Implementation of the World health organization infection prevention and control core components in the provision of care to cancer patients at the Uganda Cancer institute; a mixed methods study.

Abstract

Background: Effective implementation of infection prevention and control (IPC) is imperative for prevention and reduction of healthcare-associated infections (HAIs) especially in the cancer patient. HAIs are of significant public health concern with a considerable impact on morbidity, mortality, and quality of life especially in cancer patients. Cancer patients are at a greater risk of acquiring HAIs due to their weakened immune system arising from cancerous conditions and medications, as well as prolonged hospital stays. While there has been a study on bacteraemia in febrile cancer patients at UCI, there is scanty literature to describe the level of implementation of the World Health Organization (WHO)Infection Prevention and Control (IPC) core components (CCs) at the Uganda Cancer Institute (UCI). The aim of this study was to assess the level of implementation of WHO IPC CCs at UCI. Methods: The study was a cross sectional three-part mixed methods study, utilising the convergent parallel approach. It consisted of a (1) a hospital-based cross-sectional component (utilizing the WHO infection prevention and control assessment framework (IPCAF) tool, (2) observational checklist, (3) key informant interviews (KIIs). Findings from both the quantitative and qualitative data were collected and triangulated. Based on the overall score obtained from the IPCAF tool, UCI was assigned to one of the 4 levels of IPC promotion and practice. The results from the observational checklist were used to validate the results from the WHO IPCAF too while the findings from the KIIs provided further explanation to level of implementation of the WHO IPC CCs at UCI.Results: The overall IPC compliance score for UCI was 33.2% (265.9/800), interpreted as a basic level of compliance. IPC scores ranged from the lowest, 173/800 in Paediatric OPD to highest 432.5/800 for Lymphoma Tumor Centre (LTC). Adult units had higher IPC scores (mean = 309.3) than paediatric units (mean = 178.8) while outpatient units had higher IPC scores (mean = 276.9) than inpatient units (mean = 260.25). These differences were however not statistically significant, p=0.133 and p=0.800 respectively. Facilitators for IPC implementation included existence of an IPC committee, UCI leadership commitment, availability of PPE, skilled staff, segregation of patients and access controls. Barriers against IPC implementation included insufficient IPC staff, limited space and equipment, delayed PPE replenishment, inadequate training, lack of HAI surveillance, poor monitoring and feedback, and infrastructure limitations. Conclusion: This study revealed a lower level of implementation of WHO IPC CC at UCI 33.2% (265.9/800), which shows that there is still significant room for improvement especially for HAI surveillance (CC4), monitoring/audit and feedback (CC6), and workload, staffing and bed occupancy (CC7).