Sometimes necessity accelerates innovation. An infection prevention and control (IPC) programme piloted in Cox’s Bazar in the midst of the COVID-19 pandemic has led to improvements in 120 health facilities around Bangladesh. Bangladesh turned the COVID-19 crisis into an opportunity for strengthening IPC using an approach cutting across the health system, involving staff at national, district and facility level, and including community health workers.
How did the programme start?
In Bangladesh, the COVID-19 global pandemic provided a strong impetus to develop the “National Preparedness and Response Plan for COVID-19”, as well as a national guideline on IPC for both private and public health care facilities. Since 2020, multisectoral and multi-stakeholder cooperation rapidly scaled up the implementation of IPC due to continued top level political and leadership commitment.
WHO has supported the Government of Bangladesh to develop the IPC guideline and establish IPC committees both at district and “upazila” (facility) level to prevent and control health care-associated infections (HAIs) by setting policy and monitoring practices to reduce risks. These committees worked with defined objectives and workplans to oversee IPC performance in all the health care facilities across the district.
IPC monitoring/audit and feedback in the spirit of improvement
The government health sector, together with WHO, has also developed assessment tools and checklists to monitor IPC standards, using a monthly scorecard to enable the visualization of IPC implementation by each health care facility. These assessments are done in the spirit of improvement and used to identify gaps and breaches in adherence to guidelines, better aligning training initiatives to assure the best care delivery.
First piloted in Cox’s Bazar, this programme has led to improvements in 120 health care facilities, which were assessed regarding their IPC preparedness and readiness. Findings have been shared at policy level and reviewed for further improvement. According to the use of an IPC scorecard, significant improvements were recorded in the following areas: IPC personnel (from 8% to 100%), training (from 22% to 100%) and monitoring (from 18% to 70%).
The monthly scorecards displayed in health care facilities have been an incentive in promoting accountability and tracking progress of IPC measures. WHO, together with other health sector partners, has been working on developing a central dashboard for the visualization of IPC in health care facilities in the Rohingya camps, which could be accessed globally. This initiative is timely given the current development of a pool of IPC master trainers supporting eight divisions to roll out training in sub district facilities, scaling up monitoring including at community level.
Bangladesh’s approach to IPC training
A “Master Training and Education in IPC” programme for health workers and a “Master Training Programme for Monitoring and Auditing of IPC Activities and HAIs” were conducted at the national level and then cascaded to district hospitals, targeting 12 000+ health workers. The training consisted of theoretical and practical sessions on donning and doffing procedures for personal protective equipment and IPC practices aimed at preventing transmission of infections.
The government of Bangladesh also prioritized the improvement of the infrastructure to provide a clean and hygienic environment, by ensuring the availability of appropriate IPC materials and equipment. Priority was given to establishing functional hand hygiene stations with clean running water, soap and alcohol-based handrub for all health care facilities and escalating the provision of personal protective equipment.