Exploring healthcare facilities' readiness for standard precautions in infection prevention and control: a cross-country comparative analysis of six low- and middle-income countries using national cross-sectional surveys.

Abstract

Background: Despite the significant morbidity and mortality caused by healthcare-associated infections worldwide, especially in low- and middle-income countries (LMICs), there is a lack of understanding of the readiness to apply standard precautions for infection prevention and control (IPC) in healthcare facilities across different LMICs.

Methods: We analysed nationally representative health system data from the Service Provision Assessment surveys for six selected LMICs - Afghanistan, the Democratic Republic of Congo, Haiti, Nepal, Senegal, and Bangladesh. We recorded seven tracer items of standard precautions into binary elements. We calculated a readiness index based on the World Health Organization's Service Availability and Readiness Assessment manual. We utilised survey-weighted multivariable generalised estimating equations to identify factors associated with the readiness index.

Results: Among 6054 healthcare facilities, 55% (95% confidence interval (CI) = 53.1, 56.5) of necessary standard precautions were available, ranging from 48.1% in the Democratic Republic of the Congo to 65% in Nepal. Readiness varied by service area, with the tuberculosis service area being the least prepared at 38% and the general outpatient service area being the most prepared at 66%. Facilities in Nepal and the urban regions showed higher readiness, with mean (x̄) differences of 16% (95% CI = 13.6, 17.9) and 3% (95% CI = 1.8, 4.9) compared to the Democratic Republic of the Congo and rural areas, respectively.

Conclusions: We revealed significant deficiencies in standard precautions within healthcare facilities across six LMICs, notably in rural areas. The findings underscore an urgent need for targeted interventions to improve IPC strategies, particularly in domains like tuberculosis care.