Evaluation of the implementation of WHO infection prevention and control core components in Turkish health care facilities: results from a WHO infection prevention and control assessment framework (IPCAF)—based survey

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Abstract

Background

The core components (CCs) of infection prevention and control (IPC) from World Health Organization (WHO) are crucial for the safety and quality of health care. Our objective was to examine the level of implementation of WHO infection prevention and control core components (IPC CC) in a developing country. We also aimed to evaluate health care-associated infections (HAIs) and antimicrobial resistance (AMR) in intensive care units (ICUs) in association with implemented IPC CCs.

Methods

Members of the Turkish Infectious Diseases and Clinical Microbiology Specialization Association (EKMUD) were invited to the study via e-mail. Volunteer members of any healt care facilities (HCFs) participated in the study. The investigating doctor of each HCF filled out a questionnaire to collect data on IPC implementations, including the Infection Prevention and Control Assessment Framework (IPCAF) and HAIs/AMR in ICUs in 2021.

Results

A total of 68 HCFs from seven regions in Türkiye and the Turkish Republic of Northern Cyprus participated while 85% of these were tertiary care hospitals. Fifty (73.5%) HCFs had advanced IPC level, whereas 16 (23.5%) of the 68 hospitals had intermediate IPC levels. The hospitals’ median (IQR) IPCAF score was 668.8 (125.0) points. Workload, staffing and occupancy (CC7; median 70 points) and multimodal strategies (CC5; median 75 points) had the lowest scores. The limited number of nurses were the most important problems. Hospitals with a bed capacity of > 1000 beds had higher rates of HAIs. Certified IPC specialists, frequent feedback, and enough nurses reduced HAIs. The most common HAIs were central line-associated blood stream infections. Most HAIs were caused by gram negative bacteria, which have a high AMR.

Conclusions

Most HCFs had an advanced level of IPC implementation, for which staffing was an important driver. To further improve care quality and ensure everyone has access to safe care, it is a key element to have enough staff, the availability of certified IPC specialists, and frequent feedback. Although there is a significant decrease in HAI rates compared to previous years, HAI rates are still high and AMR is an important problem. Increasing nurses and reducing workload can prevent HAIs and AMR. Nationwide “Antibiotic Stewardship Programme” should be initiated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-023-01208-0.

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Most cited references 32

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Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Alessandro Cassini, Liselotte Diaz Högberg, Diamantis Plachouras … (2019)

Summary Background Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases. Funding European Centre for Disease Prevention and Control.

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Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis.

Benedetta Allegranzi, Sepideh Bagheri Nejad, Christophe Combescure … (2011)

Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries. We searched electronic databases and reference lists of relevant papers for articles published 1995-2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence-including overall health-care-associated infection and major infection sites, and their microbiological cause-were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis. Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6-18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7-59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance. The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices. World Health Organization. Copyright Â© 2011 Elsevier Ltd. All rights reserved.

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Health care-associated infections – an overview

Mainul Haque, Massimo Sartelli, Judy McKimm … (2018)

Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.

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Author and article information

Contributors

Emine Alp: eminealpmese@gmail.com

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 13 February 2023

Publication date PMC-release: 13 February 2023

Publication date Collection: 2023

Volume: 12

Electronic Location Identifier: 11

Affiliations

[1 ]GRID grid.411105.0, ISNI 0000 0001 0691 9040, Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, , Kocaeli University, ; Kocaeli, Türkiye

[2 ]GRID grid.14442.37, ISNI 0000 0001 2342 7339, Division of Epidemiology, Department of Public Health, Faculty of Medicine, , Hacettepe University, ; Ankara, Türkiye

[3 ]GRID grid.411691.a, ISNI 0000 0001 0694 8546, Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, , Mersin University, ; Mersin, Türkiye

[4 ]GRID grid.411822.c, ISNI 0000 0001 2033 6079, Department of Infectious Diseases and Clinical Microbiology, , Zonguldak Bulent Ecevit University Faculty of Medicine, ; Zonguldak, Türkiye

[5 ]GRID grid.449874.2, ISNI 0000 0004 0454 9762, Department of Infectious Diseases and Clinical Microbiology, , Ankara Yildirim Beyazit University, ; Ankara, Türkiye

[6 ]GRID grid.488643.5, ISNI 0000 0004 5894 3909, Department of Infectious Diseases and Clinical Microbiology, , University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, ; Istanbul, Türkiye

[7 ]GRID grid.411776.2, ISNI 0000 0004 0454 921X, Department of Infectious Diseases and Clinical Microbiology, , Istanbul Medeniyet University Faculty of Medicine, ; Istanbul, Türkiye

[8 ]GRID grid.411739.9, ISNI 0000 0001 2331 2603, Department of Infectious Diseases and Clinical Microbiology, , Erciyes University Faculty of Medicine, ; Kayseri, Türkiye

[9 ]GRID grid.414850.c, ISNI 0000 0004 0642 8921, Department of Infectious Diseases and Clinical Microbiology, , Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, ; Istanbul, Türkiye

[10 ]GRID grid.411709.a, ISNI 0000 0004 0399 3319, Department of Infectious Diseases and Clinical Microbiology, , Giresun University Faculty of Medicine, ; Giresun, Türkiye

[11 ]GRID grid.411047.7, ISNI 0000 0004 0595 9528, Department of Infectious Diseases and Clinical Microbiology, , Kirikkale University Faculty of Medicine, ; Kirikkale, Türkiye

[12 ]GRID grid.98622.37, ISNI 0000 0001 2271 3229, Department of Infectious Diseases and Clinical Microbiology, , Cukurova University Faculty of Medicine, ; Adana, Türkiye

[13 ]GRID grid.4462.4, ISNI 0000 0001 2176 9482, Faculty of Health Sciences, , University of Malta, ; Msida, Malta

[14 ]GRID grid.410675.1, ISNI 0000 0001 2325 3084, Catedràtic de Medicina, , Universitat Internacional de Catalunya, ; Barcelona, Spain

Article

Publisher ID: 1208

DOI: 10.1186/s13756-023-01208-0

PMC ID: 9923650

PubMed ID: 36782267

SO-VID: 571faeb1-ef58-4c75-a8c4-9094e081a442

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 28 September 2022

Date accepted : 21 January 2023

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: infection prevention and control,ipc core components,health care-associated infections,antimicrobial resistance,workload

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: infection prevention and control, ipc core components, health care-associated infections, antimicrobial resistance, workload

Evaluation of the implementation of WHO infection prevention and control core components in Turkish health care facilities: results from a WHO infection prevention and control assessment framework (IPCAF)—based survey

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Abstract

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Supplementary Information

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Point-Of-Care Testing for AMR

Most cited references 32

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis.

Health care-associated infections – an overview

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