Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation
Abstract Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-me...
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| Language: | English |
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2024-11-01
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| Series: | Antimicrobial Resistance and Infection Control |
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| Online Access: | https://doi.org/10.1186/s13756-024-01484-4 |
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| author | Valeria Fabre Clara Secaira Carolyn Herzig Elizabeth Bancroft Maria Paula Bernachea Lucy Anchiraico Galarza Bowen Aquiles Ana Belén Arauz Maria Del Carmen Bangher Marisa Liliana Bernan Sol Burokas Alfredo Canton Iris L. Cazali Angel Colque Marisabel Comas Rosa Verónica Contreras Wanda Cornistein Maria Gabriela Cordoba Silvia Mabel Correa Gustavo Costilla Campero Marta Isabel Chamorro Ayala Nuria Chavez Gabriela De Ascencao Carlos Cruz García Clara Esquivel Cecilia Ezcurra Leonardo Fabbro Leandro Falleroni Johana Fernandez Sandra Ferrari Veronica Freire Maria Isabel Garzón José Anel Gonzales Lucrecia Guaymas Fausto Guerrero-Toapanta Diego Laplume Sandra Lambert César Guillermo Lemir Paola Romina Lazarte Itzel L. Lopez Herberth Maldonado Guadalupe Martínez Diego M. Maurizi Florencia Mesplet Cristina Moreno Izquierdo Gabriela Luciana Moya Mariela Nájera Yanina Nuccetelli Argelis Olmedo Belén Palacio Florencia Pellice Carla Lorena Raffo Carolina Ramos Fanny Reino Viviana Rodriguez Federico Romero Juan José Romero Graciela Sadino Nancy Sandoval Mariana Suarez Maria Victoria Suayter Maria Alejandra Ureña Marisol Valle Ligia Vence Reyes Silvia Vera Amate Perez Hugo Videla Silvina Villamandos Olmedo Villarreal Maria Alejandra Viteri Eduardo Warley Rodolfo E. Quiros |
| author_facet | Valeria Fabre Clara Secaira Carolyn Herzig Elizabeth Bancroft Maria Paula Bernachea Lucy Anchiraico Galarza Bowen Aquiles Ana Belén Arauz Maria Del Carmen Bangher Marisa Liliana Bernan Sol Burokas Alfredo Canton Iris L. Cazali Angel Colque Marisabel Comas Rosa Verónica Contreras Wanda Cornistein Maria Gabriela Cordoba Silvia Mabel Correa Gustavo Costilla Campero Marta Isabel Chamorro Ayala Nuria Chavez Gabriela De Ascencao Carlos Cruz García Clara Esquivel Cecilia Ezcurra Leonardo Fabbro Leandro Falleroni Johana Fernandez Sandra Ferrari Veronica Freire Maria Isabel Garzón José Anel Gonzales Lucrecia Guaymas Fausto Guerrero-Toapanta Diego Laplume Sandra Lambert César Guillermo Lemir Paola Romina Lazarte Itzel L. Lopez Herberth Maldonado Guadalupe Martínez Diego M. Maurizi Florencia Mesplet Cristina Moreno Izquierdo Gabriela Luciana Moya Mariela Nájera Yanina Nuccetelli Argelis Olmedo Belén Palacio Florencia Pellice Carla Lorena Raffo Carolina Ramos Fanny Reino Viviana Rodriguez Federico Romero Juan José Romero Graciela Sadino Nancy Sandoval Mariana Suarez Maria Victoria Suayter Maria Alejandra Ureña Marisol Valle Ligia Vence Reyes Silvia Vera Amate Perez Hugo Videla Silvina Villamandos Olmedo Villarreal Maria Alejandra Viteri Eduardo Warley Rodolfo E. Quiros |
| author_sort | Valeria Fabre |
| collection | DOAJ |
| description | Abstract Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement. |
| format | Article |
| id | doaj-art-44d42ed3714541edb9e0a2dc8ffe7fab |
| institution | Kabale University |
| issn | 2047-2994 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj-art-44d42ed3714541edb9e0a2dc8ffe7fab2024-11-10T12:42:59ZengBMCAntimicrobial Resistance and Infection Control2047-29942024-11-0113111110.1186/s13756-024-01484-4Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluationValeria Fabre0Clara Secaira1Carolyn Herzig2Elizabeth Bancroft3Maria Paula Bernachea4Lucy Anchiraico Galarza5Bowen Aquiles6Ana Belén Arauz7Maria Del Carmen Bangher8Marisa Liliana Bernan9Sol Burokas10Alfredo Canton11Iris L. Cazali12Angel Colque13Marisabel Comas14Rosa Verónica Contreras15Wanda Cornistein16Maria Gabriela Cordoba17Silvia Mabel Correa18Gustavo Costilla Campero19Marta Isabel Chamorro Ayala20Nuria Chavez21Gabriela De Ascencao22Carlos Cruz García23Clara Esquivel24Cecilia Ezcurra25Leonardo Fabbro26Leandro Falleroni27Johana Fernandez28Sandra Ferrari29Veronica Freire30Maria Isabel Garzón31José Anel Gonzales32Lucrecia Guaymas33Fausto Guerrero-Toapanta34Diego Laplume35Sandra Lambert36César Guillermo Lemir37Paola Romina Lazarte38Itzel L. Lopez39Herberth Maldonado40Guadalupe Martínez41Diego M. Maurizi42Florencia Mesplet43Cristina Moreno Izquierdo44Gabriela Luciana Moya45Mariela Nájera46Yanina Nuccetelli47Argelis Olmedo48Belén Palacio49Florencia Pellice50Carla Lorena Raffo51Carolina Ramos52Fanny Reino53Viviana Rodriguez54Federico Romero55Juan José Romero56Graciela Sadino57Nancy Sandoval58Mariana Suarez59Maria Victoria Suayter60Maria Alejandra Ureña61Marisol Valle62Ligia Vence Reyes63Silvia Vera Amate Perez64Hugo Videla65Silvina Villamandos66Olmedo Villarreal67Maria Alejandra Viteri68Eduardo Warley69Rodolfo E. Quiros70Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins University School of MedicineInternational Infection Control Program, Division of Healthcare Quality Promotion, Centers for Disease Control and PreventionInternational Infection Control Program, Division of Healthcare Quality Promotion, Centers for Disease Control and PreventionClinica ConcienciaClínica Universitaria Privada Reina FabiolaHospital Sociedad de Lucha Contra el CáncerHospital Santo TomasInstituto de Cardiología de Corrientes “Juana Francisca Cabral”Hospital Interzonal General de Agudos San RoqueHospital Italiano de Buenos AiresPacifica Salud, Hospital Punta PacificaHospital RooseveltHospital Medico Policial Churruca ViscaHospital El CruceHospital Dr. Marcial V. QuirogaHospital Universitario AustralHospital Medico Policial Churruca ViscaDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins University School of MedicineHospital Angel C. PadillaHospital Zonal General de Agudos Dr. Alberto EurnekianHospital Regional de ZacapaHospital Provincial de RosarioHospital Sociedad de Lucha Contra el CáncerHospital San BenitoHospital AlemánHospital Universitario AustralHospital Provincial de RosarioHospital Dr. Guillermo RawsonHospital Dr. Guillermo RawsonHospital Nacional Profesor Alejandro PosadasHospital Universitario Privado de CordobaHospital Irma de Lourdes TzanetatosClinical Privada ProvincialHospital Carlos Andrade MarínHospital Nacional Profesor Alejandro PosadasHospital El CruceHospital San BernardoMaternidad Nuestra Señora De Las Mercedes De TucumánClinica Hospital San FernandoUniversidad del ValleHospital San BernardoHospital Municipal de Agudos Dr. Leonidas LuceroHospital Cesar MilsteinHospital MetropolitanoClinica ConcienciaUnidad De Cirugía Cardiovascular De GuatemalaInstituto de DiagnosticoPacifica Salud, Hospital Punta PacificaSanatorio Allende Nueva CórdobaHospital Dr. Marcial V. QuirogaHospital Municipal de Trauma Dr. Federico AbeteHospital Santo TomasHospital Carlos Andrade MarínHospital AlemánSanatorio Allende Nueva CórdobaHospital VozandesClínica Universitaria Privada Reina FabiolaHospital RooseveltHospital Interzonal General de Agudos San RoqueHospital Universitario Privado de CordobaMaternidad Nuestra Señora De Las Mercedes De TucumánHospital Municipal de Agudos Dr. Leonidas LuceroThe Panama ClinicHospital Angel C. PadillaInstituto de DiagnosticoInstituto de Cardiología de Corrientes “Juana Francisca Cabral”Hospital Irma de Lourdes TzanetatosHospital Cesar MilsteinClinical Privada ProvincialSanatorio Las LomasAbstract Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.https://doi.org/10.1186/s13756-024-01484-4Infection preventionLatin AmericaAntimicrobial resistance |
| spellingShingle | Valeria Fabre Clara Secaira Carolyn Herzig Elizabeth Bancroft Maria Paula Bernachea Lucy Anchiraico Galarza Bowen Aquiles Ana Belén Arauz Maria Del Carmen Bangher Marisa Liliana Bernan Sol Burokas Alfredo Canton Iris L. Cazali Angel Colque Marisabel Comas Rosa Verónica Contreras Wanda Cornistein Maria Gabriela Cordoba Silvia Mabel Correa Gustavo Costilla Campero Marta Isabel Chamorro Ayala Nuria Chavez Gabriela De Ascencao Carlos Cruz García Clara Esquivel Cecilia Ezcurra Leonardo Fabbro Leandro Falleroni Johana Fernandez Sandra Ferrari Veronica Freire Maria Isabel Garzón José Anel Gonzales Lucrecia Guaymas Fausto Guerrero-Toapanta Diego Laplume Sandra Lambert César Guillermo Lemir Paola Romina Lazarte Itzel L. Lopez Herberth Maldonado Guadalupe Martínez Diego M. Maurizi Florencia Mesplet Cristina Moreno Izquierdo Gabriela Luciana Moya Mariela Nájera Yanina Nuccetelli Argelis Olmedo Belén Palacio Florencia Pellice Carla Lorena Raffo Carolina Ramos Fanny Reino Viviana Rodriguez Federico Romero Juan José Romero Graciela Sadino Nancy Sandoval Mariana Suarez Maria Victoria Suayter Maria Alejandra Ureña Marisol Valle Ligia Vence Reyes Silvia Vera Amate Perez Hugo Videla Silvina Villamandos Olmedo Villarreal Maria Alejandra Viteri Eduardo Warley Rodolfo E. Quiros Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation Antimicrobial Resistance and Infection Control Infection prevention Latin America Antimicrobial resistance |
| title | Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation |
| title_full | Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation |
| title_fullStr | Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation |
| title_full_unstemmed | Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation |
| title_short | Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation |
| title_sort | contextual barriers to infection prevention and control program implementation in hospitals in latin america a mixed methods evaluation |
| topic | Infection prevention Latin America Antimicrobial resistance |
| url | https://doi.org/10.1186/s13756-024-01484-4 |
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