Feasibility and outcomes of integrating continuous quality improvement measures in infection prevention and control interventions at selected health facilities in Nairobi, Kenya during the COVID-19 pandemic, 2020 – 2021
DOI:
https://doi.org/10.3396/ijic.v21.23826Keywords:
Infection Prevention and Control, Continuous Quality Improvement, Safety, Healthcare-Associated Infections, Low- and Middle-Income Countries, KenyaAbstract
Background: Infection prevention and control (IPC) programs are critical for safe, high-quality, and people-centered care. While the effect of IPC in averting Healthcare-associated infections (HAIs) is not in contention, the intervention models to promote IPC performance are little understood in developing countries such as Kenya. This study tested the feasibility of integrating continuous quality improvement (CQI) approaches in IPC measures and the resultant performance of IPC uptake in selected PEPFAR-supported health facilities in Nairobi, Kenya.
Methods: We conducted a baseline assessment (October 2020–December 2020) followed by quarterly assessments over 9 months (January 2021–September 2021) to assess the uptake of IPC practices upon implementation of IPC interventions through a CQI approach. The assessment was done in 49 health facilities in Nairobi, Kenya. The IPC interventions included the following: triage and screening; policies and training; supplies; Tuberculosis (TB) clinic measures; laboratory measures; injection safety; environmental cleaning; and device processing. Each of these interventions had specific activities that were tracked during the assessment. Specific CQI programs at each facility were developed to address gaps observed during baseline assessments, such as hand hygiene, healthcare worker screening, waste management, and triaging.
Results: All 49 facilities implemented interventions to improve IPC under a CQI program but only 40 had data available regarding CQI activities. During the assessment period, mean scores for all IPC domains increased across all 49 facilities. There were significant improvements across all domains with the highest improvements recorded in the domains of policies, coordination, and training (from 15 to 100%; p < 0.001), patient screening, and triage (45 to 100%; p < 0.001), TB clinic measures (38 to 86%; p < 0.001), and healthcare worker screening and triage (35 to 72%; p < 0.001).
Conclusion: IPC interventions, using a CQI approach, improved IPC mean scores substantially during the assessment period. Evidently, integrating CQI has an additive and significant effect on IPC uptake.
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References
1. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) results. Seattle, WA: Institute for Health Metrics and Evaluation; 2019.
2. Sastry S, Masroor N, Bearman G, Hajjeh R, Holmes A, Memish Z, et al. The 17th International Congress on Infectious Diseases workshop on developing infec- tion prevention and control resources for low- and middle-in- come countries. Int J Infect Dis 2017; 57: 138–43. doi: 10.1016/J.IJID.2017.01.040
3. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: sys- tematic review and metaanalysis. Lancet 2011; 377(9761): 228–41. doi: 10.1016/S0140-6736(10)61458-4
4. Schreiber PW, Sax H, Wolfensberger A, Clack L, Kuster SP. The preventable proportion of healthcare-associated infections 2005–2016: systematic review and meta-analysis. Infect Control Hosp Epidemiol 2018; 39(11): 1277–95. doi: 10.1017/ICE.2018.183
5. Tomczyk S, Twyman A, de Kraker MEA, Coutinho Rehse AP, Tartari E, Toledo JP, et al. The first WHO global survey on infection prevention and control in health-care facilities. Lancet Infect Dis 2022; 22(6): 845–56. doi: 10.1016/S1473-3099(21)00809-4
6. World Health Organization. Infection prevention and control. Crit Care Nurs Clin North Am 2019; 31(3): 419–429. doi: 10.1016/s0899-5885(18)30628-2
7. Bardossy AC, Zervos J, Zervos M. Preventing hospital-acquired infections in low-income and middle-income countries: impact, gaps, and opportunities. Infect Dis Clin North Am 2016; 30(3): 805–18. doi: 10.1016/j.idc.2016.04.006
8. Maki G, Zervos M. Health care–acquired infections in low- and middle-income countries and the role of infection prevention and control. Infect Dis Clin North Am 2021; 35(3): 827. doi: 10.1016/J.IDC.2021.04.014
9. WHO. Global report on infection prevention and control global report on infection prevention and control. Geneva: World Health Organization; 2022.
10. Powell-Jackson T, King JJC, Goodman C, Spieker N, Woodd S, Risha P, et al. Infection prevention and control compliance in Tanzanian outpatient facilities: a cross-sectional study with implications for the control of COVID-19. Lancet Glob Health 2020; 8: e780–9. doi: 10.1016/S2214-109X(20)30222-9
11. Tartari E, Tomczyk S, Pires D, Zayed B, Coutinho Rehse AP, Kariyo P, et al. Implementation of the infection prevention and control core components at the national level: a global situational analysis. J Hosp Infect 2021; 108: 94–103. doi: 10.1016/j.jhin.2020.11.025
12. WHO. World Health Organization (WHO) coronavirus dashboard. World Health Organization; 2022. Available from: https://www.bing.com/search?pglt=43&q=World+Health+Organization.+WHO+Coronavirus+(COVID-19)+Dashboard&cvid=f074ab611a3b479b8bf9a8c51350397f&aqs=edge..69i57j69i11004.1005j0j1&FORM=ANNAB1&PC=U531 [cited 14 July 2023].
13. World Health Organization. Global report on infection prevention and control. Geneva: World Health Organization; 2022. pp. 1–182.
14. Kimble LE, Massoud MR, Heiby J. Using quality improvement to address hospital-acquired infections and antimicrobial resistance. AMR Control; 2017.
15. Adams D, Hine V, Bucior H, Foster W, Mukombe N, Ryan J, et al. Quality improvement collaborative: a novel approach to improve infection prevention and control. Perceptions of lead infection prevention nurses who participated. J Infect Prev 2018; 19(2): 64–71. doi: 10.1177/1757177417726154
16. Kibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, et al. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrob Resist Infect Control. 2022; 11(1): 56. doi: 10.1186/S13756-022-01093-Z
17. Infection prevention and control assessment framework at the facility level. Available from: https://www.who.int/publications/i/item/WHO-HIS-SDS-2018.9 [cited 21 February 2024].
18. Ministry of Health Kenya. Integrated guideline for tuberculosis, leprosy and lung disease. Nairobi: Ministry of Health; 2021.
19. World Health Organization. Harmonized modules for health facility assessment in the context of the COVID-19 pandemic: interim guidance, 31 May 2020. Geneva: World Health Organization; 2020.
20. Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, et al. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control 2017; 6(1): 6. doi: 10.1186/S13756-016-0149-9
21. Allegranzi B, Kilpatrick C, Storr J, Kelley E, Park BJ, Donaldson L. Global infection prevention and control priorities 2018–22: a call for action. Lancet Glob Health 2017; 5(12): e1178–80. doi: 10.1016/S2214-109X(17)30427-8
22. Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Lalitha R, Owachi D, et al. Integration of COVID-19 and TB screening in Kampala, Uganda – healthcare provider perspectives. Res Sq 2023; 4(1). doi: 10.21203/RS.3.RS-1448831/V1
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Copyright (c) 2025 Rebbecca Wangusi, Sam Wafula, Emmanuel Amadi, Joshua Orawo, Emmah Momanyi, Joram Ondigo, Geoffrey Ndichu, Taylor Lascko , Marie-Claude Lavoie, Patricia Rarriw, Tina Masai, Elizabeth Mueni, Anthony Kiplagat, Caroline Ngunu, Immaculate Mutisya, Linus Ndegwa, Elizabeth Bancroft, Caroline Ng’eno , Emily Koech, Kassim Sidibe, Herman Weyenga
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