Table 4 Key findings of IPCAF assessment in selected tertiary care hospitals of Bangladesh

CC1: IPC program

IPC program

Have an IPC program except for clearly defined objectives

8

72.7

Program with clearly defined objectives, annual activity plan

2

18.2

IPC program supported by part-time IPC professional

5

45.5

All the IPC teams include both doctors and nurses

8

72.7

IPC committee

IPC committee actively supporting the IPC team

5

45.5

Senior facility leadership represented/ included in the committee

7

63.6

Senior clinical staff

9

81.8

Facility management

10

90.9

Have clearly defined IPC objectives for specific critical areas

9

81.8

Institutional support

Allocated budget specifically for the IPC program

5

45.5

Demonstrable support for IPC objectives, indicators in the facility

4

36.4

Have microbiological lab support and deliver results reliably

9

81.8

CC2: IPC guidelines

Available guidelines for

Expertise for developing or adapting guidelines

7

63.6

Hand hygiene

11

100.0

Disinfection and sterilization

10

90.9

Waste management

10

90.9

Standard precautions

8

72.7

Healthcare worker protection safety

8

72.7

Transmission-based precautions

6

54.5

Prevention of SSI

6

54.5

Injection safety

5

45.5

Antibiotic stewardship

1

9.1

Guidelines develop and monitor

Guidelines consistent with national/international guidelines

9

81.8

Stakeholders developed guidelines on local needs and healthcare workers executed those

7

63.6

Healthcare workers received specific updated IPC training

5

45.5

Monitored IPC guideline implementation regularly

5

45.5

CC3: IPC education and training

IPC training

Presence of IPC experts for conduction of training

6

54.5

Received IPC training during annual new employee orientation

7

63.6

IPC training not received by healthcare workers

4

36.4

IPC training not received by cleaners and other supporting staffs

5

45.5

IPC training not received by Administrative and managerial staff

7

63.6

No specific IPC training for patients and their family members

9

81.8

Evaluation of IPC training/education

Periodic evaluation of the effectiveness of the IPC training

3

27.3

Ongoing development/education offered to staff about IPC

3

27.3

CC4: HAI surveillance

Organization of Surveillance

Surveillance is a defined component of IPC programs

0

0

Trained professionals in basic epi, surveillance and IPC

0

0

Informatics/IT support to conduct surveillance

0

0

Personnel responsible for surveillance

1

9.1

Priorities of Surveillance and conducting areas

Prioritization to determine HAIs for surveillance

0

0

No surveillance for local priority epidemic infections (TB, flu) and vulnerable populations such as neonates, ICU

6

54.5

Surveillance for:

Surgical site infections

2

18.2

Device associated infections

2

18.2

Multidrug-resistant colonization

2

18.2

Impacts on healthcare staff in the clinical, laboratory settings

2

18.2

Regular evaluate the surveillance

2

18.2

Methods of surveillance

Use of reliable case definitions and standardized data collection methods

0

0

Not had any processes to regularly review the data quality

10

90.9

Not had adequate microbiology and lab capacity to support surveillance

6

54.5

Adequate microbiology and lab capacity to support surveillance through analyzing the antibiotic drug-resistant pattern

2

18.2

Information analysis dissemination, and governance

Not use of surveillance data to develop a tailored plan for improved IPC

10

90.9

Regular feedback on up-to-date surveillance IPC committee/administration

1

9.1

Regular feedback on up-to-date surveillance information with doctor/nurse

4

36.4

Annually feedback on up-to-date surveillance information by written/orally

4

36.4

CC5: Multi-modal strategies for implementation of IPC interventions

Multi-modal element inclusions

Use of multi-modal strategies for implementation of IPC activities

8

72.7

Education and training: Written or oral or e-learning mode of information

5

45.5

Safety climate and culture change: Managers/leaders show visible support

3

27.3

Monitoring and feedback: Monitoring compliance with outcome indicators

6

54.5

System change: Interventions to ensure the necessary infrastructure and continuous availability of supplies

8

72.7

Communications and reminders: Reminders, posters, or other advocacy/awareness-raising tools to promote the intervention

9

81.8

Implementation strategy

Strategies include bundles or checklists

0

0

Regularly link to colleagues from quality improvement and patient safety

5

45.5

The multidisciplinary team used to implement IPC multimodal strategies

3

27.3

CC6: Monitoring/audit of IPC training and feedback

Monitoring plan

No well-defined monitoring plan with clear goals, targets and activities

10

90.9

No trained personnel responsible for monitoring/audit of IPC practices

10

90.9

Monitoring indicators

Transmission-based precautions and isolation

4

36.4

Usage of alcohol-based hand rub or soap

6

54.5

Wound dressing change

7

63.6

Hand hygiene compliance

8

72.7

Cleaning of the ward environment

9

81.8

Disinfection and sterilization

9

81.8

Consumption/usage of antimicrobial agents

4

36.4

Feedback and auditing report

Provide feedback on IPC performance audit report

0

0

Conduct WHO hand hygiene self-assessment survey

2

18.2

Reporting of monitoring data annually and assess safety cultural factors

1

9.1

CC7: Workload, bed staffing and occupancy

Staffing

Staffing level assessment in the facility

3

27.3

System of staffing needs assessments during staffing levels deemed to low

5

45.5

Maintenance of WHO/national said ratio for Health care worker (HCW) to patients in around 50 of total units

6

54.5

Bed occupancy

Facility’s ward design in accordance with international standards only in certain departments

5

45.5

Bed occupancy for one patient per bed for all units (including emergency departments and pediatrics)

6

54.5

Patients NOT placed in beds standing in the corridor outside of the room

5

45.5

adequate spacing of > 1 m between patient beds for all units (including emergency departments and pediatrics)

3

27.3

No system to assess and respond when adequate bed capacity is exceeded

4

36.4

CC8: Built environment, materials and equipment for IPC at the facility level

Water

Water services are available at all times and of sufficient quantity

10

90.9

Reliable safe drinking water station present and accessible at all times

7

63.6

Hand hygiene, sanitation

Functional hand hygiene station with reliably available supplies

8

72.7

Functional and sufficient number (≥ 4) toilets/improved latrines available

4

36.4

Power supply, ventilation

Functional environmental ventilation available in patient-care areas

11

100

Sufficient energy/power supply available day and night for all uses

8

72.7

Appropriate and well-maintained materials for cleaning are available

7

63.6

Cohorting and PPE use

Sufficient and continued availability of PPE for HCW

6

54.5

Single room is available for cohorting

2

18.2

Suitable room is available (except a single room) for patient cohorting

6

54.5

Medical waste and sewage management

Functional waste collection containers to all waste generation points

7

63.6

Functional burial pit/fenced waste dump or municipal pick-up available

6

54.5

Functional incinerator or alternative treatment technology available

1

9.1

Functional wastewater treatment system available

2

18.2

Decontamination and sterilization

Functioning reliably dedicated decontamination area/ sterile department

6

54.5

Reliably have sufficient sterile and disinfected equipment for everyday use

9

81.8

Disposable items are continuously available when necessary

11

100