Assessment of the level of implementation of infection prevention and control practices in District and Regional Hospitals In Dar Es Salaam, Tanzania

Abstract

ABSTRACT Introduction: Infection prevention and control (IPC) is imperative for the prevention of healthcare associated infection (HCAI) and multi drug resistant bacteria. However, IPC implementation is suboptimal in developing countries. To improve optimization of IPC measures, and resources, World Health Organization (WHO) has developed the Infection Prevention and Control Assessment Framework (IPCAF) as a self-assessment tool for the level of IPC implementation at healthcare facility. Objectives: This study aimed to assess the level of implementation of IPC activities in district and regional hospitals in Dar es Salaam, using the WHO IPCAF Materials and Methods: A cross-sectional study was done to collect data between April and July, 2024. This assessment recruited three regional referral hospitals, five district hospitals and one health centre in Dar es Salaam. Only high-volume hospitals were purposively selected. Implementation of IPC was assessed using the WHO IPCAF tool. IPC focal person, hospital pharmacist, matron/patron (clinical nurse manager), laboratory manager, environmental health officer and human resource manager or health secretary were interviewed to provide data regarding IPC implementation. Scores were calculated based on each IPC core component (CC) and on the summation of all eight core components. The total scores were used to categorize the hospitals into four distinct IPC levels– Inadequate, Basic, Intermediate, and Advanced. Results: The overall median IPCAF level was 417 (IQR 478.6˗408.75). About 89% of the surveyed facilities had intermediate IPC and the remaining 11% fell into basic IPC level. All facilities had well-elaborated IPC guidelines, good environment, materials and equipment. Surveillance and monitoring were found to be areas with big gaps in all study facilities. Underperformance of these indicators fuel AMR and HCAIs. All hospitals had inadequate staffing levels, indicating patient workload. No facility-maintained bed occupancy of one patient per bed in all units. Bed standing in corridor outside the ward was not found in RRH, however, it was found in 33.33% of hospitals at district level. Conclusion and recommendations: Majority (89%) of the facilities had intermediate IPC level. IPC gaps observed in the accessed facilities, underscore the requirement of quality improvement programs and feedback.