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

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Valeria Fabre, Clara Secaira, Carolyn Herzig, Elizabeth Bancroft, Maria Paula Bernachea, Lucy Anchiraico Galarza, Bowen Aquiles, Ana Belén Arauz, Maria Del Carmen Bangher, Marisa Liliana Bernan, Sol Burokas, Alfredo Canton, Iris L Cazali, Angel Colque, Marisabel Comas, Rosa Verónica Contreras, Wanda Cornistein, Maria Gabriela Cordoba, Silvia Mabel Correa, Gustavo Costilla Campero, Marta Isabel Chamorro Ayala, Nuria Chavez, Gabriela De Ascencao, Carlos Cruz García, Clara Esquivel, Cecilia Ezcurra, Leonardo Fabbro, Leandro Falleroni, Johana Fernandez, Sandra Ferrari, Veronica Freire, Maria Isabel Garzón, José Anel Gonzales, Lucrecia Guaymas, Fausto Guerrero-Toapanta, Diego Laplume, Sandra Lambert, César Guillermo Lemir, Paola Romina Lazarte, Itzel L Lopez, Herberth Maldonado, Guadalupe Martínez, Diego M Maurizi, Florencia Mesplet, Cristina Moreno Izquierdo, Gabriela Luciana Moya, Mariela Nájera, Yanina Nuccetelli, Argelis Olmedo, Belén Palacio, Florencia Pellice, Carla Lorena Raffo, Carolina Ramos, Fanny Reino, Viviana Rodriguez, Federico Romero, Juan José Romero, Graciela Sadino, Nancy Sandoval, Mariana Suarez, Maria Victoria Suayter, Maria Alejandra Ureña, Marisol Valle, Ligia Vence Reyes, Silvia Vera Amate Perez, Hugo Videla, Silvina Villamandos, Olmedo Villarreal, Maria Alejandra Viteri, Eduardo Warley, Rodolfo E Quiros
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引用次数: 0

Abstract

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.

拉丁美洲医院实施感染预防与控制计划的环境障碍:混合方法评估。
背景:感染预防与控制(IPC)计划对于预防和控制耐多药生物在医疗机构(HCF)中的传播至关重要。这些计划目前在拉丁美洲的实施情况在很大程度上仍不为人所知:我们采用混合方法对 2022 年 3 月至 7 月期间危地马拉、巴拿马、厄瓜多尔和阿根廷的医疗机构实施 IPC 计划的情况进行了评估。我们采用了世界卫生组织(WHO)的IPC评估框架(IPCAF)调查,这是一份事先经过验证的结构化问卷,并配有相关的评分系统,用于评估IPC的八个核心组成部分(IPC计划;IPC指南;IPC教育和培训;医源性感染监测;多模式策略;IPC实践和反馈的监测与审核;工作量、人员配备和床位占用率;以及建筑环境和IPC材料与设备)。每个部分的得分均为 0-100。根据最终得分,HCF IPC 项目实施情况分为四个等级:不足(0-200 分)、基础(201-400 分)、中级(401-600 分)或高级(601-800 分)。此外,我们还采用 "患者安全系统工程倡议 "模型对 IPC 人员和微生物学家进行了半结构化访谈,以评估 IPC 计划实施的障碍和促进因素。我们对访谈记录进行了定向内容分析,以确定有关 IPC 项目实施障碍和促进因素的主题,并对这些主题进行了描述性总结:37 家保健基金会(15 家营利性基金会和 22 家非营利性基金会)完成了 IPCAF 调查。总得分中位数为 614 分(IQR 为 569 分至 693 分),相当于 IPC 实施的 "高级 "水平(32% [7/22] 非营利性医疗机构与 93% [14/15] 营利性医疗机构在此类别中)。得分最低的是工作量、人员配备和病床占用率,其次是 IPC 培训和多模式策略。来自 16 家护理机构的 40 人接受了访谈。他们认为,人员配备和技术资源不足、领导支持有限以及文化决定因素是有效实施IPC指南的主要障碍,而来自公共卫生机构的外部认证和技术支持则是促进因素:结论:在拉丁美洲的医疗保健设施中,加强IPC活动的工作重点应放在改善医院领导层和公共卫生机构的支持上,以确保更好地分配资源、促进安全文化以及改善质量改进方面的培训。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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