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
Emel Azak, Ahmet Sertçelik, Gülden Ersöz, Güven Çelebi, Fatma Eser, Ayşe Batırel, Yasemin Çağ, Zeynep Türe, Derya Öztürk-Engin, Meltem Arzu Yetkin, Sedat Kaygusuz, Aslıhan Candevir, Ermira Tartari, Jordi Rello, Emine Alp, Ali Seydi ALPAY, Arzu Altunçekiç Yıldırım, Aslı Vatan, Aysun Yahşi, Ayşe Kaya Kalem, Ayşe Sağmak Tartar, Ayşegül Tuna, Banu Karaca, Belgin Coşkun, Burcu Gonulal, Canan Demir, Davut İpek, Dilsat Tepe, Duru Mıstanoglu Ozatag, Edanur Sezer, Emine Sehmen, Emine Ünal Evren, Emsal Aydın, Ertuğrul Güçlü, Esma Eren, Esmeray Mutlu Yılmaz, Fatma Yılmaz Karadağ, Ferhan Kerget, Filiz Bayar, Gamze Kalın Ünüvar, Gülden Eser Karlıdağ, Gülfem Akengin Öcal, Gülnur Kul, Güneş Şenol, Gürdal Yılmaz, Haluk Erdoğan, Handan Alay, Hande Arslan, Hasip Kahraman, Hatun Öztürk Çerik, Hülya Çaşkurlu, İlknur Erdem, İlknur Esen Yıldız, Kıvanç Şerefhanoğlu, Kübra DEMİR ÖNDER, Lütfiye Nilsun Altunal, Mehmet Çelik, Mehmet Reşat Ceylan, Merve Sefa Sayar, Metehan Özen, Muharrem Guler, Mustafa Uğuz, Mustafa Yı́ldı́rı́m, Esra Koçoğlu, Müge Ayhan, Müge Toygar Deniz, Nagehan Didem Sarı, Nazan Tuna, Nevin İnce, Ozlem Bayrak, Öznur Ak, Ramazan Gozukuçuk, Recep Balık, Salih Atakan Nemli, Selda Aslan, S. Sahin, Semiha Solak Grassie, Serpil Ünlü, Sevil Alkan, Sibel Altunışık Toplu, Suna Secil Ozturk Deniz, Süheyla Kömür, Süleyman Koç, Şaban İncecik, Tuba Yalçın, Tuna Demırdal, Türkan Tüzün, Verda Tuna, Yasemin Çakır, Yasemin Ersozlu, Yeşim Aybar Bilir, Yeşim Uygun Kızmaz, Yıldız Olçar, Zerrin Yuluğkural
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.