MTaPS’ Interventions Raise Infection Prevention and Control Level in Ethiopian Hospitals

Poor infection prevention and control (IPC) practices are a major challenge in Ethiopian hospitals – they compromise quality of patient care and promote antimicrobial resistance. Factors contributing to this include the lack of an IPC program with clear objectives, up-to-date IPC guidance, and a strategy that addresses behavior change to bring a sustainable cultural change on the front of IPC.

The USAID MTaPS program worked with the Federal Ministry of Health to improve IPC practices in Ethiopia’s hospitals. From October to December 2019, MTaPS supported 21 hospitals to conduct baseline assessments using the Infection Prevention and Control Assessment Framework (IPCAF), a tool that supports implementation of World Health Organization (WHO) guidelines on core components of IPC programs at the health care facility level. The assessments showed that 9 of 21 hospitals (43%) scored at basic level, while 11 of 21 (52%) were graded as intermediate and 1 (5%) was graded as inadequate. Following the assessment, MTaPS provided IPC training to the hospitals, assisted 15 of them in developing an IPC facility improvement action plan, and supported implementation of their action plans.

In August 2020, MTaPS selected four hospitals from the initial group of 21 to conduct self-assessments using the IPCAF tool to evaluate their implementation of IPC action plans. The findings shed light on the improvements made at the hospitals through MTaPS’ interventions when compared with the baseline data from 2019.

Table 1. Results of IPC implementation assessment before and after MTaPS’ support
* Score 0–200: Inadequate; 201–400: Basic; 401–600: Intermediate; 601–800: Advanced

Source: WHO. Infection Prevention and Control (IPC) Assessment Framework (IPCAF). https://www.who.int/infection-prevention/tools/core-components/en/

All four hospitals showed improvement in their IPCAF score. One hospital progressed from inadequate to the higher end of the score for basic level, while the second progressed from basic IPC level to intermediate. The other two hospitals maintained their IPC level but improved their IPC score by 20–25%. The increase in scores reflected major improvements at the hospitals, including:

•     Introduction of IPC programs with clearly defined objectives and action plans
•     Establishment of multidisciplinary IPC committees
•     Designation of dedicated and full-time IPC focal persons to lead IPC activities
•     Use of updated IPC guidelines on hand hygiene, standard precautions, transmission-based precautions, disinfection and sterilization, and prevention of surgical site infection.

Ethiopia’s Joint External Evaluation (JEE) of core capacities, conducted in 2016, indicated limited capacity for IPC (score of 2). The progress shown by the four hospitals will contribute to raising the country’s JEE score on IPC to developed capacity (score 3). The demonstrated efficacy of MTaPS’ methods to improve IPC at health care facilities provides a clear path to stronger IPC practices in Ethiopia’s hospitals, which contributes to both fighting AMR and achieving better health outcomes for patients.