WHO Guidelines on Core Components of Infection Prevention and Control (IPC) Programmes

Ruvy Tan De Guzman, RN, MGM
PHICNA, Inc. President

Learning Outcomes :
 Apply the evidence and expert consensus –based
recommendations on the core components of IPC
programmes that are required to be in place at the national
level and facility level to prevent HAI and to combat AMR
through IPC good practices.
 Develop or strengthen IPC programs and strategies through
the provision of evidence- and consensus-based guidance
that can be adapted to the local context, while taking
account of available resources and public health needs.

Learning Outcomes :
 Enhance a safe, effective and a high quality of
health service delivery for every person accessing
health care, as well as to protect the health
workforce delivering those services through
continuous monitoring of IPC practices and
evaluation and reporting of IPC outcomes

Public health problem
Introduction:
HAI
Adverse events
With an impact on
Morbidity
Mortality
Quality of life
Economic
burden

Rationale:
IHR position
effective IPC
as a key
strategy to
prevent PH
threats of
international
concern.
United Nation SDG
highlighted the
importance of
Infection
Prevention Control
Increasing
evidence as on
going health
challenges
EPIDEMIC & PANDEMIC
DISEASES

Rationale:
Prevent current and future threats
Strengthen health service resilience
Help combat antimicrobial resistance
4
Support countries
Support Health care facilities
5

Objectives :
Provide evidence- based recommendations
to prevent HAI and combat AMR through
IPC good practices
Support countries and HCF to develop and
strengthen IPC programmes and strategies
through the provision of evidence and
consensus – based guidance that can be
adapted to the local context while taking
account the available of resources and
public health needs

Methods :
1. Identification of the primary outcomes and
formulation of question (PICO)
P- Population/participants
I- Interventions
C- Comparator (regular care practices)
O- Outcome
2. Performing two systematic reviews for the retrieval
of the evidence using a standardized methodology
3. Developing an inventory of national and regional
IPC action plans and strategic documents
4. Assessment and synthesis of the evidence
5. Formulation of recommendations and good
practice statements in an expert meeting
6. Writing of the guidelines and planning for the
dissemination and implementation strategies

Methods :
Dimensions and corresponding components used for the
SIGHT review update
1
Org. Structure of
IPC programmes
2
Surveillance
3
Education and
Training
4
Behaviour
change
strategies
5
Standard and
transmission-based
precautions
6
Auditing
7
Patient
Participation
8
Target Setting
9
Knowledge
Management

Core Components:
1. IPC Programme
2. IPC Guidelines
3. IPC Education And Training
4. Surveillance
5. Multimodal Strategies
6. Monitoring / Audit Of IPC Practices and Feedback
7. Workload, Staffing And Bed Occupancy
8. Built Environment, Materials And Equipment For IPC

Core Component 1:
Infection Prevention and Control Programme
1a: Health care facility level
An IPC programme with a dedicated, trained team
should be in place in each acute health care facility for
the purpose of preventing HAI and combating AMR
through IPC good practices.
The organization of IPC programmes must have:
Clearly defined objectives
Defined activities:
- Surveillance of HAIs & AMR,
- IPC activities related to patients, visitors,
healthcare workers safety and the prevention
of AMR transmission

Core Component 1:
- Development or adaptation of guidelines
and standardization of effective preventive
practices and their implementation
- Outbreak prevention and response
- HCW education and practical training
- Maintaining effective aseptic techniques for
health care practices.
- Assessment and feedback of compliance with
IPC practices

Core Component 1:
- Assurance of continuous procurement of
adequate supplies relevant to IPC practices
- Assurance that patient care activities are
undertaken in a clean and hygienic
environment and supported by adequate
infrastructure.

Core Component 1:
 Dedicated , trained professionals in every acute care
facility
- 1full time IP:250 beds
- 1 full time IP: 100 beds
 IPC support in all types of health care facilities
- IPC committee
- provision of materials, organizational and
administrative support
- allocation of a protected and dedicated budget
- good quality microbiological laboratory support

Core Component 1:
 Clinics providing specialized treatment and care for
patients with highly transmissible communicable
disease
 Reporting lines for IPC teams (should be clear both
within the facilities and externally)
 IPC programmes aligned to national programmes and
interlinked with public health initiatives and IHR
 Data management systems

Core Component 1:
1b: National level
Active, stand-alone, national IPC programmes with
clearly defined objectives, functions and activities
should be established for the purpose of preventing
HAI and combating AMR through IPC good practices.
National IPC programmes should be linked with other
relevant national programmes and professional
organizations
.

Core Component 1:
1b: National level
The organization of national IPC programmes must :
 Established with clear objectives, functions,
appointed infection preventionists and a defined
scope of responsibilities.
- goals to be achieved for endemic and
epidemic infections
- development of recommendations for IPC
processes and practices in preventing HAI &
AMR
.

Core Component 1:
1b: National level
The organization of national IPC programmes should include
the following components:
- Appointed technical team of trained infection
preventionist including medical and nursing professionals
-The technical teams should have formal IPC training and
allocated time according to task
-The team should have the authority to make decisions and
to influence field implementation
-The team should have a protected and dedicated budget
according to planned IPC activity and support by national
authorities and leaders

Core Component 1:
1b: National level
The IHR and the WHO Global action plan on AMR support
national level action on IPC as a central part of health
systems’ capacity building and preparedness. This includes
the development of national plans for :
- preventing HAI ,
- development/strengthening of national
policies and standards of practice and the
associated monitoring of the implementation
and adherence to national policies and
standards

Core Component 1:
1b: National level
The linkages between the national IPC programme and other
related programmes are key and should be established and
maintained including:
-WASH
-Environmental authorities
-Prevention and containment of AMR including ASP
-TB and HIV and other priority public health programmes
-National referral laboratories
-Laboratory biosafety
-Occupational Health
-Quality of health service delivery
-Patient safety

Core Component 1:
1b: National level
The linkages between the national IPC programme and other
related programmes are key and should be established and
maintained including:
-Waste management and other environmental issues
-Patients’ associations/civil society bodies
-Scientific professional organizations
-Training establishment academia
-Relevant teams or programmes in other ministries
-Relevant sub-national bodies such as provincial or district
health offices
-Immunization programme
-Maternal and child health

Core Component 1:
Basic Set of Key Activities:
1. Surveillance of HAIs , AMR and Dissemination of
Data
2. Ensuring Implementation of the following:
(Standard Precautions, Transmission-based
Precautions, Appropriate selection and use of IPC
supplies, Preventive Techniques for Clinical
Procedures, Sterilization and Disinfection of clinical
materials, Waste management, adequate access to
safe water, sanitation and environmental cleaning)

Core Component 1:
3. Development of National Technical Guidelines,
SOPs and implementation strategies
4. Outbreak prevention and response including
ensuring that the national plan is in place
5. Training of Health care workers
6. Assessment & feedback of compliance with IPC
practices

Core Component 1:
7. Assurance of national procurement of adequate
supplies
8. Coordination or collaboration with relevant
ministries
9. Monitoring and evaluation of the National IPC
programmes

Core Component 2:
Infection Prevention and Control Guidelines
Evidence-based guidelines should be developed and
implemented for the purpose of reducing HAI and AMR. The
education and training of relevant health care workers on
the guideline recommendations and the monitoring of
adherence with guideline recommendations should be
undertaken to achieve successful implementation.
Health care facility level:
- Appropriate IPC expertise
- Guidelines ( evidence-based and reference international and
national standards)
- Monitoring adherence to guideline implementation

Core Component 2:
National level:
-Developing relevant evidence-based national IPC
guidelines and related implementation strategies
-ensure that the necessary infrastructures and
supplies are in place
-should support and mandate health care workers’
education and training focused on the guideline
recommendations.

Core Component 2:
IPC GUIDELINES
Standard Precautions
Hand Hygiene; PPE; Decontamination & Sterilization of medical
devices; Respiratory Hygiene & Cough Etiquette; Environmental
Cleaning; Safe Handling of linen & Laundry; Healthcare Waste
Management; Principles of Asepsis; Prevention of injuries from
sharp instruments and PEP
Transmission-Based Precautions
Aseptic Technique & Device Management Procedures
( according to scope of care)

Core Component 3:
Infection Prevention and Control Education &Training
3a. Health care facility level:
IPC education should be in place for all healthcare
workers by utilizing team- and task-based strategies
that are participatory and include bedside and
simulation training to reduce the risk of HAI and
AMR.

Core Component 3:
IPC education and training should be a part of an
overall health facility education strategy, including
new employee orientation and the provision of
continuous educational opportunities for existing
staff, regardless of level and position.

Core Component 3:
Categories of human resources were identified as targets
for IPC training and requiring different strategies and training
contents:
- IPC specialists,
- all health care workers involved in service
delivery and patient care,
- other personnel that support health service
delivery

Core Component 3:
3a. Health care facility level
Periodic evaluations of both the effectiveness of
training programmes and assessment of staff
knowledge should be undertaken on a routine basis.

Core Component 3:
3b. National level
The national IPC programme should support the education and
training of the health workforce as one of its core functions.
The IPC national team plays a key role to support and make
IPC training happen at the facility level.
To support the development and maintenance of a skilled,
knowledgeable health workforce, national pre-graduate and
post-graduate IPC curricula should be developed in
collaboration with local academic institutions.

Core Component 3:
3b. National level
In the curricula development process, it is advisable to refer
to international curricula and networks for specialized IPC
programmes and to adapt these documents and approaches
to national needs and local available resources.
The national IPC programme should provide guidance and
recommendations for in-service training to be rolled out at
the facility level according to detailed IPC core competencies
for health care workers and covering all professional
categories

Facility-based HAI surveillance should be
performed to guide IPC interventions and
detect outbreaks, including AMR surveillance
with timely feedback of results to health care
workers and stakeholders and through
national networks.
Core Component 4: HAI Surveillance

-Surveillance of HAI is critical to inform and guide IPC
strategies.
- Health care facility surveillance should be based on
national recommendations and standard definitions
and customized to the facility according to available
resources with clear objectives and strategies.

- Surveillance should provide information for:
▪ describing the status of infections associated with
health care
▪ identification of the most relevant AMR patterns.
▪ identification of high risk populations, procedures
and exposures.
▪ existence and functioning of WASH infrastructures,
such as a water supply, toilets and health care
waste disposal.
▪ early detection of clusters and outbreaks .
▪ Evaluation of the impact of interventions.

- Quality microbiology and laboratory capacity is
essential.
- The responsibility for planning and conducting
surveillance and analysing, interpreting and
disseminating the collected data remains usually
with the IPC committee and the IPC team.
- Methods for detecting infections should be active.
- Different surveillance strategies could include the
use of prevalence or incidence studies.

- Hospital-based infection surveillance systems should
be linked to integrated public health infection
surveillance systems.
- Surveillance reports should be disseminated in timely
manner to those at the managerial or administration
level and the unit/ward level.
- A system for surveillance data quality assessment is
of the utmost importance.

 HAIs selected for surveillance purposes include those that are
preventable. The following could be prioritized:
-Infections that may become epidemic in the health care
facility
-Infections in vulnerable populations
-Infections that may cause severe outcomes such as high case
fatality and patient morbidity and suffering.
-Infections caused by resistant microorganisms with an
emphasis on multidrug-resistant pathogens
-Infections associated with selected invasive devices or
specific procedures
-Infections that may affect healthcare workers in clinical,
laboratory and other setting
-
-

4b. National Level:
National HAI surveillance programmes and
networks that include mechanisms for timely
data feedback and with the potential to be
used for benchmarking purposes should be
established to reduce HAI and AMR.

4b National level:
- National HAI surveillance systems feed in to general
public health capacity building and the
strengthening of essential public health functions.
- National surveillance programmes are also crucial for
the early detection of some outbreaks in which cases
are described by the identification of the pathogen
concerned or a distinct AMR pattern.
- National microbiological data about HAI aetiology
and resistance patterns also provide information
relevant for policies on the use of antimicrobials and
other AMR-related strategies and interventions.

4b National level:
-Establishing a national HAI surveillance programme
requires full support and engagement by
governments and other respective authorities and the
allocation of human and financial resources.
-National surveillance should have clear objectives, a
standardized set of case definitions, methods for
detecting infections (numerators) and the exposed
population (denominators), a process for the analysis
of data and reports and a method for evaluating the
quality of the data.

4b National level:
- Clear regular reporting lines of HAI surveillance data
from the local facility to the national level should be
established.
- International guidelines on HAI definitions are
important, but it is the adaptation at country level that
is critical for implementation.
-Microbiology and laboratory capacity and quality are
critical for national and hospital-based HAI and AMR
surveillance.

4b National level:
- Standardized definitions and laboratory methods
should be adopted.
- Good quality microbiological support provided by at
least one national reference laboratory is a critical
factor for an effective national IPC surveillance
programme.

4b National level:
- A national training programme for performing
surveillance should be established to ensure the
appropriate and consistent application of national
surveillance guidelines and corresponding
implementation toolkits.
- Surveillance data is needed to guide the development
and implementation of effective control interventions.

Core Component 5: Multimodal Strategies for
implementing IPC activities
IPC activities using multimodal strategies
should be implemented to improve practices
and reduce HAI and AMR.

Multimodal strategy: consist of several elements or
components implemented in an integrated way with the aim of
improving outcome and changing behaviour. It includes tools
such as bundles and checklist.
Bundles: A bundle is an implementation tool aiming to
improve the care process and patient outcomes in a structured
manner. It comprises a small , straightforward set of evidence-
based practices that has been proven to improve patient
outcomes when performed collectively and reliably.

Components of Multimodal strategies:
i. System change
ii. Education and training of healthcare workers and
key players
iii. Monitoring infrastructures, practices, processes,
outcomes and providing data feedback
iv. Reminders in the workplace communications
v. Culture change with the establishment or
strengthening of a safety climate

- Successful multimodal strategies include the
involvement of champions or role models in several
cases.
- Implementation of multimodal strategies within
health care institutions needs to be linked with
national quality aims and initiatives, including
health care quality improvement initiatives or health
facility accreditation bodies.

5b. National level:
National IPC programmes should coordinate
and facilitate the implementation of IPC
activities through multimodal strategies on a
nationwide or sub-national level.

5b. National level:
-The national approach to coordinating and supporting
local (health facility level) multimodal interventions
should be within the mandate of the national IPC
programme and be considered within the context of
other quality improvement programmes or health
facility accreditation bodies.

5b. National level:
-Ministry of health support and the necessary resources,
including policies, regulations and tools, are essential
for effective central coordination.
-Successful multimodal interventions should be
associated with overall cross-organizational culture
change as effective IPC can be a reflector of quality
care, a positive organizational culture and an enhanced
patient safety climate.

5b. National level:
- Strong consideration should be given to country
adaptation of implementation strategies reported
in the literature, as well as to feedback of results
to key stakeholders and education and training to
all relevant persons involved in the implementation
of the multimodal approach.

Core Component 6: Monitoring/audit of IPC
practices and feedback
Regular monitoring/audit and timely
feedback of health care practices according
to IPC standards should be performed to
prevent and control HAI and AMR at the
health care facility level. Feedback should be
provided to all audited persons and relevant
staff.

Purpose:
-achieve behaviour change or other process
modification to improve the quality of care and
practice with the goal of reducing the risk of HAI and
AMR spread.
-engaging stakeholders, creating partnerships and
developing working groups and networks.

- Sharing the audit results and providing feedback
not only with those being audited (individual
change), but also with hospital management and
senior administration (organizational change) are
critical steps. IPC teams and committees should
also be included as IPC care practices are quality
markers for these programmes.

-IPC programmes should be periodically evaluated to assess :
- the extent to which the objectives are met,
- goals accomplished,
- whether the activities are being performed
according to requirements
- identify aspects that may need improvement
identified via standardized audits.

National IPC monitoring and evaluation programme
should be established to assess the extent to which
standards are being met and activities are being
performed according to the programme’s goals and
objectives. Hand hygiene monitoring with feedback
should be considered as a key performance indicator
at the national level.
6b. National level:

- Regular monitoring and evaluation provides
a systematic method to document the
progress and impact of national programmes
in terms of defined indicators, for example,
tracking hand hygiene improvement as a key
indicator, including hand hygiene
compliance monitoring.
6b. National level:

-National level monitoring and evaluation should have
in place mechanisms that:
▪ Provide regular reports on the state of the national goals
(outcomes and processes) and strategies.
▪ Regularly monitor and evaluate the WASH services, IPC
activities and structure of the health care facilities through
audits or other officially recognized means.
▪ Promote the evaluation of the performance of local IPC
programmes in a non- punitive institutional culture.
6b. National level:

Core Component 7: Workload, staffing and bed
occupancy (acute health care facility only)
The following elements should be adhered to
in order to reduce the risk of HAI and the
spread of AMR:
(1) bed occupancy should not exceed the
standard capacity of the facility;
(2) health care worker staffing levels should
be adequately assigned according to
patient workload.

- Standards for bed occupancy should be one
patient per bed with adequate spacing
between patient beds and that this should not
be exceeded.

- Ward design regarding bed capacity should be
adhered to and in accordance with standards.
- In exceptional circumstances where bed capacity is
exceeded, hospital management should act to
ensure appropriate staffing levels that meet patient
demand and an adequate distance between beds.
These principles apply to all units and departments
with inpatient beds, including emergency
department.

-The WHO Workload Indicators of Staffing Need
method provides health managers with a systematic
way to determine how many health workers of a
particular type are required to cope with the
workload of a given health facility and decision-
making (http://www.who.int/hrh/resources/wisn_user_manual/en/).
-Overcrowding was recognized as being a public
health issue that can lead to disease transmission.

Core Component 8: Built environment, materials
and equipment for IPC at the facility level (acute
health care facility only)
8a. Patient care activities should be undertaken in a clean and/or
hygienic environment that facilitates practices related to the
prevention and control of HAI, as well as AMR, including all
elements around the WASH infrastructure and services and the
availability of appropriate IPC materials and equipment.
8b. Materials and equipment and ergonomics for appropriate
hand hygiene

-An appropriate environment, WASH services and
materials and equipment for IPC are a core
component of effective IPC programmes at health
care facilities.
a. Health facility infrastructure and WASH
- appropriate infrastructure
- availability of safe water and sanitation facilities
- IPC teams should involved in the design ,
construction and commissioning of any new or
upgraded building

- IPC teams should engaged when major renovation or
demolition work is being planned
-Adequate and continuous supply of safe water (5-400 L
/person per day)
-Safe water should be available in all treatment wards and in
waiting areas.
-Water should be available for drinking, hand washing for
food preparations, personal hygiene, medical activities,
cleaning and laundry, water for bathing.

-Ensuring an adequate hygienic environment is the
responsibility of senior facility managers and local
authorities.
- At least 1 toilet for every 20 users for
inpatient setting and built according to
technical specifications
- Fecal waste should be safely managed
- Sufficient energy should be available to pump
water, power health care waste destruction
technologies and provide lighting for toilets.

Key building features for appropriate IPC
- Adequate ventilation should be in place for isolation rooms
- Adequate facilities requires for the isolation of patients
-The facility should be built in a way so that traffic flow can
be regulated to minimize exposures of high-risk patients
and to facilitate patient transport.
-Precautions to control rodents, insects and other vectors of
diseases should be in place
-One patient per bed with adequate bed spacing 1 meter
between beds and 2.5 meters in critical care areas

- Availability of good quality, close to the point of use and
readily accessible PPE
- Dedicated area for decontamination of items, equipment
and medical devices
- Waste management structure and processes guidelines
- Dedicated clean storage area for patient care items and
equipment, including sterile materials, and separate are for
the storage of clean linen
- The environment should be thoroughly clean using the
general principles of cleaning

The central government and national IPC and WASH programmes
also play an important role in developing standards and
recommending their implementation regarding adequate WASH
services in health care facilities, the hygienic environment, and
the availability of IPC materials and equipment at the point of
care.
- standards for drinking water quality, sanitation and
environmental health in health care facilities should be
implemented.

REFERENCE: http://www.who.int/gpsc/core-components.pdf?ua=1

WHO Guidelines on Core Components of Infection Prevention and Control (IPC) Programmes

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WHO Guidelines on Core Components of Infection Prevention and Control (IPC) Programmes