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Policy  –  Elements of a plan

Infection prevention and control

Preventing disease and controlling spread of resistant bacteria is of major importance when tackling antibiotic resistance. This section provides guidance and tools to address and implement Infection prevention and control in national action plans on antimicrobial resistance.

Infection prevention and control initiatives work to limit the spread of infections and resistant bacteria in health care facilities, long-term care and congregate settings, in the community and in animals. Poor sanitation and hygiene increases the risk for spread of drug-resistant infections, which can result in prolonged illness, hospitalization, and increased costs of health care. Effective infection control practices reduce the need for antibiotics, prevent the spread of infections caused by multidrug-resistant bacteria, and help to curb the emergence of antibiotic resistance.

Infection prevention and control in national action plans on antimicrobial resistance

Improved infection prevention and control is an essential component of a national action plan on resistance. This is also highlighted in the Global Action Plan on Antimicrobial Resistance, where one of the five strategic objectives is to reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures. For humans, an overall cornerstone in this work is to prioritize and invest in efforts to provide clean water, basic toilets and hygiene services. For animals, infection prevention and control is no less important both in increasing animal welfare, preventing economic losses and descreasing antibiotic use. Experiences in limiting H5N1 HPAI (Highly Pathogenic Avian Influenza) in Vietnam showed that cooperation between the public health and agricultural sector is crucial.

Multi-level and multimodal strategies in human health

Infection prevention and control should take place both at the level of national governments and at the health care-facilities level. Ideally, work should also take place at the community level. Measures can be implemented in a variety of settings and should employ multimodal strategies to improve outcomes. Depending on the setting and scale of the initiative, different stakeholders must be involved. Regardless of where the initiative begins, coordination and collaboration between the national, facility and community levels is needed.

  • At the national level, evidence-based guidelines on infection control can form the basis for and facilitate the development and implementation of infection control programs at health care facilities. Moreover, issues of accountability, surveillance, standards for human resources and the like can be handled at national level.
  • At the level of health care-facilities, activities such as infection control programs, built environment, sufficient staffing and educational initiatives are of high importance.
  • At the community level, preventing spread of infectious diseases, resistant bacteria and promoting a healthy lifestyle will help reduce unnecessary use of antibiotics. In this work, hygiene and sanitation initiatives, such as hand-washing campaigns, are important tools, as well as strengthened vaccination programs to reduce the burden of infectious diseases.

Congregate settings

Congregate settings are places where a number of people meet or gather and share the same space for a period of time. Congregate settings include a mix of settings that range from correctional facilities and military barracks, to homeless shelters, refugee camps, dormitories and daycare centers. Anytime many people are gathered in close surroundings there is a risk of spreading disease and transmission of resistant bacteria. Due to the diversity of settings, recommendations for infection prevention and control in congregate settings are less specific than that of health care facilities. Congregate settings pose their own challenges of often not being monitored or evaluated, and their importance should not be overlooked.

Key factors for infection prevention and control in congregate settings

  • Assess the risks of infection and plan infection control strategies accordingly
  • Create an environment that promotes good hygiene, includes hand-washing facilities, adequate ventilation, and limits the occurrence of overcrowding
  • Identify infected individuals in a timely manner, with prompt and proper case management
    Include long-term care facilities and congregate settings in local, regional, and national surveillance systems
  • Educate care providers, residents, and families on the risks of infection in congregate settings
  • Ensure vaccination coverage for staff and residents

Ensure animal health without the use of antibiotics

In many parts of the world, modern animal production practices are associated with regular use of antibiotics. It has been estimated that antibiotic consumption within the food animal sector will increase with 67% between 2010 and 2030. It is therefore of crucial importance to develop sustainable animal production practices where high productivity is reached without inappropriate use of antibiotics. The key element is to focus on animal health, as this has the potential to support both high productivity and diminish use of antibiotics. A successful example comes from intensive pig, broiler and salmon production in the Nordic countries. The combination of a strict legislation together with governmental efforts and industrial based campaigns on disease prevention management routines and development of guidelines on prudent use have been important components in this work.

Veterinary para-professionals

Veterinary para-professionals are people authorized by the veterinary statutory body to carry out certain designated tasks that are delegated to them under the responsibility of a veterinarian. Such a system can greatly increase the availability and quality of animal health services in remote areas. Providing effective animal health services to livestock keepers in low and middle-income countries has remained a challenge, and veterinary para-professionals are particularly relevant in areas where there is a shortage of qualified veterinarians. However, governance issues have remained relatively neglected in the discussion on animal health services. Studies have shown that there are synergistic relationships between veterinarians and para-professionals. Therefore, there is a need to develop an integrated animal health care system where governmental and private veterinarians and para-professionals work together.

Movement of animals and risk of spread of resistant bacteria

Movement of animals is important in the spread of infectious diseases, and antibiotic resistant bacteria are transmitted in the same way as other bacteria. Measures to prevent animal diseases, such as increased biosecurity, are therefore of benefit to also limit the spread of antibiotic resistance. Trade with breeding animals has been identified as a major risk factor in the spread of antibiotic resistance. For example, a significant correlation has been demonstrated between the number of breeding pigs imported and the prevalence of MRSA-positive breeding pig holdings. Also, trade in live animals is seen as a risk factor for spread of bacterial strains producing the resistance determinants ESBL/AmpC. Introduction of systems to certify which animals/farms are documented free from ESBL/AmpC-producing bacteria have been suggested as a way to decrease the risk connected to trade.

The resources below have been sorted into the following tables:

  • Human sector
  • Food animals

Water, Sanitation and Hygiene (WASH) is closely linked to both environmental considerations and infection prevention and control. Some resources of interest may also be found in Environmental considerations.

For work to improve infection prevention in in health care facilities and food animal production, see PREVENT INFECTION: Health care and Food animals

For monitoring diseases in humans and animals, see MEASURE: Infections

Awareness raising and education for behavior change plays an important complementary role. See Awareness and understanding.

Selected Resources

Resource Description
Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level Evidence-based guidelines from WHO that aims to support IPC improvements and help countries during their development and implementation of national antimicrobial resistance action plans. A summary of the document is available here (PDF, 176kb). Available in English and Spanish.
Interim Practical Manual supporting national implementation of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes A practical manual from WHO to support development and implementation at national level of the core components of infection prevention and control at the national and acute health care facility level above. Second manual on this page.
National level assessment tool (IPCAT2) and IPCAT2 instruction booklet Tool to assess infection prevention and control status + IPCAT2 instruction manual. Excel-based tool from WHO. Note: Both located under “Related Documents” (this is a support tool for implementation of the WHO Guidelines on Core Components of above).
Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study This study provides a model for the implementation of WHO antibiotic guidelines and broader strategies to reduce HAIs and antibiotic resistance in resource-limited settings. It describes an infection control and antibiotic stewardship program in the pediatric ward of an Indonesian teaching hospital and evaluates its effectiveness in reducing health care associated infections and antibiotic use.
The ISID Guide to Infection Control in the Healthcare setting Guide that summarizes principles, interventions, and strategies to reduce healthcare associated infections. Contains more than 60 short chapters on a variety of topics, including antibiotic resistance, often specifically addressing settings with limited resources. The guide is also available in Spanish.
Policy Toolkit for Healthcare-associated Infection Prevention CDC toolkit and companion report to provide guidance to policy makers on promising ways to use legal and policy interventions as tools in implementing a comprehensive HAI prevention program.
Last-line antibiotics are failing: options to address this urgent threat to patients and healthcare systems Concrete policy suggestions from ECDC to reduce the spread of resistant bacteria in hospitals in Europe. Also contains 3 country examples.
Tackling Antimicrobial Resistance: Supporting national measures to address infection prevention and control, and water, sanitation and hygiene in health care settings (PDF) WHO and UNICEF fact sheet on AMR, infection prevention and water, sanitation and hygiene with recommended actions.
Infection prevention, control and surveillance: Limiting the development and spread of drug resistance Review on antimicrobial resistance that examines the need for infection prevention, control and surveillance to take a central role in tackling drug-resistance infections. Fundamental improvements within these areas are essential for gains in health outcomes, but are often not given enough attention.

Food animals

Resource Description
Guidelines for Animal Disease Control (PDF 0,78 MB) Guidelines for identifying priorities, objectives and the desired goal during development and implementation of disease control programs. Highlights the importance of economic assessment of disease intervention options in the design of programs taking into consideration effectiveness, feasibility of implementation, as well as costs and benefits. The purpose is to provide a conceptual framework that can be adapted to a particular national and epidemiological context.
Guide to good farming practices for animal production food safety Guidance for Competent Authorities assisting farmers and other stakeholders in keeping livestock to produce safe food. Spanish and French versions included.
Information on aquatic and terrestrial animal diseases Information portal from OIE with resources and information on more than 100 diseases affecting animals. Diseases listed in alphabetical order and for the type of animal.
OIE Terrestrial Animal Health Code Standards for the improvement of terrestrial animal health and welfare and veterinary public health worldwide. Intended for use by Veterinary Authorities.
OIE Aquatic Animal Health Code Standards for improvement of aquatic animal health worldwide, to be used by the Competent Authorities.
CODEX ALIMENTARIUS International Food Standards: Codes of practice Standards from CODEX ALIMENTARIUS. Several of relevance for reducing the spread of infections via the food chain. Se for example General Principles of Food Hygiene (CXC 1-1969), Code of Hygienic Practice for Eggs and Egg Products (CXC 15-1976), Code of Practice for Fish and Fishery Products (CXC 52-2003), Code of Practice on Good Animal Feeding (CXC 54-2004), Code of Hygienic Practice for Meat (CXC 58-2005), Code of Hygienic Practice for Milk and Milk Products (CXC 57-2004). Available in English, French and Spanish and additional languages.
1.
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World Health Organization - WHO. National level assessment tool (IPCAT2) and IPCAT2 instruction manual [Internet]. WHO - Infection prevention and control. 2017 [cited 2017 Nov 17]. Available from: http://www.who.int/infection-prevention/publications/core-components/en/
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