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Health care  –  Set up a program

Evaluate progress

The monitoring and evaluation provides insight into impact of the program. It helps to see if goals are being accomplished and can identify aspects that may need improvement which is important in the scale-up, and replication of interventions.

Outputs from evaluation can be used for evaluating interventions, revising national or local guidelines, or presenting facts for underlying policy decisions. Benchmarking between departments or health care facilities can be used to encourage improvement as no one wants to be seen as the worst. However it is important to encourage improvement and promote learning from experience without fear of negative consequences.

Develop a monitoring and evaluation framework

Often evaluation is done by measuring indicators, however in addition, the collection of descriptive data can be helpful to give a comprehensive view of the extent to which changes are occurring. When developing a monitoring and evaluation framework, teams should consider:

  • What will be measured?
  • How data will be collected and recorded
  • Analysis and interpretation of data
  • Feedback of the results to all stakeholders
  • Acting on the results

Measurement and indicators

Both process and outcome measures should be used within the monitoring and evaluation framework. The two types of indicators give different perspectives on the success of infection prevention and control programs.

Process indicators

Process measures give a view if improvements have been made in infection prevention and control practices and techniques. Some examples are:

  • % of staff members who are vaccinated
  • % of patients who are screened for infection control risk
  • % of staff who attended a training

Outcome indicators

Outcome measures inform if the infection prevention and control programs or interventions have improved the infection situation. Some examples are:

  • % improvement of staff following hand hygiene guidelines
  • % change in antibiotic consumption
  • % reduction in duration of hospitalization
  • % reduction in resistance rates
  • % reduction in health care-associated infections
  • Incidence of Clostridium difficile infections

Analyze results

Data collected should be analyzed by the committee and additional key stakeholders. Involving people from outside the committee can provide additional understanding of what is happening in a particular setting and helps to build ownership of finding solutions. When reviewing results, dialog and discussion can help to understand the meaning of the results. Interventions showing progress can be considered for scaling up. However when there is no indication of change or improvement, committees should discuss possible explanations and decide if changes need to be made to the program.

Communicate results and provide feedback

Results should be fed back to collaborating partners and interested stakeholders, especially management. Communication methods and content should be tailored to the audience. It is good to acknowledge positive progress, including to give public recognition of the contributions and successes of all partners involved in the project. Affirmation of hard work will provide incentive for staff to continually improve and be involved in the process.

In MEASURE you can find tools and resources for measuring various aspects of antibiotic resistance, such as incidence of infections, quantity of antibiotic use and knowledge and practices.

When assessing impact of a program, many of the same tools and checklists are relevant as for the baseline assessment (see Assess the situation).

Selected Resources

Resource Description
Improving infection prevention and control at the health facility: interim practical manual supporting implementation of the WHO guidelines on core components of infection prevention and control programmes Manual to support effective implementation of IPC programs in health facilities. Tools and resources for evaluation and feedback can be found under for example Step 2: BASELINE ASSESSMENT and Step 4: ASSESSING IMPACT as well as under Core component 6: IPC monitoring/audit of IPC practices and feedback, such as

  • IPCAF: A systematic tool that can provide a baseline assessment of the IPC program
WHO Hand hygiene monitoring tools
Information portal. WHO tools and resources for monitoring hand hygiene, such as the WHO Hand Hygiene Self-Assessment Framework, Observation tools and perception surveys, as well as Data Entry Analysis Tools.
Hand Hygiene Observation Toolkit (HHOT) Toolkit developed by MSF to enable users to observe, record, analyze and share hand hygiene observations across facilities, wards and staff groups. The toolkit covers an open-source application for mobile devices and an interactive analytical dashboard. A study on the use of HHOT as an effective and feasible tool in improving hand hygiene adherence in low-resource settings can be found here.
Infection Prevention and Control: A guide for health professionals in low-resource settings e-book for training in infection prevention and control (IPC) in resource-limited settings. See “Read for free online”. Chapter 1 “Role and structure of IPC programmes” covers for example Audits in IPC and Report writing in IPC, with simple examples.

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