participant the recommended hand washing techniques. Uni of Abuja Teaching Hospital, Nigeria