CMPH Journal

Abstract

Background: Adherence to Infection prevention and control standard practice protocol is critical in minimizing the risk of contracting COVID-19 infection among healthcare workers. With the increasing trend of nosocomial transmission of COVID-19 among healthcare workers during the pandemic in Nigeria, we assessed the status of IPC in facilities in the Federal Capital Territory (FCT), Abuja during the COVID-19 pandemic. Methods: A cross-sectional study design was conducted from March to April 2020 in the Federal Capital Territory (FCT), Abuja. A semi-structured intervieweradministered checklist adapted from the World Health Organization (WHO) IPC scorecard for health facilities was used. IPC focal persons for each health facility visited were interviewed on the twelve IPC domains. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS) version 26. A p<0.05 was considered statistically significant for all statistical tests. Result: Four hundred fifty-eight facilities took part in the study. The majority of the facilities 320 (69.9%) were public/ government owned, with more than half 315 (68.8%) being secondary health facilities. The overall IPC status was good in 408 (89.0%) of the health institutions. However, there was a statistically significant difference in IPC practices between private and public facilities in the majority of IPC domains: Functional IPC Committee (p0.001), facility triaging (p0.001), temporary holding area (THA) (P0.001), PPE (P0.001), Waste disposal (p=0.023), hospital sterilization (p=0.008), and hospital decontamination (p=0.004). Conclusion: The study found a satisfactory level of IPC protocol operationalization status in mostly public health facilities in the Federal Capital Territory (FCT), Abuja. Nevertheless, there is a need for interventions targeting mostly private health facilities to address the disparity and gaps identified in IPC practices.

Keywords: Infection Prevention and Control; COVID-19; Healthcare workers; Federal Capital Territory; Abuja

Introduction

Infection prevention and control (IPC) practices in health care facilities during COVID-19 were poised with increasing challenges of ensuring optimal practices due to increased patients presenting with COVID-19 and patients with routine care needs [1]. The absence of an adequate work force to maintain a functional local response and patient care during the pandemic was responsible fora high rate of infection among Health Care Workers (HCWs) [2]. In Federal Capital Territory (FCT), Abuja a total of seven hundred and fifty-six (756) health care workers have been infected with COVD19 in the course of duty between 20th of March 2020 to the 31st of March 2021 [3]. Health Care Workers (HCWs) are generally at risk of emerging viral diseases SARS-COV-2, due to novel nature of the disease and poor IPC practices [2,4,5].

In Nigeria, studies reported the prevalence of nosocomial infection ranging between 14%-49% [6-8]. In Wuhan, China, during the early phase of the COVID-19 epidemic about 29% of patients with SARS-CoV-2 were health-care workers and were assumed to have acquired the infection in hospital.9Deaths among health-care workers infected with SARS-CoV-2 were mostly among aged 50 and above [10]. With an increasing understanding of the COVID-19, the proportion of healthcare workers contracting COVID-19 infection in hospital setting has decreased, but stringent IPC measures and continued vigilance are needed. Facility-based Infection Prevention and Control (IPC) measures are fundamental to addressing this challenge while public health measures target community transmission [11].

Infection prevention and control is a proven solution that has the ability to mitigate the incalculable suffering and costs to both healthcare workers and the health system [12]. Compelling evidence shows that up to 70% of Hospital Acquired Infections (HAIs) can be prevented by scaling up an array of effective IPC interventions. Investing in IPC is one of the most cost effective interventions available. In particular, hand hygiene and environmental hygiene in health care facilities were found to halve the risk of death due to infections with AMR pathogens, and decrease the associated long-term complications and health burden by at least 40%. Improving hand hygiene in health care settings could save about US$ 16.50 and reduced health care expenditure, while generating substantial net saving across countries worldwide [13]. During the first six months of the COVID-19 pandemic, access to appropriate personal protective equipment combined with rapid IPC training would have had the potential to avert SARS-CoV-2 infections and related deaths among health care workers globally [13].

IPC measures are extensive in hospitals managing patients infected with SARS-CoV-2 and include rigorous cleaning and disinfection to reduce environmental contamination, use of Personal Protective Equipment (PPE), isolation, and isolation [14]. COVID-19 has stretched IPC practice in facilities both in terms of human capacity to ensure the practice and increased demand for IPC materials [2].

The COVID-19 pandemic and other recent large disease outbreaks have highlighted the extent to which health care settings can contribute to the spread of infections, to patients, health workers and visitors, are at risk of contracting nosocomial infections if little attention is paid to IPC. Good hand hygiene and other cost-effective practices can prevent up to 70% such infections [13]. The COVID-19 pandemic has exposed many exiting challenges encountered in the implementation of IPC in all regions and countries, including those with the most advanced IPC programmes. It has also provided an unprecedented opportunity to take stock of the situation, rapidly scale up disease outbreak readiness and response through proper implementation of IPC practices, as well as strengthening IPC programmes across the health system [13]. The aim of the study is to determine the status of IPC in facilities during the COVID 19 pandemic.

Materials and Methods

Study settings, design, and sample size

A cross-sectional study was carried out from March 2020 to April 2020 in the Federal Capital Territory (FCT), Abuja. The Federal capital territory is a cosmopolitan city and the political capital of Nigeria, which experiences high influx of diverse people with wide diurnal nocturnal ratio. The estimated total population of the FCT is about 5,338,550 with a landmass of 1769 km².There are 6 Area Councils (AC) and 62 political wards in the FCT [13,14].

FCT operates a 3-tier health system of primary, secondary, and tertiary levels of care that spread over rural and urban areas. There are 754 accredited health facilities made up of 500 private health facilities and 254 public health facilities. The 254 public health facilities are disaggregated into 237 primary health facilities, 14 secondary health facilities, and 3 tertiary hospitals namely; National Hospital, Federal Medical Centre and University of Abuja Teaching Hospital located in Gwagwalada Area Council. The three tertiary hospitals are owned and funded by the Federal Government, while the secondary facilities are managed by the Hospitals Management Board (HMB), and the PHC facilities are managed by the FCT Primary Health Care Board (PHCB). The private health facilities consist of hospitals, maternity homes, faithbased hospitals and clinics, diagnostic centers, and pharmacies. The private sector provides healthcare for a substantial proportion of the population [14].

The minimum sample size was calculated using the formula for a cross-sectional study. The significant level was placed at a 95% confidence interval, power of 80% using prevalence from a similar previous study.

Study population and sampling techniques

The IPC scorecard adapted from the World Health Organization (WHO) was administered to IPC focal persons in the facilities [15]. All the public tertiary and secondary health facilities were selected. The study population consisted of consenting Primary Healthcare workers 18 years and above, residing and working in the FCT for at least six months.

The list of all the private and publics primary health care facilities was obtained to form the sampling frame. A proportion to size sampling technique was used to select the number of primary health facilities in the 6 Area council.

Twenty-two HCWs, twelve nurses and ten Community Health Officers (CHOs) were recruited and trained for two days as research assistants. A written informed consent was sought and obtained from each eligible participant, and a semi-structured interviewer-administered questionnaire was used to collect information from all facilities.

Study instrument and data collection

A semi-structured interviewer-administered checklist adapted from WHO core component and facilities scorecard for IPC was utilized [15]. IPC was assessed in twelve domains in all facilities. IPC committee or hygiene committee in place, Triage area in place, identification of a temporary holding area, Hand hygiene, availability and usage of PPE, waste collection and segregation, waste disposal, staff training, intra-hospital alert, sterilization, decontamination of the environment and risk assessment of healthcare worker exposed.

Each domains has set of questions and the responses are score as 1 for a yes response and 0 for a no response. Each domain score was graded as good (75%-100%), fair (50%-74%) and poor (1%-49%). The checklist was pretested among 10% of the total sample size in PHC facilities in Karu LGA.

Measurement of variables

The dependent variables was the IPC status categorized as good, fair and poor while the twelve domains were independent.

Data analysis

All the data generated was entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS) version 26. A p<0.05 was considered statistically significant for all statistical tests. The data analysis was stratified by facility ownership. Mean scores and standard deviations were used to summarize the quantitative variables. Chi-square test was done to describe associations between IPC domains and facility ownership.

Ethical consideration

Ethical approval for the study was obtained from the FCTA Health and Research Ethics Committee (FHERC). Written informed consent was obtained from each study participant. Respondents were free to withdraw anytime during the study if they so desired. The participants were assured of the confidentiality of their information. All methods were carried out in accordance with relevant guidelines and regulations.

Results

Most of the facilities were public government owned 320(69.9%) and majority were secondary health facilities (Table 1, Figure 1).

Table 1: Characteristics of Health Facilities Assessed for IPC in Federal Capital Territory Abuja.

Figure 1: Respondents responses on the IPC Practices in facilities in Federal Capital Territory.

Most public facilities shows better IPC practice in compared to private facilities except for availability sterilization equipment, SOP on disinfection and the presence of infection control protocol. Only about two-third of the facilities has protocol for IPC available. Functional incineration is only available in Less than 30% of private facilities and about 50% of public facilities (Table 2).

Table 2: Assessment of IPC Domain in Health Facilities in Federal Capital Territory Abuja.

Table 2: The functional IPC committee was categories as good in only about 25 (5.5%). Most facilities had good triaging place 293 (64.0%). Half of the Health facilities have good temporary holding area 241 (52.6%). Hand washing and hygiene was optimal in most of the facilities 436 (95.2%). PPEs was available in two third of the facilities 305 (66.6%). Waste collection was good 399 (87.1%) with only 90 (19.7%) having good disposal methods. Less than half 223(48.7%) of the health care workers reported having good training on IPC. Most of the hospital 359 (78.4%) had good sterilization methods in the facilities and most of the facilities does hospital decontamination 379 (82.8%). Hospital health workers risk assessment was good in only 180 (39.3%) (Figure 2).

Figure 2: Overall IPC status in Health Facilities in Federal Capital Territory Abuja.

Overall IPC status in health facilities was good 408 (89.0%) and this was poor in only 44 (10.0%). There was a significant statistical difference in the IPC practices among private and public facilities in most of the IPC domains Functional IPC Committee (p<0.001), facility triaging (p<0.001), THA (P<0.001), PPE (P<0.001), Waste disposal (p=0.023), hospital sterilization (p=0.008), and Hospital decontamination (p=0.004). No statistical difference was observed in hand hygiene (p=0.546), waste collection (p=0.233), health workers training on IPC (p=0.160) and hospital health workers risk assessment (0.156) (Table 3).

Table 3: IPC status in Public and Private Health Facilities in Federal Capital Territory Abuja.

There was no significant statistical difference in good IPC practice between private and public facilities (p=0.085), however most facilities in the public facilities had good IPC practice 292(91.3%) compared to private 116(84.0%) (Table 4).

Table 4: Comparison of overall IPC status in Public and Private Health Facilities in Federal Capital Territory Abuja.