BMJ Glob Health: Creation of a national infection prevention and control programme in Sierra Leone, 2015

7 August, 2019

Dear HIA colleagues,

Congratulations to HIFA steering group member Julie Storr and colleagues for this important new paper in BMJ Global Health. Citation, abstract, summary, selected extract and a comment from me below.

CITATION: BMJ Glob Health. 2019; 4(3): e001504.

Creation of a national infection prevention and control programme in Sierra Leone, 2015

Hossinatu Kanu,1 Kathryn Wilson,corresponding author2 Nanah Sesay-Kamara,1 Sarah Bennett,3 Shaheen Mehtar,4 Julie Storr,5 Benedetta Allegranzi,5 Hassan Benya,3 Benjamin Park,2 and Amy Kolwaite2

Published online 2019 May 22. doi: 10.1136/bmjgh-2019-001504

ABSTRACT

Prior to the 2014–2016 Ebola epidemic, Sierra Leone’s Ministry of Health and Sanitation had no infection prevention and control programme. High rates of Ebola virus disease transmission in healthcare facilities underscored the need for infection prevention and control in the healthcare system. The Ministry of Health and Sanitation led an effort among international partners to rapidly stand up a national infection prevention and control programme to decrease Ebola transmission in healthcare facilities and strengthen healthcare safety and quality. Leadership and ownership by the Ministry of Health and Sanitation was the catalyst for development of the programme, including the presence of an infection prevention and control champion within the ministry. A national policy and guidelines were drafted and approved to outline organisation and standards for the programme. Infection prevention and control focal persons were identified and embedded at public hospitals to manage implementation. The Ministry of Health and Sanitation and international partners initiated training for new infection prevention and control focal persons and committees. Monitoring systems to track infection prevention and control implementation were also established. This is a novel example of rapid development of a national infection prevention and control programme under challenging conditions. The approach to rapidly develop a national infection prevention and control programme in Sierra Leone may provide useful lessons for other programmes in countries or contexts starting from a low baseline for infection prevention and control.

SUMMARY BOX

Inadequate infection prevention and control in Sierra Leone contributed to high rates of Ebola virus disease transmission in healthcare settings during the 2014–2016 West Africa epidemic.

The Sierra Leone Ministry of Health and Sanitation rapidly stood up a permanent national infection prevention and control programme for healthcare personnel and patient safety.

Ownership, financial commitment and leadership from the Ministry of Health and Sanitation were critical and should be promoted in other settings.

This process was a novel example of establishing a national infection prevention and control programme in a resource-limited setting during a public health crisis.

SELECTED EXTRACT

The high frequency of EVD transmission in general healthcare facilities was primarily a consequence of absent infection prevention and control (IPC) infrastructure and systems compounded by gaps in knowledge and practices among healthcare personnel and unavailable supplies and personal protective equipment.

COMMENT (NPW)

The selected extract emphasises the importance of knowledge and practice. What lessons can be learned from the Sierra Leone experience in relation to the ongoing Ebola outbreak in DR Congo? To what extent are other countries in the region prepared with respect to infection prevention and control?

We have heard previously from HIFA members about the link between Ebola transmission in health facilities and the (lack of) trust in the population. It is critical to focus our attention on meeting the basic needs of health workers to achieve the highest possible standards in infection control and quality of care. The more we can meet their needs, the more trust there will be in the health system.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org