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Health care  –  Interventions

Basic interventions

A variety of basic actions can be used to prevent and control infections.

WHO’s guidelines on core components of infection prevention and control programmes promote the implementation of standard precautions such as:

  • Hand hygiene. Hand hygiene is the single most effective measure to stop transmission of health care associated pathogens.
  • Use of personal protective equipment
  • Sterilization and medical devices decontamination
  • Applying principles of asepsis
  • Prevention of injuries from sharp instruments
  • Proper patient placement
  • Environmental cleaning
  • Waste management
  • Safe handling of linen and laundry

Improved water sanitation and hygiene heavily reduced wound sepsis after C-section

Description: Health care in Sierra Leone crippled in the post-conflict period. A lack of electricity, water and basic supplies used for infection prevention and control made safe deliveries difficult. At one hospital – the Bo District Hospital – 60% of women who gave birth through caesarian-section got sepsis due to infected wounds. To address these issues, development partners in Sierra Leone that worked on maternal and newborn health shifted the focus of their programs. Boreholes were drilled, water storage facilities were introduced and a generator was supplied to the operating theatre of the Bo District Hospital. Staff was trained in water sanitation and hygiene and wound care.

Place: Bo District Hospital, Sierra Leone.

Setting: Maternity unit

Finding: Within a period of 3 months, post-caesarian wound sepsis decreased from 60% to 10%. Use of antibiotics decreased dramatically. Within 6 months, more than twice as many women chose to deliver at this maternity unit since their improved services quickly became known to patients.

A selection of resources for basic interventions are found in the table below. In addition, many countries have their own guidelines that are adapted to the local circumstances.

Educational materials are collected in RAISE AWARENESS: Education and training.

For tools and guidance how to measure the effects of interventions, go to MEASURE.

Selected Resources

Resource Description
Strengthening infection prevention and control in primary care
Guidelines. WHO document describing already existing acute health care IPC measures  that can be further implemented in primary care systems. 
WHO Hand hygiene implementation tools Information portal. WHO tools and resources for hand hygiene interventions, such as Guide to local production: WHO-recommended handrub formulations, Tips for implementing a patient participation programme, and the Five moments for hand hygiene poster in multiple languages, as well as local adaptations of tools. From here you can also access:

A Guide to the Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy Manual to assist health care facilities to implement improvements in hand hygiene in accordance with the WHO guidelines on hand hygiene in health care. Available in English and French.
Infection Control Assessment Tool (ICAT) for Primary Health Care Facilities Tool to help improve practices for the prevention and control of infections through easy to apply instruments, and highlight deficiencies in current practices as well as proposing reformatory actions.
Infection prevention and control – Guidance to action tools Tools. Three improvement tools (called “aide-memoires”) to help put IPC guidance into action with the focus on 1)‎ respiratory and hand hygiene, 2)‎ personal protective equipment, and 3)‎ environmental cleaning, waste and linen management. Provide action checks to empower IPC focal points and other leaders to take actions that will sustain improvements in practices.
Booklet. A quick desk reference for infection prevention and control in resource limited settings. Available in English and French (Earlier version in Spanish). Step-by-step instructions for how to perform critical procedures.
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 often specifically addressing settings with limited resources. See for example chapters on:

The guide is also available in Spanish.

Water and Sanitation for Health Facility Improvement Tool ‘WASH FIT’ Framework and tools to help monitor improvements to water, sanitation, and hygiene (WASH) in health care facilities, to improve quality of care (by WHO and UNICEF). Largely designed for primary, and in some instances secondary, health care facilities in resource-limited settings. The WASH FIT Mobile is a free complementary tool for the same purpose available here.
Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings Manual from Infection Control Africa Network (ICAN) and CDC. The best practices are divided into three chapters focusing on 1) environmental cleaning programs 2) supplies and equipment and 3) procedures. Should be used and implemented within the framework of existing IPC programs. Also available in French, Spanish and Portuguese.
Natural ventilation for infection control in health-care settings Report that gives an overview on natural ventilation and its design requirements in relation to infection control in health care settings.
Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study Intervention example. Describes the implementation of a multifaceted infection control and antibiotic stewardship program in Indonesia, with good results in terms of reducing hospital-acquired infections and antibiotic use.
Tackling Antimicrobial Resistance: Supporting national measures to address infection prevention and control, and water, sanitation and hygiene in health care settings (PDF) Fact sheet. WHO and UNICEF fact sheet on AMR, infection prevention and water, sanitation and hygiene with recommended actions.
Guidelines library – Resources toward elimination of HAIs Guidelines from CDC on strategies for surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance and related events in healthcare settings. The page includes for example:

Guideline for Disinfection and Sterilization
Guideline for Isolation Precautions

Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care Guide with infection prevention recommendations for outpatient (ambulatory care) settings based primarily on elements of standard precautions and represents the minimum infection prevention expectations for safe care in ambulatory care settings. From US CDC.
AMR travel tool Framework. Online platform to support clinical management of patients returning from international travel. Focuses on assessing risks of being colonized by antibiotic resistant bacteria. The tool is based on surveillance data from multiple sources. Also provides a section with pre-travel advice for travellers.

More from "Interventions"

1.
World Health Organization. Infection prevention and control - Guidance to action tools. https://www.euro.who.int/en/publications/abstracts/infection-prevention-and-control-guidance-to-action-tools-2021 (2021).
1.
WHO. Strengthening infection prevention and control in primary care: A collection of existing standards, measurement and implementation resources.
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International Society for Infectious Diseases - ISID. Guide to Infection Control in the Healthcare Setting. https://isid.org/guide/.
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Centers for Disease Control and Prevention CDC. Guidelines & Guidance Library. https://www.cdc.gov/infectioncontrol/guidelines/index.html.
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Centers for Disease Control and Prevention - CDC & Infection Control Africa Network - ICAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. (2019).
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World Health Organization - WHO. Natural ventilation for infection control in health-care settings. (World Health Organization, 2009).
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World Health Organization - WHO & UNICEF. Water and Sanitation for Health Facility Improvement Tool ‘WASH FIT’: A practical guide for improving quality of care through water, sanitation, and hygiene in health care facilities. https://www.who.int/publications/i/item/9789241511698 (2018).
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World Health Organization - WHO. A Guide to the Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. (2009).
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World Health Organization - WHO. Evidence of hand hygiene as the building block for infection prevention and control. https://www.who.int/publications-detail-redirect/WHO-HIS-SDS-2017.7 (2017).
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Engender Health. Infection prevention: a reference booklet for health care providers. (2011).
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World Health Organization - WHO. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. WHO https://www.who.int/publications/i/item/9789241549929 (2016).
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EPI-Net COMBACTE. TRAVEL HEALTH and Antimicrobial resistance (AMR) - EPI-Net. https://epi-net.eu/travel-tool/overview/.
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Velleman, Y. et al. From Joint Thinking to Joint Action: A Call to Action on Improving Water, Sanitation, and Hygiene for Maternal and Newborn Health. PLoS Med 11, e1001771 (2014).
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World Health Organization - WHO & UNICEF. Tackling Antimicrobial Resistance: Supporting national measures to address infection prevention and control and water, sanitation and hygiene in health care settings. https://www.washinhcf.org/resource/tackling-antimicrobial-resistance-supporting-national-measures-to-address-infection-prevention-and-control-and-water-sanitation-and-hygiene-in-health-care-settings/.
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Centers for Disease Control and Prevention - CDC. Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care. http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html.
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Systems for Improved Access to Pharmaceuticals and Services, A. Infection Control Assessment Tool for Primary Health Care Facilities. http://siapsprogram.org/publication/infection-control-assessment-tool-for-primary-health-care-facilities/ (2013).
1.
Murni, I. K., Duke, T., Kinney, S., Daley, A. J. & Soenarto, Y. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Arch Dis Child 100, 454–459 (2015).