Infection Prevention And Control Strategic Framework

Objectives

The Infection Prevention and Control Strategic Framework 2021–2025 aims to embed infection prevention and control (IPC) as a core function of safe, high-quality health care in Seychelles, improving patient safety, healthcare worker protection, health-system resilience and progress towards universal health coverage.[1][2]It supports prevention of healthcare-associated infections (HAIs), antimicrobial resistance (AMR) and infectious-disease threats, while contributing to International Health Regulations core capacities and public-health emergency preparedness.[3][4]

• Institutionalise effective IPC leadership, organisation and management through a multidisciplinary national programme, oversight structures and defined responsibilities at national and facility levels.[5][6]
• Strengthen governance, partnerships and resource mobilisation so that IPC is integrated into health-sector and relevant non-health-sector policies, plans and service-delivery structures.[7][8]
• Apply multimodal prevention strategies combining guidance, training, procurement, infrastructure, monitoring and feedback, organisational culture and behavioural interventions.[3][9]
• Develop, update and disseminate evidence-based national and facility-level IPC policies, guidelines and standard operating procedures, including guidance for COVID-19 and emerging infectious diseases.[10][11]
• Build workforce competence through induction, pre-service curricula, continuing professional development, on-the-job training, supportive supervision and development of IPC specialists.[10][12]
• Educate patients, clients, carers and communities on infection risks and preventive behaviours through teaching materials, public communication and a national communication strategy.[10][13]
• Strengthen surveillance of selected HAIs, outbreaks, occupational infections and AMR, including surgical-site infection surveillance, laboratory support and use of surveillance findings for prompt action.[7][12][14]
• Improve the built environment, water, sanitation and hygiene, environmental cleaning, waste management, isolation capacity, equipment reprocessing and reliable IPC logistics.[7][15][16]

The framework is structured around eight strategic areas: governance and resource mobilisation; multimodal strategies; guidance; education and training; surveillance; supportive supervision, monitoring and evaluation; the built environment and water, sanitation and hygiene; and standardised equipment and logistics management.[7]Five-year ambitions include a functioning national IPC programme with annual plans and performance reports, IPC focal persons in all public and private facilities, national guidelines available in all facilities, and institutionalised healthcare-worker protection and surveillance.[2]

Implementation

Implementation is designed as a nationally coordinated, facility-led programme using multidisciplinary collaboration, annual planning, defined responsibilities, guidance dissemination, training, surveillance, supportive supervision and performance review.[17][6]The Infection Prevention and Control Committee (IPCC), supported by the IPC Unit and facility focal persons, has primary responsibility for implementation, while the Ministry of Health and Health Care Agency provide leadership, endorsement and workforce support.[15][18]

• Establish and maintain national and facility IPC governance by appointing a national IPC coordinator and assistants, convening the multidisciplinary IPCC, designating facility focal persons, and requiring endorsed annual IPC plans.[5][6][18]
• Coordinate action across Ministry of Health units, healthcare facilities, public-health and clinical laboratories, human resources, procurement, stores and logistics, occupational health, health promotion, professional councils, the National Institute of Health and Social Studies, non-governmental organisations and relevant partners.[12][19][20]
• Develop, print, publish and disseminate national guidance, standard operating procedures and facilitator materials, adapting implementation to facility context and level of care.[3][21][11]
• Train IPC focal persons, trainers, supervisors, healthcare workers and managers through initial, refresher, induction and competency programmes, while updating pre-service curricula and professional standards.[22][23]
• Implement triage, isolation, standard and transmission-based precautions, hand hygiene, personal protective equipment management, cleaning, decontamination, linen management and safe healthcare-waste systems.[24][25][16]
• Integrate IPC requirements into facility design, construction, renovation and maintenance, including domestic and sluice rooms, water storage, emergency power and sanitary facilities.[15][26][27]
• Standardise supply lists, quantify current and projected needs, train stores and logistics personnel, track tracer supplies quarterly and involve IPC officers in procurement decisions.[15][20]

Monitoring arrangements include a work-plan matrix with activities, indicators, means of verification, time frames and assigned responsibilities.[2][7]The framework calls for baseline assessment of IPC key performance indicators, integration of IPC indicators into national and programme monitoring systems, quarterly internal supervision, twice-yearly external supportive supervision, annual national performance audits, annual reviews and a formal end-term evaluation in 2026.[19][15][28]Evidence sources include IPCC records, endorsed plans, guidelines, training and dissemination reports, supervision reports, surveillance reports, audit findings and resource-allocation records.[6][9][28]

Specified performance targets include training 90% of healthcare workers in standard and transmission-based precautions, achieving 60% hand-hygiene adherence, ensuring hand-hygiene resources in 90% of facilities, maintaining tracer personal protective equipment at all times, providing surgical-site infection surveillance and response in all hospitals undertaking surgery, and reporting against agreed IPC indicators from all public facilities.[2][17]The framework advocates a dedicated domestic IPC budget line at national and facility levels and alternative support from industry and private companies, but it provides no quantified budget, allocation, funding gap or currency value.[5][21]

Monitoring & Evaluation

The framework establishes a comprehensive infection prevention and control monitoring, evaluation and accountability system, combining national and facility-level performance measurement, healthcare-associated infection surveillance, supportive supervision, periodic audits, reviews and formal evaluations.[2][7][19][28]

• Measure implementation through a work-plan matrix that specifies strategic and intermediate objectives, activities, indicators, means of verification, time frames and assigned responsibilities.[2][7]
• Establish baseline information through assessment of 2021 IPC key performance indicators, update monitoring guidelines, indicators and tools, and integrate IPC indicators into national and programme monitoring systems, including HIV, tuberculosis and immunisation programmes.[19][15][28]
• Conduct quarterly internal facility supervision, targeted external supportive supervision at least twice yearly, annual national IPC performance audits, annual performance-review conferences, an organisational safety-culture survey, and mid-term and end-term evaluations in 2023 and 2026 respectively.[19][28][26]
• Require implementing agencies and partners to prepare annual plans, monitor assigned actions and report progress to the national Infection Prevention and Control Committee.[5][6][18]
• Verify implementation through meeting records, appointment letters, endorsed plans, implementation reports, guidelines, standard operating procedures, training reports, supervision reports, audit reports, survey findings and evidence of resource allocation.[6][18][9][11][22]

Surveillance priorities cover selected healthcare-associated infections, surgical-site infections, outbreaks, occupational infections among healthcare workers, antimicrobial resistance and antimicrobial use or consumption. Surveillance is intended to collect, collate, analyse, interpret, report and feed back data for prompt action, supported by laboratory information on antibiotic-resistant organisms.[12][19][14][29]

• Adopt international healthcare-associated infection case definitions, finalise surveillance protocols and tools, strengthen laboratory integration, conduct targeted environmental surveillance and obtain technical assistance for a point-prevalence survey.[12][19][14][29]
• Monitor occupational infection prevention through guidelines, healthcare-worker screening, immunisation, surveillance reports and follow-up systems for workers exposed to or infected with COVID-19.[12][19][29][30]
• Track surgical-site infection surveillance and documented response measures in hospitals undertaking surgery, using hospital surveillance data, ward registers, operation books and patient folders for clean-surgery wound infection monitoring.[17][27][31]
• Assess preparedness and practice through indicators for functional IPC programmes and focal persons, annual reports, guideline availability, triage and isolation arrangements, staff training, hand hygiene, personal protective equipment, cleaning, decontamination, waste management, water, sanitation and emergency power.[32][24][33][25][30][34][16][27]

Specified five-year performance targets include IPC focal persons in all public and private facilities, national IPC guidelines in all facilities, 90% of healthcare workers trained in standard and transmission-based precautions with updates at least every two years, hand-hygiene resources in 90% of facilities, 60% hand-hygiene adherence, and continuous availability of tracer personal protective equipment.[2][17]Monitoring frequencies range from monthly supply audits to quarterly facility assessments, biannual training and management-awareness reviews, and annual reporting or auditing.[25][30][34]

Baseline performance weaknesses justify the proposed system: the 2019 healthcare-associated infection surveillance score was 38%, national performance against IPC standards was 21%, reporting submission was low, and monitoring was often ad hoc.[10][35]A 2014 monitoring and evaluation guideline containing standards, indicators and checklist tools had not been finalised; the strategy proposes its implementation and routine integration.[35]

Costing & Financing

The framework seeks stronger domestic financing and resource mobilisation for infection prevention and control, but the supplied text provides no quantified budget, allocation, currency value, financing share, funding gap or economic assumption.[7][5][21][9]

• Advocate for adequate annual Ministry of Health allocations and a dedicated domestic IPC budget line at national and healthcare-facility levels.[5][21][9]
• Mobilise alternative financial or in-kind support from industry, private companies and external partners, while recording evidence of budget or external-resource allocations.[21][18][9]
• Reduce dependence on donor support, which is identified as a sustainability challenge for IPC programmes.[36][5]
• Strengthen resource planning for IPC supplies, equipment and logistics through standardised supply lists, needs quantification, stock tracking and IPC involvement in procurement decisions.[15][20]
• Recognise the national economic situation as an implementation risk, alongside unforeseen pandemics, Ministry of Health restructuring and population instability.[8][37]

Resource-intensive activities include workforce training, production and dissemination of guidance and communication materials, surveillance, laboratory support, technical assistance, supportive supervision, audits, facility infrastructure improvements, water, sanitation and hygiene measures, and procurement of IPC equipment and supplies.[12][19][15][26][20]The framework does not include procurement cost estimates for IPC supplies and equipment.[15]