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      Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

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          Abstract

          Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

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          The online version of this article (doi:10.1186/s13756-016-0149-9) contains supplementary material, which is available to authorized users.

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          Most cited references106

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          The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals.

          In a representative sample of US general hospitals, the authors found that the establishment of intensive infection surveillance and control programs was strongly associated with reductions in rates of nosocomial urinary tract infection, surgical wound infection, pneumonia, and bacteremia between 1970 and 1975-1976, after controlling for other characteristics of the hospitals and their patients. Essential components of effective programs included conducting organized surveillance and control activities and having a trained, effectual infection control physician, an infection control nurse per 250 beds, and a system for reporting infection rates to practicing surgeons. Programs with these components reduced their hospitals' infection rates by 32%. Since relatively few hospitals had very effective programs, however, only 6% of the nation's approximately 2 million nosocomial infections were being prevented in the mid-1970s, leaving another 26% to be prevented by universal adoption of these programs. Among hospitals without effective programs, the overall infection rate increased by 18% from 1970 to 1976.
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            Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus.

            Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37,000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate use of guidelines; education and training; auditing; surveillance and feedback; multimodal and multidisciplinary prevention programmes that include behavioural change; engagement of champions; and positive organisational culture. These components comprise manageable and widely applicable ways to reduce health-care-associated infections and improve patients' safety.
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              Hand hygiene among physicians: performance, beliefs, and perceptions.

              Physician adherence to hand hygiene remains low in most hospitals. To identify risk factors for nonadherence and assess beliefs and perceptions associated with hand hygiene among physicians. Cross-sectional survey of physician practices, beliefs, and attitudes toward hand hygiene. Large university hospital. 163 physicians. Individual observation of physician hand hygiene practices during routine patient care with documentation of relevant risk factors; self-report questionnaire to measure beliefs and perceptions. Logistic regression identified variables independently associated with adherence. Adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for nonadherence. Direct observation of physicians may have influenced both adherence to hand hygiene and responses to the self-report questionnaire. Generalizability of study results requires additional testing in other health care settings and physician populations. Physician adherence to hand hygiene is associated with work and system constraints, as well as knowledge and cognitive factors. At the individual level, strengthening a positive attitude toward hand hygiene and reinforcing the conviction that each individual can influence the group behavior may improve adherence among physicians. Physicians who work in technical specialties should also be targeted for improvement.
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                Author and article information

                Contributors
                storrj@who.int
                anthony.twyman@gmail.com
                walter.zingg@hcuge.ch
                nizdamani@aol.com
                kilpatrickc@who.int
                Jacqui.reilly@gcu.ac.uk
                l.price@gcu.ac.uk
                matthias.egger@ispm.unibe.ch
                Lindsay.grayson@austin.org.au
                kelleye@who.int
                +41 797287710 , allegranzib@who.int
                Journal
                Antimicrob Resist Infect Control
                Antimicrob Resist Infect Control
                Antimicrobial Resistance and Infection Control
                BioMed Central (London )
                2047-2994
                10 January 2017
                10 January 2017
                2017
                : 6
                : 6
                Affiliations
                [1 ]Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
                [2 ]Infection Control Programme, and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
                [3 ]Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
                [4 ]Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
                [5 ]Austin Health and University of Melbourne, 145 Studley Road, PO Box 5555, Heidelberg, VIC Australia
                Article
                149
                10.1186/s13756-016-0149-9
                5223492
                28078082
                bfd94b7a-575d-46d7-b96f-0c25aa42ebe7
                © World Health Organization. 2017

                This article is distributed under the terms of the Creative Commons Attribution IGO License ( http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

                History
                : 27 October 2016
                : 4 November 2016
                Categories
                Guidelines Article
                Custom metadata
                © The Author(s) 2017

                Infectious disease & Microbiology
                infection prevention and control,hai,ipc programmes,hand hygiene,antimicrobial resistance,ipc guideline,surveillance,multimodal strategy,ipc education,workload,staffing,workforce,bed occupancy,ipc practices,universal health coverage

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