COVID-19: an opportunity to improve infection prevention and control in LMICs
Authors: Michuki Maina, Olga Tosas-Auguet, Mike English, Constance Schultsz, Jacob McKnight
Journal: The Lancet Global Health (2020)

We congratulate Paul Sonenthal and colleagues (July 2020)1Sonenthal PD Masiye J Kasomekera N et al.COVID-19 preparedness in Malawi: a national facility-based critical care assessment.Lancet Glob Health. 2020; 8: e890-e892Google Scholar for the timely assessment of COVID-19 preparedness in Malawi. The authors highlight clear gaps in infection prevention and control, including the availability of personal protective equipment, but cautiously suggest that these findings might not be generalisable to other low-income and middle-income countries. We did detailed surveys before the COVID-19 pandemic to evaluate water sanitation and hygiene, and infection prevention and control preparedness at 14 Kenyan public hospitals.2WHOUNICEFWASH in health care facilities: global baseline report 2019. World Health Organization, Geneva2019Google Scholar From the surveys, we noted that, even for these large facilities, there were challenges in providing adequately treated water. Additionally, there were scarce resources available to install new hand hygiene and waste disposal structures, especially in locations where they were absent.3Maina M Tosas-Auguet O McKnight J et al.Extending the use of the World Health Organisations' water sanitation and hygiene assessment tool for surveys in hospitals - from WASH-FIT to WASH-FAST.PLoS One. 2019; 14e0226548Google Scholar We found that the responsibility for water sanitation and hygiene, and infection prevention and control in hospitals is often poorly defined. Working with stakeholders, we developed a framework to assign responsibility to specific groups within the hospital and regional governments on the basis of their capacity for action. This framework allowed us to identify the specific groups who were best placed to tackle the problems we had highlighted. One of the important groups identified was the hospital's infection prevention and control committee.4Maina M Tosas-Auguet O McKnight J et al.Evaluating the foundations that help avert antimicrobial resistance: performance of essential water sanitation and hygiene functions in hospitals and requirements for action in Kenya.PLoS One. 2019; 14e0222922Google Scholar Our prepandemic survey suggested that these committees were inactive and poorly constituted.3Maina M Tosas-Auguet O McKnight J et al.Extending the use of the World Health Organisations' water sanitation and hygiene assessment tool for surveys in hospitals - from WASH-FIT to WASH-FAST.PLoS One. 2019; 14e0226548Google Scholar The low status and awareness of infection prevention and control in the hospitals contributed to these committees being largely dormant.4Maina M Tosas-Auguet O McKnight J et al.Evaluating the foundations that help avert antimicrobial resistance: performance of essential water sanitation and hygiene functions in hospitals and requirements for action in Kenya.PLoS One. 2019; 14e0222922Google Scholar However, from our interviews with health-care workers done during the COVID-19 pandemic in April, 2020, we found that these infection prevention and control committees are playing a crucial role in training medical staff on personal protective equipment use and infection prevention and control procedures (Maina M, unpublished). These committees can provide strategic leadership on the purchase of good quality infection prevention and control materials, and address any deficiencies in the hand hygiene and waste management infrastructure. With infection prevention and control playing a crucial role in the management of COVID-19, it provides an opportunity for the proper training of all health workers on the best infection prevention and control practices (Maina M, unpublished). The COVID-19 pandemic provides an opportunity to strengthen crucial aspects of the health-care system that have been previously overlooked.5Zhao Y McKnight J English M Low-income countries' bids for World Bank funding raise serious concerns about their coronavirus strategies.https://theconversation.com/low-income-countries-bids-for-world-bank-funding-raise-serious-concerns-about-their-coronavirus-strategies-138628Date: 2020Date accessed: June 18, 2020Google Scholar These aspects include the infection prevention and control infrastructure and the formation of active infection prevention and control committees to provide much-needed leadership. These improvements will prove to be valuable not only during the COVID-19 pandemic, but also in the fight against other infectious diseases and antimicrobial resistance. We declare no competing interests. COVID-19 preparedness in Malawi: a national facility-based critical care assessmentCOVID-19 has emerged in 46 countries in the WHO African region as of May 6, 2020.1 To treat patients with the disease, facilities require oxygen, intensive care unit (ICU) beds, ventilators, isolation space, and personal protective equipment (PPE) among other resources.2 Even in well-resourced countries, COVID-19 has strained or overwhelmed health systems, necessitating surges in ICU capacity to accommodate the increased number of patients who are critically ill.3 Full-Text PDF Open Access