INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

INFECTION PREVENTION
AND CONTROL ASSESSMENT
FRAMEWORK AT THE
FACILITY LEVEL

Introduction and user instructions
The Infection Prevention and Control (IPC) Assessment Framework (IPCAF) is a tool to support the implementation of theWorld Health Organization (WHO) Guidelines on core components of IPC programmes1 at the acute health care facility level.
The user should be familiar with the contents of these guidelines, including the Interim practical manual supporting the implementation of the IPC core components at the facility level2 before using this tool. The IPCAF is a systematic tool that can
provide a baseline assessment of the IPC programme and activities within a health care facility, as well as ongoing evaluations through repeated administration to document progress over time and facilitate improvement.

What is its purpose?
The IPCAF is a structured, closed-formatted questionnaire with an associated scoring system. It is primarily intended to be
self-administered (that is, a self-assessment tool), but it can also be used for joint assessments, through careful discussions
between external assessors (for example, from the Ministry of Health, WHO or other stakeholders) and facility staff. The
framework is intended for acute health care facilities, but it can be used in other inpatient health care settings. Althoughsome indicators will be straightforward for high- and middle-income countries, this is a global tool that is valid for assessment of IPC standards in any country. The goal of the framework is to assess the current IPC situation in your facility, thatis, existing IPC activities/resources, and identify strengths and gaps that can inform future plans. It can be considered as adiagnostic tool for facilities to detect relevant problems or shortcomings that require improvement and identify areas where
they can meet international standards and requirements. If the IPCAF is undertaken as a self-assessment, its usefulness
depends on being completed objectively and as accurately as possible. Identifying existing strengths and achievements will
help build confidence and convince decision-makers that success and progress is possible. Honestly recognizing gaps will
help to create a sense of urgency for the changes needed to improve IPC. For these reasons, it is important to determine thecorrect score for each section as well as the overall score. Overall, the IPCAF gives a score that can be used as an indicatorof the level of progress from an improvement perspective. These results can be used to develop an action plan, using theInterim practical manual2 for the implementation of the IPC core components at the facility level among other resources, tostrengthen existing measures and motivate facilities to intensify efforts where needed. By completing it regularly, facilities
can monitor their progress over time.

1 WHO Guidelines on core components of IPC programmes at the national and acute health care facility level. 2016 (http://www.who.int/infection-prevention/publications/core-com-

ponents/en/, accessed 13 April 2018).

2 Improving infection prevention and control at the health facility level. Interim practical manual supporting implementation of the WHO guidelines on core components of infection

prevention and control programmes. (http://www.who.int/infection-prevention/tools/core-components/en/, accessed 3 May 2018)

WHO/HIS/SDS/2018.9 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO.

1

2

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

WHO proposes five steps for the implementation of IPC facility programmes:
1.
2.
3.
4.
5.

preparing for action
baseline assessment
developing and executing an action planassessing impact
sustaining the programme over the long term.

In particular, the IPCAF is a valuable tool to support Steps 2 and 4 of this process. Step 2 “baseline assessment” is concerned with
understanding the current situation, including strengths and weaknesses, to guide action planning for improvement. Step 4 “assessing
impact” is concerned with evaluating the effectiveness of activities undertaken in the context of the action plan.

Who should complete and use the IPCAF?

• Health care professionals/teams responsible for organizing and implementing IPC activities, who have in-depth understanding andknowledge of IPC activities at the facility level.
• If there are no professionals in charge of IPC or there is not yet an IPC programme established, the tool should be completed and usedby senior facility managers.
• The IPCAF assesses the health care facility as a whole. Of note: in most cases “you” refers to the facility and is not directly addressing the
IPC lead/professional answering the question. The IPC team may need to consult with other relevant teams in the facility (for example,
health care worker protection and safety, occupational health, surveillance and epidemiology, cleaning and maintenance, environmental
health, administration, etc.) to be able to respond to questions accurately.
• The IPCAF is designed for global use at facilities of any size, regardless of their medical focus or development stage.
• If used in joint evaluations, the external assessor should be an IPC professional with an understanding of the recommendations containedin the WHO Guidelines on core components of IPC programmes1.

How is it structured?
The IPCAF is structured according to the recommendations in the WHO Guidelines on core components of IPC programmes1 at the acutehealth care facility level and thus, it is divided into eight sections reflecting the eight WHO IPC core components, which are then addressedby a total of 81 indicators. These indicators are based on evidence and expert consensus and have been framed as questions with defined
answers to provide an orientation for assessment. Based on the overall score achieved in the eight sections, the facility is assigned to one
of four levels of IPC promotion and practice.
1. Inadequate: IPC core components implementation is deficient. Significant improvement is required.
2. Basic: Some aspects of the IPC core components are in place, but not sufficiently implemented. Further improvement is required.
3. Intermediate: Most aspects of the IPC core components are appropriately implemented. The facility should continue to improve thescope and quality of implementation and focus on the development of long-term plans to sustain and further promote the existing IPC
programme activities.
4. Advanced: The IPC core components are fully implemented according to the WHO recommendations and appropriate to the needs ofthe facility.

How does it work?
When completing the questions contained in the eight sections, choose the answer(s) that most accurately describe(s) the situation atyour facility. When you are unfamiliar with terminology in the stated questions, it is strongly recommended to consult the WHO Guidelines
on core components of IPC programmes1 or other resources provided in the footnotes to familiarize yourself with new terms and concepts.
Difficulties in answering specific questions could indicate that some IPC aspects are not sufficiently developed at your facility and users
are encouraged to self-reflect. This can also help lead to improvement. In general, you should choose only one answer per question(questions marked either “yes/no” or “choose one answer”). Some questions are designed to allow multiple answers. These questions aremarked with the note “please tick all that apply”, which enables you to choose all answers that are appropriate to your facility (choose atleast one). Points are allocated to the individual answers of each question, depending on the importance of the question/answer in thecontext of the respective core component. In each section (core component), a maximum score of 100 points can be achieved. After you
have answered all questions of a component, the score can be calculated by adding the points of every chosen answer. By adding the total
scores of all eight components, the overall score is calculated.

Is the IPCAF suitable for inter-facility comparison?
The primary goal of the framework is to provide an orientation to assess the situation of IPC at the individual health care facility level and tomonitor the development and improvement of IPC activities over time through repeated use. The comparison of different health care facilities
should be done very carefully, particularly when of different sizes, medical focus and socioeconomic setting. Therefore, the framework is
not primarily intended for external comparison or benchmarking, but these might be possible - provided that a sound methodology is used.

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

3Core component 1: Infection Prevention and Control (IPC) programme
Question
1. Do you have an IPC programme?3
Choose one answer

Answer

Score

No

0

Yes, without clearly defined objectives

5

Yes, with clearly defined objectives and annual activity plan

10

No

0

Not a team, only an IPC focal person

5

Yes

10

No IPC professional available

0No, only a part-time IPC professional available

2.5

Yes, one per > 250 beds

5

Yes, one per ≤ 250 beds

10

4. Does the IPC team or focal person have dedicated time for IPC
activities?

No

0

Yes

10

5. Does the IPC team include both doctors and nurses?

No

0

Yes

10

No

0

Yes

10

2. Is the IPC programme supported by an IPC team comprisingof IPC professionals?4
Choose one answer

3. Does the IPC team have at least one full-time IPC professional
or equivalent (nurse or doctor working 100% in IPC) available?
Choose one answer

6. Do you have an IPC committee5 actively supporting the IPC team?

7. Are any of the following professional groups represented/included in the IPC committee?
Senior facility leadership (for example, administrative director, chief
executive officer [CEO], medical director)

No

0

Yes

5

Senior clinical staff (for example, physician, nurse)

No

0

Yes

2.5

Facility management (for example, biosafety, waste, and those tasked
with addressing water, sanitation, and hygiene [WASH])

No

0

Yes

2.5

8. Do you have clearly defined IPC objectives (that is, in specificcritical areas)?
Choose one answer

No0Yes, IPC objectives only

2.5

Yes, IPC objectives and measurable outcome indicators (that is,adequate measures for improvement)

5

Yes, IPC objectives, measurable outcome indicators and set
future targets

10

9. Does the senior facility leadership show clear commitment and support for the IPC programme:
By an allocated budget specifically for the IPC programme (that is,covering IPC activities, including salaries)?

No

0

Yes

5

By demonstrable support for IPC objectives and indicators within thefacility (for example, at executive level meetings, executive rounds,
participation in morbidity and mortality meetings)?

No

0

Yes

5

10. Does your facility have microbiological laboratory support(either present on or off site) for routine day-to-day use?
Choose one answer

No0

Subtotal score

Yes, but not delivering results reliably (timely and of sufficientquality)

5

Yes, and delivering results reliably (timely and of sufficientquality)

10/100

3 IPC programmes should have clearly defined objectives based on local epidemiology and priorities according to risk assessment, and defined functions and activities that align with and contribute towards theprevention of health care-associated infections and antimicrobial resistance in health care. They should also include dedicated, trained IPC professionals. See the WHO Guidelines on core components of IPC
programmes at the national and acute health care facility level for more information (http://www.who.int/infection-prevention/publications/core-components/en/, accessed 13 April 2018).
4 IPC professional: medical or nursing staff trained in a certified IPC course.
5 An IPC committee is a multidisciplinary group with interested stakeholders across the facility, which interacts with and advises the IPC team. An IPC team includes dedicated IPC professionals who areresponsible for the IPC programme.

4

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVELCore component 2: Infection Prevention and Control (IPC) guidelines
Question
1. Does your facility have the expertise (in IPC and/or infectious diseases) for developing or adapting guidelines?

Answer

Score

No

0

Yes

7.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

2. Does your facility have guidelines available for:Standard precautions?

Hand hygiene?

Transmission-based precautions?6

Outbreak management and preparedness?

Prevention of surgical site infection?7

Prevention of vascular catheter-associated bloodstream infections?
Prevention of hospital-acquired pneumonia ([HAP]; all types of HAP, including (but not exclusively) ventilator-associatedpneumonia)?
Prevention of catheter-associated urinary tract infections?

Prevention of transmission of multidrug-resistant (MDR) pathogens?

Disinfection and sterilization?

Health care worker protection and safety8

Injection safety?

Waste management?

Antibiotic stewardship?96 Transmission-based Precautions are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed

to prevent infection transmission. They are based on the routes of transmission of specific pathogens (for example, contact versus droplets). More information can be found in the United States Centers for
Disease Control and Prevention Guidelines for Isolation Precautions (https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf, accessed 13 April 2018).

7 If no surgical interventions are undertaken at your facility, choose answer “Yes”.
8 Includes aspects of improving working conditions, detection of occupational diseases, health surveillance of workers, pre-employment screening and vaccinations.
9 Refers to the appropriate use of antimicrobials to improve patient outcomes while minimizing the development and spread of resistance. More information can be found in the WHO Global Frameworkfor Development & Stewardship to Combat Antimicrobial Resistance (http://www.who.int/phi/implementation/research/UpdatedRoadmap-Global-Framework-for-Development-Stewardship-tocombatAMR_2017_11_03.pdf?ua=1, accessed 29 March 2018).

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

3. Are the guidelines in your facility consistent with national/international guidelines (if they exist)?

No

0

Yes

10

4. Is implementation of the guidelines adapted10 according to the local needs and resources while maintaining key IPC
standards?

No

0

Yes

10

5. Are frontline health care workers involved in both planning and executing the implementation of IPC guidelines
in addition to IPC personnel?

No

0

Yes

10

6. Are relevant stakeholders (for example, lead doctors and nurses, hospital managers, quality management) involvedin the development and adaptation of the IPC guidelines in addition to IPC personnel?

No

0

Yes

7.5

7. Do health care workers receive specific training related to new or updated IPC guidelines introduced in the facility?

No

0

Yes

10

No

0

Yes

10

8. Do you regularly monitor the implementation of at least some of the IPC guidelines in your facility?

Subtotal score
10 IPC team carefully reviews guidelines to prioritize activities according to needs and resources while maintaining key IPC standards.

/100

5

6

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVELCore component 3: Infection Prevention and Control (IPC) education and training
Question

AnswerScore

1. Are there personnel with the IPC expertise (in IPC and/or infectious
diseases) to lead IPC training?

No

0

Yes

10

2. Are there additional non-IPC personnel with adequate skills toserve as trainers and mentors (for example, link nurses or doctors,
champions)?
Choose one answer

No

0

Yes

10

3. How frequently do health care workers receive training regarding
IPC in your facility?
Choose one answer

Never or rarely0

New employee orientation only for health care workers

5

New employee orientation and regular (at least annually) IPC
training for health care workers offered but not mandatory10

New employee orientation and regular (at least annually)
mandatory IPC training for all health care workers

15

4. How frequently do cleaners and other personnel directly involvedin patient care receive training regarding IPC in your facility?
Choose one answer

Never or rarely0

New employee orientation only for other personnel

5

New employee orientation and regular (at least annually) training
for other personnel offered but not mandatory10

New employee orientation and regular (at least annually)
mandatory IPC training for other personnel

15

5. Does administrative and managerial staff receive general training
regarding IPC in your facility?
Choose one answer

No

0

Yes

5

6. How are health care workers and other personnel trained?
Choose one answer

No training available

0

Using written information and/or oral instruction and/or
e-learning only

5

Includes additional interactive training sessions (for example,
simulation and/or bedside training)

10

7. Are there periodic evaluations of the effectiveness of training
programmes (for example, hand hygiene audits, other checks on
knowledge)?
Choose one answer

No0Yes, but not regularly

5

Yes, regularly (at least annually)10

8. Is IPC training integrated in the clinical practice and training ofother specialties (for example, training of surgeons involves aspectsof IPC)?
Choose one answer

No0Yes, in some disciplines

5

Yes, in all disciplines

10

9. Is there specific IPC training for patients or family members
to minimize the potential for health care-associated infections(for example, immunosuppressed patients, patients with invasive
devices, patients with multidrug-resistant infections)?

No

0

Yes

5

10. Is ongoing development/education offered for IPC staff(for example, by regularly attending conferences, courses)?

No

0

Yes

10

Subtotal score/100

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

7Core component 4: Health care-associated infection (HAI) surveillance
Question

AnswerScore

Organization of surveillance
1. Is surveillance a defined component of your IPC programme?

No

0

Yes

5

No

0

Yes

5

3. Have the professionals responsible for surveillance activities
been trained in basic epidemiology, surveillance and IPC (that is,
capacity to oversee surveillance methods, data management andinterpretation)?

No

0

Yes

5

4. Do you have informatics/IT support to conduct your surveillance(for example, equipment, mobile technologies, electronic healthrecords)?

No

0

Yes

5

No

0

Yes

5

No

0

Yes

2.5

Device-associated infections (for example, catheter-associated urinary
tract infections, central line-associated bloodstream infections,peripheral-line associated bloodstream infections, ventilator-associatedpneumonia)?

No

0

Yes

2.5

Clinically-defined infections (for example, definitions based only on
clinical signs or symptoms in the absence of microbiological testing)?

No

0

Yes

2.5

Colonization or infections caused by multidrug-resistant13 pathogens
according to your local epidemiological situation?

No

0

Yes

2.5

Local priority epidemic-prone infections (for example, norovirus,
influenza, tuberculosis [TB], severe acute respiratory syndrome [SARS],
Ebola, Lassa fever)?

No

0

Yes

2.5

Infections in vulnerable populations (for example, neonates, intensive
care unit, immunocompromised, burn patients)?14

No

0

Yes

2.5

Infections that may affect health care workers in clinical, laboratory, orother settings (for example, hepatitis B or C, human immunodeficiency
virus [HIV], influenza)?

No

0

Yes

2.5

7. Do you regularly evaluate if your surveillance is in line with thecurrent needs and priorities of your facility?11

No

0

Yes

5

2. Do you have personnel responsible for surveillance activities?

Priorities for surveillance - defined according to the scope of care
5. Do you go through a prioritization exercise to determine the HAIs
to be targeted for surveillance according to the local context (thatis, identifying infections that are major causes of morbidity andmortality in the facility)?11
6. In your facility is surveillance conducted for:
Surgical site infections?12

11 A prioritization exercise should be undertaken to determine which HAIs to target for surveillance according to the local context (for example, areas and/or patients most at risk) according to available

resources (see Interim practical manual supporting implementation of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes at http://www.who.int/infectionprevention/tools/core-components/en/, accessed 3 May 2018)12 If no surgical interventions are undertaken at your facility, choose answer “Yes”.
13 Multidrug-resistant: Non-susceptibility to at least one agent in three or more antimicrobial categories;
14 If vulnerable patient populations are not treated at your facility, choose answer “Yes”.

8

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

Methods of surveillance
8. Do you use reliable surveillance case definitions (defined
numerator and denominator according to international definitions[e.g. CDC NHSN/ECDC]15 or if adapted, through an evidence-based
adaptation process and expert consultation?

No

0

Yes

5

9. Do you use standardized data collection methods (for example,
active prospective surveillance) according to international
surveillance protocols (for example, CDC NHSN/ECDC) or if
adapted, through an evidence-based adaptation process and expert
consultation?

No

0

Yes

5

10. Do you have processes in place to regularly review data quality(for example, assessment of case report forms, review
of microbiology results, denominator determination, etc.)?

No

0

Yes

5

11. Do you have adequate microbiology and laboratory capacity
to support surveillance?
Choose one answer

No0Yes, can differentiate gram-positive/negative strains but cannot
identify pathogens

2.5

Yes, can reliably identify pathogens (for example, isolate
identification) in a timely manner

5

Yes, can reliably identify pathogens and antimicrobial drug
resistance patterns (that is, susceptibilities) in a timely manner

10

Information analysis and dissemination/data use, linkage, and governance
12. Are surveillance data used to make tailored unit/facility-basedplans for the improvement of IPC practices?

No

0

Yes

5

13. Do you analyze antimicrobial drug resistance on a regular basis(for example, quarterly/half-yearly/annually)?

No

0

Yes

5

14. Do you regularly (for example, quarterly/half-yearly/annually) feedback up-to-date surveillance information to:
No

0

Yes

2.5

No

0

Yes

2.5

No

0

Yes

2.5

Non-clinical management/administration (chief executive officer/chief
financial officer)?

No

0

Yes

2.5

15. How do you feedback up-to-date surveillance information?
(at least annually)
Choose one answer

No feedback0

By written/oral information only

2.5

Frontline health care workers (doctors/nurses)?

Clinical leaders/heads of department

IPC committee

By presentation and interactive problem-orientated solution
finding
Subtotal score
15 United States Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) (https://www.cdc.gov/nhsn/index.html, accessed 13 April 2018);

7.5
/100

European Centre for Disease Prevention and Control (ECDC) (https://ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/hai-net, accessed 13 April 2018).

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

9Core component 5: Multimodal strategies16 for implementation of infection prevention and control (IPC)
interventions
Question
1. Do you use multimodal strategies16 to implement IPC
interventions?
2. Do your multimodal strategies include any or all of
the following elements:
Choose one answer (the most accurate) per element

Answer

Score

No

0

Yes

15

System change
Element not included in multimodal strategies00Interventions to ensure the necessary infrastructure and continuous
availability of supplies are in place

5

Interventions to ensure the necessary infrastructure and continuous
availability of supplies are in place and addressing ergonomics17 and accessibility,
such as the best placement of central venous catheter set and tray

10

Education and training
Element not included in multimodal strategies

0

Written information and/or oral instruction and/or e-learning only

5

Additional interactive training sessions (includes simulation and/or bedsidetraining)

10

Monitoring and feedback
Element not included in multimodal strategies

0

Monitoring compliance with process or outcome indicators (for example,
audits of hand hygiene or catheter practices)5

Monitoring compliance and providing timely feedback of monitoring results tohealth care workers and key players

10Communications and reminders
Element not included in multimodal strategies

0Reminders, posters, or other advocacy/awareness-raising tools to promote
the intervention

5

Additional methods/initiatives to improve team communication across units
and disciplines (for example, by establishing regular case conferences andfeedback rounds)

10

Safety climate and culture change
Element not included in multimodal strategies

0Managers/leaders show visible support and act as champions and rolemodels, promoting an adaptive approach18 and strengthening a culture that
supports IPC, patient safety and quality

5

Additionally, teams and individuals are empowered so that they perceive
ownership of the intervention (for example, by participatory feedback rounds)

10

16 See definition at http://www.who.int/infection-prevention/publications/ipc-cc-mis.pdf?ua=1, accessed 13 April 2018. The use of multimodal strategies in IPC has been shown to be the best evidence-

based approach to achieve sustained system and behavioural change for the implementation of IPC interventions. Multimodal strategy: ≥3 components implemented in an integrated way to achieve
improvement of an outcome and change behavior (for example, hand hygiene practices). Components can include (i) system change (for example, making the necessary infrastructure, supplies andhuman resources available), (ii) education and training of health care workers and key players (for example, managers), (iii) monitoring infrastructures, practices, processes, outcomes and providing data
feedback; (iv) reminders in the workplace/communications; and (v) culture change within the establishment or the strengthening of a safety climate. It also includes tools, such as checklists and bundles,
developed by multidisciplinary teams that take into account local conditions. All five areas should be considered and necessary action taken, based on the local context and situation informed by periodic
assessments. Lessons from the field of implementation science suggest that targeting only one of these five elements (that is, using a “unimodal” strategy) is more likely to result in improvements thatare short-lived and not sustainable.
For more information, please see: http://www.who.int/infection-prevention/publications/ipc-cc-mis.pdf?ua=1, accessed 13 April 2018 and the Interim practical manual supporting implementation of the
WHO Guidelines on Core Components of Infection Prevention and Control Programmes at http://www.who.int/infection-prevention/tools/core-components/en/, accessed 3 April 2018.
17 Ergonomics: human factors or an understanding of interactions among humans and elements of a system to optimize human well-being and overall system performance and prevent human error. Moreinformation at: http://www.health.org.uk/sites/health/files/IntegratingHumanFactorsWithInfectionAndPreventionControl.pdf, accessed 13 April 2018.

18 Adaptive approaches consider the behavioural, organizational and cultural complexity in health care systems. They aim to improve the local safety climate and motivate local teams to consistently perform

best practices by shaping attitudes, beliefs, and values of clinicians. This could include engaging leadership, improving collaborations and team work, and facilitating staff ownership of the intervention.
More information at: https://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/index.html, accessed 13 April 2018.

10

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

3. Is a multidisciplinary team used to implement IPC
multimodal strategies?

No

0

Yes

15

4. Do you regularly link to colleagues from quality
improvement and patient safety to develop andpromote IPC multimodal strategies?

No

0

Yes

10

5. Do these strategies include bundles19 or checklists?

No

0

Yes

10

Subtotal score/100

19 Bundles: sets of evidence-based practices focused on improving the care process in a structured manner, for example, improvement of catheter insertion. Please note that bundles and multimodal

strategies are not the same concept; bundles are tools that can be used to facilitate the implementation of IPC measures, ideally in the context of multimodal strategies16 which are a much morecomprehensive approach.

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

11Core component 6: Monitoring/audit of IPC practices and feedback
Question

AnswerScore

1. Do you have trained personnel responsible for monitoring/auditof IPC practices and feedback?

No

0

Yes

10

2. Do you have a well-defined monitoring plan with clear goals,
targets and activities (including tools to collect data in a systematic
way)?

No

0

Yes

7.5

3. Which processes and indicators do you monitor in your facility?
Tick all that apply

None

0

Hand hygiene compliance (using the WHO hand hygiene
observation tool20 or equivalent)Intravascular catheter insertion and/or care

5

Wound dressing change

5Transmission-based precautions and isolation to prevent the
spread of multidrug resistant organisms (MDRO)

4. How frequently is the WHO Hand Hygiene Self-Assessment
Framework Survey 21 undertaken?
Choose one answer

5. Do you feedback auditing reports (for example, feedback on handhygiene compliance data or other processes) on the state of the IPC
activities/performance?
Tick all that apply

5

5Cleaning of the ward environment

5Disinfection and sterilization of medical equipment/instruments

5Consumption/usage of alcohol-based handrub or soap

5Consumption/usage of antimicrobial agents

5

Waste management

5

Never

0

Periodically, but no regular schedule

2.5

At least annually5

No reporting

0

Yes, within the IPC team

2.5

Yes, to department leaders and managers in the areas being
auditedYes, to frontline health care workers

2.5
2.5

Yes, to the IPC committee or quality of care committees or
equivalent

2.5

Yes, to hospital management and senior administration

2.5

6. Is the reporting of monitoring data undertaken regularly (at least
annually)?

No

0

Yes

10

7. Are monitoring and feedback of IPC processes and indicators
performed in a “blame-free” institutional culture aimed at
improvement and behavioural change?

No

0

Yes

5

8. Do you assess safety cultural factors in your facility (for example,
by using other surveys such as HSOPSC, SAQ, PSCHO, HSC22)

No

0

Yes

5

Subtotal score/100

20 WHO hand hygiene monitoring and feedback tools can be found here: http://www.who.int/infection-prevention/tools/hand-hygiene/evaluation_feedback/en/, accessed 18 April 2018.
21 WHO Hand Hygiene Self-Assessment Framework can be found here: http://www.who.int/gpsc/country_work/hhsa_framework_October_2010.pdf?ua=1, accessed 18 April 2018.
22 HSOPSC: Hospital survey on patient safety culture; SAQ: Safety attitudes questionnaire, PSCHO: Patient safety climate in healthcare organizations; HSC: Hospital safety climate scale. A summary of thesesurveys can be found at: Colla JB, et al. Measuring patient safety climate: a review of survey. Qual Saf Health Care. 2005;14(5):364-6 (https://www.ncbi.nlm.nih.gov/pubmed/16195571, accessed 13 April2018).

12

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVELCore component 7: Workload, staffing and bed occupancy23
Question

AnswerScore

Staffing
1. Are appropriate staffing levels assessed in your facility according
to patient workload using national standards or a standard staffing
needs assessment tool such as the WHO Workload indicators ofstaffing need 24 method?

No

0

Yes

5

2. Is an agreed (that is, WHO or national) ratio of health care workers
to patients25 maintained across your facility?
Choose one answer

No0Yes, for staff in less than 50% of units

5

Yes, for staff in more than 50% of units

10

Yes, for all health care workers in the facility

15

No

0

Yes

10

No

0

Yes, but only in certain departments

5

3. Is a system in place in your facility to act on the results of thestaffing needs assessments when staffing levels are deemed to be
too low?
Bed occupancy
4. Is the design of wards in your facility in accordance withinternational standards26 regarding bed capacity?
Choose one answer

Yes, for all departments (including emergency department andpediatrics)
5. Is bed occupancy in your facility kept to one patient per bed?
Choose one answer

No0Yes, but only in certain departments

5

Yes, for all units (including emergency departments andpediatrics)
6. Are patients in your facility placed in beds standing in the corridor
outside of the room (including beds in the emergency department)?
Choose one answer

7. Is adequate spacing of > 1 meter between patient beds ensured
in your facility?
Choose one answer

15

Yes, more frequently than twice a week

0

Yes, less frequently than twice a week

5

No

15

No

0

Yes, but only in certain departments

5

Yes, for all departments (including emergency department andpediatrics)
8. Is a system in place in your facility to assess and respond whenadequate bed capacity is exceeded?
Choose one answer

15

15

No

0

Yes, this is the responsibility of the head of department

5

Yes, this is the responsibility of the hospital administration/
management

10

Subtotal score/100

23 Particularly for these questions, the IPC team may need to consult with other relevant teams in the facility to be able to respond to questions accordingly.
24 The WHO Workload indicators of staffing need method provides health managers with a systematic way to determine how many health workers of a particular type are required to cope with the workload ofa given health facility and aid decision-making (http://www.who.int/hrh/resources/wisn_user_manual/en/, accessed 13 April 2018).

25 Taking into account all health care workers involved in service delivery and patient care, including clinical staff (doctors, nurses, dentists, medical assistants, etc.), laboratory technicians and other healthcare workers (for example, cleaners).

26 The WHO Essential environmental health standards in health care guidance provides guidance on standards required for health care in medium- and low-resource countries. These guidelines have been written

for use by health managers and planners, architects, urban planners, water and sanitation staff, clinical and nursing staff, carers and other health care providers, and health promoters (http://www.who.int/
water_sanitation_health/publications/ehs_hc/en/, accessed 13 April 2018).

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

13Core component 8: Built environment, materials and equipment for IPC at the facility level27
Question

Answer

Score

Water
1. Are water services available at all times and of sufficient quantity
for all uses (for example, hand washing, drinking, personal hygiene,
medical activities, sterilization, decontamination, cleaning andlaundry)?
Choose one answer
2. Is a reliable safe drinking water station present and accessible forstaff, patients and families at all times and in all locations/wards?
Choose one answer

No, available on average < 5 days per week
Yes, available on average ≥ 5 days per week or every day but notof sufficient quantity

0
2.5

Yes, every day and of sufficient quantity

7.5

No, not available

0

Sometimes, or only in some places or not available for all users

2.5

Yes, accessible at all times and for all wards/groups

7.5

No, not present

0Yes, stations present, but supplies are not reliably available

2.5

Yes, with reliably available supplies

7.5

Hand hygiene and sanitation facilities
3. Are functioning hand hygiene stations (that is, alcohol-based
handrub solution or soap and water and clean single-use towels)
available at all points of care?
Choose one answer
4. In your facility, are ≥ 4 toilets or improved latrines28 available foroutpatient settings or ≥ 1 per 20 users for inpatient settings?
Choose one answer

Less than required number of toilets or latrines available andfunctioning0

Sufficient number present but not all functioning

2.5

Sufficient number present and functioning

7.5

5. In your health care facility, is sufficient energy/power supply
available at day and night for all uses (for example, pumping andboiling water, sterilization and decontamination, incineration oralternative treatment technologies, electronic medical devices,
general lighting of areas where health care procedures are performed
to ensure safe provision of health care and lighting of toilet facilities
and showers)? Choose one answer

No0Yes, sometimes or only in some of the mentioned areas

2.5

Yes, always and in all mentioned areas

5

6. Is functioning environmental ventilation (natural or mechanical29)
available in patient care areas?

No

0

Yes

5

7. For floors and horizontal work surfaces, is there an accessible
record of cleaning, signed by the cleaners each day?
Choose one answer

No record of floors and surfaces being cleaned

0Power supply, ventilation and cleaning

8. Are appropriate and well-maintained materials for cleaning(for example, detergent, mops, buckets, etc.) available?
Choose one answer

Record exists, but is not completed and signed daily or isoutdated

2.5

Yes, record completed and signed daily

5

No materials available

0

Yes, available but not well maintained

2.5

Yes, available and well-maintained5

27 This component can be assessed in more detail using the WHO Water and sanitation for health facility improvement tool (WASH FIT) (http://www.who.int/water_sanitation_health/publications/water-and-sanitation-for-health-facility-improvement-tool/en/, accessed13 April 2018). Particularly for these questions, the IPC team may need to consult with other relevant teams in the facility to be able to respondto questions accordingly and accurately.

28 Improved sanitation facilities include flush toilets into a managed sewer or septic tank and soak-away pit, VIP latrines, pit latrines with slab and composting toilets. To be considered usable, a toilet/latrine

should have a door that is unlocked when not in use (or for which a key is available at any time) and can be locked from the inside during use. There should be no major holes or cracks or leaks in the toilet
structure, the hole or pit should not be blocked, water should be available for flush/pour flush toilets. It should be within the grounds of the facility and it should be clean as noted by absence of waste,visible dirt and excreta and insects.

29 Natural ventilation: outdoor air driven by natural forces (for example, winds) through building purpose-built openings, including windows, doors, solar chimneys, wind towers and trickle ventilators.

Mechanical ventilation: air driven by mechanical vans installed directly in windows or walls or in air ducts for supplying air into, or exhausting air from, a room. More information at: http://www.who.int/
water_sanitation_health/publications/natural_ventilation/en/, accessed 13 April 2018.

14

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

Patient placement and personal protective equipment (PPE) in health care settings
9. Do you have single patient rooms or rooms for cohorting30
patients with similar pathogens if the number of isolation rooms is
insufficient (for example, TB, measles, cholera, Ebola, SARS)?31
Choose one answer

10. Is PPE32 available at all times and in sufficient quantity for alluses for all health care workers?
Choose one answer

No
No single rooms but rather rooms suitable for patient cohorting
available

0
2.5

Yes, single rooms are available

7.5

No

0

Yes, but not continuously available in sufficient quantities

2.5

Yes, continuously available in sufficient quantities

7.5

No bins or separate sharps disposal

0

Medical waste management and sewage
11. Do you have functional waste collection containers for
non-infectious (general) waste, infectious waste and, sharps waste
in close proximity to all waste generation points?
Choose one answer

12. Is a functional burial pit/fenced waste dump or municipal
pick-up available for disposal of non-infectious (non-hazardous/
general waste)?
Choose one answer

Separate bins present but lids missing or more than 3/4 full;
only two bins (instead of three); or bins at some but not all waste
generation points

2.5

Yes

5

No pit or other disposal method used0

Pit in facility but insufficient dimensions; pits/dumps overfilled
or not fenced/locked; or irregular municipal waste pick up

2.5

Yes

5

13. Is an incinerator or alternative treatment technology for thetreatment of infectious and sharp waste (for example, an autoclave)present (either present on or off site and operated by a licensed
waste management service), functional and of a sufficient capacity?
Choose one answer

No, none present

0Present, but not functional

1

Yes

5

14. Is a wastewater treatment system (for example, septic tankfollowed by drainage pit) present (either on or off site) andfunctioning reliably?
Choose one answer

No, not present

0Yes, but not functioning reliably

2.5

Yes and functioning reliably

5

15. Does your health care facility provide a dedicateddecontamination area and/or sterile supply department (either
present on or off site and operated by a licensed decontamination
management service) for the decontamination and sterilizationof medical devices and other items/equipment?
Choose one answer

No, not present

0Yes, but not functioning reliably

2.5

Yes and functioning reliably

5

16. Do you reliably have sterile and disinfected equipment readyfor use?
Choose one answer

No, available on average < five days per week0

Decontamination and sterilization

17. Are disposable items available when necessary? (for example,
injection safety devices, examination gloves)
Choose one answer

Yes, available on average ≥ five days per week or every day, but
not of sufficient quantity

2.5

Yes, available every day and of sufficient quantity

5No, not available

0

Yes, but only sometimes available

2.5

Yes, continuously available

5

Subtotal score/100

30 Cohorting strategies should be based on a risk assessment conducted by the IPC team.
31 Negative pressure ventilation conditions in isolation rooms may be necessary to prevention transmission of some organisms (for example, multidrug-resistant TB).
32 Personal Protective Equipment (PPE): Medical non-sterile and surgical sterile gloves, surgical masks, goggles or face shields and gowns are considered as essential PPE. Respirators and aprons should

also be available in adequate quantities in all facilities for use when necessary.

INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK AT THE FACILITY LEVEL

15Interpretation: A three-step process
1. Add up your points
Score
Section (Core component)

Subtotals

1. IPC programme
2. IPC guidelines
3. IPC education and training
4. HAI surveillance
5. Multimodal strategies
6. Monitoring/audits of IPC practices and feedback
7. Workload, staffing and bed occupancy
8. Built environment, materials and equipment for IPC at the facility level
Final total score/800

2. Determine the assigned “IPC level” in your facility using the total score from Step 1
Total score (range)

IPC level

0–200

Inadequate

201–400

Basic

401–600

Intermediate

601–800

Advanced

3. Review the framework results and develop an action plan
Review the areas identified by this evaluation as requiring improvement in your facility and develop an action plan to address them. To
undertake this task, consult the WHO Interim practical manual supporting implementation of the WHO Guidelines on Core Components ofInfection Prevention and Control Programmes2 which will provide you with guidance, templates, tips, and examples from around the world
as well as with a list of relevant IPC improvement tools. Keep a copy of this assessment to compare with repeated uses in the future.