Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
Valeria Fabre, Clara Secaira, Carolyn Herzig, Elizabeth A. Bancroft, Maria Paula Bernachea, Lucy Anchiraico Galarza, Bowen Aquiles, Ana Belén Araúz, María del Carmen Bangher, Marisa L Bernan, Sol Burokas, Alfredo Canton, Iris Cazali, Ángel M Colque, Marisabel Comas, Rosa Verónica Contreras, Wanda Cornistein, María Gabriela Córdoba, Silvia Mabel Correa, Gustavo Costilla Campero, Mireia Urrea Ayala, Nuria Chavez, Gabriela De Ascencao, Carlos García, Clara Esquivel, Cecilia Ezcurra, Leonardo Fabbro, Leandro A Falleroni, Johana Fernandez, Sandra Ferrari, Verónica Freire, María Isabel Garzón, José Anel Gonzales, Lucrecia Guaymas, Fausto Guerrero-Toapanta, Diego Laplume, Sandra Lambert, César Guillermo Lemir, Paola Romina Lazarte, Itzel L Lopez, Herberth Maldonado, Guadalupe Martínez, Diego M Maurizi, Florencia Mesplet, Cristina Moreno Izquierdo, Gabriela Luciana Moya, M. Nájera, Yanina Nuccetelli, A. Barrado Olmedo, Belén Palacio, Florencia Pellice, Carla Raffo, Carolina Ramos, Fanny Reino, Viviana Rodríguez, Federico Romero, Juan José Romero, Graciela Sadino, Nancy Sandoval, Mariana Suarez, Maria Victoria Suayter, Maria Alejandra Ureña, Marisol Valle, Ligia Vence Reyes, Silvia Vera Amate Perez, Hugo Videla, Silvina Villamandos, Olmedo Villarreal, Maria Alejandra Viteri, Eduardo Warley, Rodolfo E Quiros
Abstract
BACKGROUND: Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. METHODS: We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0-100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0-200), basic (201-400), intermediate (401-600), or advanced (601-800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. RESULTS: Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an "advanced" level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. CONCLUSIONS: Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.