Strengthening the Hospital Infection Control Program in Senegal

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View the original story on the Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program website.

In Senegal, the first national survey of health care-associated infections, conducted in 2007 by the Directorate General for Health of the Ministry of Health (MOH), showed that the volume of antimicrobial prescriptions, combined with low levels of hygiene observed during care at facilities, is the main cause of the emergence of antimicrobial resistance (AMR).

Health care-associated infection control committees (comités de lutte contre les infections nosocomiales or CLIN) play a critical role in overseeing and implementing infection prevention and control (IPC)-related activities in hospitals, which is pivotal to containing AMR. The MOH implemented CLINs in all health care facilities in Senegal in 2004, under the direction of its National Program to Combat Nosocomial Infections (PRONALIN). However, in April 2017, PRONALIN determined during supervision visits that up to 90% of the CLINs are not functioning efficiently.

To reverse this trend, the Directorate for Quality, Security, and Hospital Hygiene (DQSHH) tasked the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program to revitalize pilot hospitals’ CLINs by helping them implement effective action plans. In Senegal, MTaPS is addressing the challenges of AMR by strengthening health systems and practices for IPC and optimal use of antimicrobial medicines.

Revitalizing Tivaouane’s CLIN

MTaPS started working with the DQSHH in August 2019 to conduct a baseline situation analysis of the hospital of Tivaouane, a city 100 km east of Dakar. The assessment, using the World Health Organization’s IPC Assessment Framework (IPCAF) for health facilities, showed a score of 13% (100 out of 800), demonstrating poor IPC capacity at the facility. Several challenges were observed, including a lack of equipment for collecting and packaging biomedical waste, limited IPC capacity of health care workers, and no capacity for surveillance and detection of health care-associated infections. Following this exercise, Tivaouane hospital’s CLIN developed an improvement plan and committed to fully implementing it with support from the DQSHH and MTaPS.

The CLIN started reforming its functioning by putting in place regular meetings between the committee and the hospital’s leadership and by submitting quarterly reports to the MOH. MTaPS conducted tailored IPC trainings; including a training of trainers; a training for medical doctors, nurses, and midwives; and a training for the hospital’s support staff. The trainings focused on IPC components such as hand hygiene and waste management and used a continuous improvement approach to self-monitor activity implementation. MTaPS also monitored progress remotely and through field visits to track both achievements and challenges.

After six months, the hospital’s CLIN conducted a self-assessment using the IPCAF and obtained an improved score of 38% (300 out of 800), raising the hospital’s IPC capacity from inadequate to basic. After a year, the CLIN overcame additional challenges, including successfully implementing proper biomedical waste management. These efforts further helped the hospital drive up its IPC capacity to an intermediate level with a score of 68% (500 out of 800).

“After a year of implementing the IPC action plan […] in Tivaouane, we have noticed a remarkable improvement in the management of biomedical waste, thanks to the support of MTaPS and the DQSHH in the training of hospital staff, especially the training that was carried out in the local language to enable frontline workers to master the biomedical waste component.” — Dr. Ablaye Sakho, President of the medical commission of the Tivaouane hospital

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Toward safe health care and reduced AMR spread at hospitals

With assistance from the DQSHH and MTaPS, the Tivaouane hospital’s CLIN demonstrated a continued improvement trend of its IPC capacity level, achieving a 55 percentage point increase from its initial baseline score. These interventions will help the hospitals successfully contain the spread of AMR and provide quality health care to patients in a safe environment. Following this first success, MTaPS is working with the DQSHH to document lessons learned and facilitate knowledge sharing so that these results and experiences can inform and scale up the program of revitalizing CLINs.