Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation

Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-methods...

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Autor principal: Bernan, Marisa Liliana
Formato: Articulo
Lenguaje:Inglés
Publicado: 2024
Materias:
Ciencias Médicas
Infection prevention
Latin America
Antimicrobial resistance
Acceso en línea:http://sedici.unlp.edu.ar/handle/10915/172959
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SEDICI (UNLP) de Universidad Nacional de La Plata
id I19-R120-10915-172959
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spelling I19-R120-10915-1729592024-11-13T20:11:14Z http://sedici.unlp.edu.ar/handle/10915/172959 Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation Bernan, Marisa Liliana 2024-11-03 2024-11-13T13:40:14Z en Ciencias Médicas Infection prevention Latin America Antimicrobial resistance Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement. La lista completa de autores puede verse en el archivo asociado. Facultad de Ciencias Médicas Articulo Articulo http://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International (CC BY 4.0) application/pdf
institution Universidad Nacional de La Plata
institution_str I-19
repository_str R-120
collection SEDICI (UNLP)
language Inglés
topic Ciencias Médicas
Infection prevention
Latin America
Antimicrobial resistance
spellingShingle Ciencias Médicas
Infection prevention
Latin America
Antimicrobial resistance
Bernan, Marisa Liliana
Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
topic_facet Ciencias Médicas
Infection prevention
Latin America
Antimicrobial resistance
description Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.
format Articulo
Articulo
author Bernan, Marisa Liliana
author_facet Bernan, Marisa Liliana
author_sort Bernan, Marisa Liliana
title Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
title_short Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
title_full Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
title_fullStr Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
title_full_unstemmed Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
title_sort contextual barriers to infection prevention and control program implementation in hospitals in latin america: a mixed methods evaluation
publishDate 2024
url http://sedici.unlp.edu.ar/handle/10915/172959
work_keys_str_mv AT bernanmarisaliliana contextualbarrierstoinfectionpreventionandcontrolprogramimplementationinhospitalsinlatinamericaamixedmethodsevaluation
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