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
Authors: Azak Emel , Sertcelik Ahmet , Ersoz Gulden , Celebi Guven , Eser Fatma , Batirel Ayse , Cag Yasemin , Ture Zeynep , Ozturk Engin Derya , Yetkin Meltem Arzu , Kaygusuz Sedat , Candevir Aslıhan , Tartari Ermira , Rello Jordi , Alp Emine ,   THIRG, Turkish Hospital Infection Research Group, Alpay Ali Seydi , Altuncekic Yildirim Arzu , Vatan Asli , Yahsi Aysun , Kaya Kalem Ayse , Sagmak Tartar Ayse , Tuna Aysegul , Karaca Banu , Coskun Belgin , Gonulal Burcu , Demir Canan , Ipek Davut , Tepe Dilsat , Mıstanoglu Ozatag Duru , Sezer Edanur , Sehmen Emine , Unal Evren Emine , Aydın Emsal , Guclu Ertugrul , Eryilmaz Eren Esma , Mutlu Yilmaz Esmeray , Yilmaz Karadag Fatma , Kerget Ferhan , Surucu Bayar Filiz , Kalin Unuvar Gamze , Eser Karlidag Gulden , Akengin Ocal Gulfem , Kul Gulnur , Senol Gunes , Yilmaz Gurdal , Erdogan Haluk , Alay Handan , Arslan Hande , Kahraman Hasip , Ozturk Cerik Hatun , Caskurlu Hulya , Erdem Ilknur , Esen Yildiz Ilknur , Serefhanoglu Kivanc , Demir Onder Kubra , Altunal Lutfiye Nilsun , Celik Mehmet , Ceylan Mehmet Resat , Sefa Sayar Merve , Ozen Metehan , Guler Muharrem , Uguz Mustafa , Yildirim Mustafa , Kocoglu Mucahide Esra , Ayhan Muge , Toygar Deniz Muge , Sari Nagehan Didem , Tuna Nazan , Ince Nevin , Bayrak Ozlem , Ak Oznur , Gozukuçuk Ramazan , Balik Recep , Nemli Salih Atakan , Aslan Selda , Sahin Selma Ilkay , Solak Grassie Semiha , Unlu Serpil , Alkan Sevil , Altunisik Toplu Sibel , Ozturk Deniz Suna Secil , Komur Suheyla , Koc Suleyman , Incecik Saban , Yanik Yalcin Tuba , Demirdal Tuna , Tuzun Turkan , Dinar Tuna Verda , Cakir Yasemin , Ersozlu Yasemin , Aybar Bilir Yesim , Uygun Kizmaz Yesim , Olcar Yildiz , Yulugkural Zerrin 
Published: February 2023

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.