Nationwide Improvement of IPC Practices in Honduran Hospitals: a Baseline Assessment
Authors: Molina Sara Eloisa Rivera , Morales Marcela Alejandra Orellana 
Published: November 2023

Abstract

Background
Healthcare-acquired infections (HAIs) are one of the most common adverse events related to the provision of healthcare services. They constitute a significant public health problem and lead to increased morbidity and mortality, costs, and prolonged hospitalization. Essential to reducing HAIs is creating a safety culture where no infection is perceived as acceptable by the healthcare worker.
Critical to prioritizing actions and implementing improvement strategies is the development of a baseline situation analysis. The World Health Organization′s IPC and Hand Hygiene assessment frameworks allow hospitals to gain understanding regarding resources and practices.

Methods
A survey was conducted between June 2021 and May 2022 using the World Health Organization′s Frameworks for IPC and Hand Hygiene. The IPC framework evaluates eight core components, and the hand hygiene self-assessment evaluates five. With technical assistance from the Health Policy Plus Project and the National Panamerican Health Organization, the Honduran MoH conducted the assessment in 20 public hospitals. The hospitaĹs staff involved in IPC activities attended the virtual meetings. The results were categorized into four levels of IPC promotion and practices. The results supported the identification of strengths and weaknesses that were essential to the development of improvement plans.

Results
Twenty of 32 (62.5%) hospitals of the Honduran MoH were evaluated, covering 75% of the health regions.
Evaluation of Hand Hygiene Programs
Hospitals obtained an overall median result of 353/500 points (IQR: 259-382). Ten (50%) were in the Intermediate category, 6 (30%) in the Advanced category, 3 (15%) in basic category and 1 (5%) was inadequate. After a close evaluation of each component, Component 5 Institutional safety climate for Hand Hygiene (median: 55/100) had the lowest score, followed by component 3 - Evaluation and feedback (median: 65/100). Higher scores were obtained for component 1 System Change (median: 80/100).
Evaluation of Infection Prevention and Control Programs at the facility level
The median score was 567/800 points, (IQR: 448-630). Eleven (55%) hospitals were in the Intermediate category, and 7 (35%) in the Advanced category. After a close evaluation, Core Component 7, Workload, staffing and bed occupancy (median: 40/100) had the lowest score, followed by Core Component 3: Education and training IPC (median: 65/100). Higher scores were obtained for Core Component 5: Multimodal strategies for implementation of infection prevention and control interventions (median: 82/100) and Core Component 6: Monitoring/auditing of IPC practices and feedback (median: 81/100). Only 3 (15%) hospitals reported having staff dedicated exclusively to IPC activities (1 per &lt;250 beds).
Only 10 (50%) hospitals reported having trained professionals responsible for surveillance activities (basic epidemiology, surveillance, and IPC).
Table 1: Infection Prevention and Control Assessment Framework Results

Conclusions
This is the first IPC nationwide assessment conducted in hospitals in Honduras. Results prove that IPC promotion and practices require improvement. Baseline results allow us to understand the IPC situation to promote data-driven decision-making to improve and foster a safety culture in Honduran hospitals.

References
1. Infection prevention and control assessment framework at the facility level, World Health Organization, 2018. (https://www.who.int/publications/i/item/WHO-HIS-SDS-2018.9)
2. 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/.
3. Hand Hygiene Self-Assessment Framework 2010, World Health Organization, https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/hand-hygiene/monitoring/hhsa-framework-october-2010.pdf?sfvrsn=41ba0450_6