Claire is a graduate of the University of Glasgow with a post-grad Diploma in infection prevention and control (IPC) and a MSc in medical sciences (travel medicine). In 2023 she was awarded a Doctor of Science for impact in the areas of IPC, water, sanitation and hygiene and patient and health worker safety by Glasgow Caledonian University. She is also a member of the Royal College of Physicians and Surgeons (Glasgow) and a nurse by background. She has worked in global health since 2008 and with SHIP on a variety of publications since 2016.
Infection Prevention and Control (IPC) is a practical, evidence-based approach to prevent avoidable infections in health care settings, including those caused by anti-microbial resistant germs.
You might think this seems straightforward and clear, so why the blog?!
Well, sometimes people can think that IPC is just personal protection equipment (PPE) such as gloves and aprons. The COVID-19 pandemic further confounded this and led to some confusion for sure, but a SHIP publication led by Lucy Gozdzielewska, was one way the IPC community continued to help people understand the importance of hand hygiene as one IPC measure in preventing community transmission or acquisition of novel coronavirus or influenza infections.
For a number of years the SHIP team has addressed a range of topics that have influenced the global understanding of and commitment to IPC – I have been excited to be involved in some of these, including:
- Price L., MacDonald J., Melone L., Howe T., Flowers P, Currie K, Curran E, Ness V, Waddell D., Manoukian S., McFarland A., Kilpatrick C., et al. (2018) Effectiveness of multi-centre infection prevention and control interventions in high income and upper-middle income countries: a systematic review. Lancet Infectious Diseases 18(5):E159-171
- Price L., Melone L., McLarnon N., Bunyan D., Kilpatrick C., et al. (2018) A systematic review to evaluate the evidence base for the World Health Organization’s adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers. American Journal of Infection Control 46(7):814–823
Importantly, the first publications in support of the first ever WHO IPC guidelines on the core components of IPC programmes involved the SHIP team and were issued in 2016 and 2017. They outlined what these eight core components consist of, to achieve a successful IPC programme based on the evidence:
- MacDonald, J., Price, L., Melone, L., Howe, T., Currie, K., Flowers, P., Curran, E., Manoukian, S., Ness, V., Reilly, J., Allegranzi, B., Allen, T., Kilpatrick, C., Storr, J., & Twyman, A. (2016). A systematic literature review on the core components for national infection prevention and control programmes. Journal of Infection Prevention, 17(1S), S39
- Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, Price L, Egger M, Grayson ML, Kelley E, Allegranzi B; WHO Guidelines Development Group. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control. 2017 Jan 10;6:6.
And again in 2023, the SHIP team published: Effectiveness of national and subnational interventions for prevention and control of health-care-associated infections in acute hospitals in high-income and upper-middle-income counties: a systematic review update to keep progressing this agenda.
But what does all this mean for IPC at the global level?
It means that in recent years steps have been taken to highlight the role of this specialty across all countries, however, gaps remain. Ensuring all countries, wherever they are, whatever their income level are committed to progressing safe, quality care, and protection through IPC is not yet being achieved – this has been acknowledged through WHO global reports; the latest report being in 2022, with another being prepared now.
Moving on to the current global status of IPC in order to aim to address the gaps, a ‘resolution’ was presented and adopted by consensus at the Seventy-fifth World Health Assembly (WHA). This resolution included 13 calls to Member States (those countries recognised by the United Nations) for improving IPC at the national, subnational and facility levels, in line with the WHO recommended core components for IPC programmes. It also requested the WHO Director-General (DG) to develop a global strategy on IPC (GSIPC), a global action plan, and a monitoring framework in consultation with Member States and regional economic integration organizations. The subsequent GSIPC was launched by the WHO IPC unit on behalf of the DG, and is country- and stakeholder-driven, with a focus on IPC in any setting where health care is delivered across the continuum of the health system.
What is the WHA?
It is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by an Executive Board, which also includes Member States. The main functions of the WHA are to determine the policies of the WHO, supervise financial policies, and review and approve the proposed programme budget. It is held annually in Geneva, Switzerland and essentially is THE decision making body for WHO activities and all that is global health – the WHA has the final say on WHO’s priorities.
What is a resolution?
Each WHA typically considers scores of agenda items from the immediate to the long term, the operational to the strategic. The agenda in any Assembly is vast and diverse. And, as noted, in 2022 the agenda included many, what are called, ‘resolutions’ including one on IPC; a document, which with inputs from supporting Member States outlined the necessary actions to ensure IPC is truly global. Once a resolution is presented within the WHA agenda, and then approved by all Member States, the work must go forward. Discussions on agenda resolutions can begin weeks, or even months, in advance of the WHA. Negotiations often continue even in the final days of the Assembly and into late in the night.
So what now for the WHO GIPCS and for all countries?
In 2024, the WHO Global action plan and monitoring framework for IPC (2024-2030) was also approved, this time at the 77th WHA. It provides clear actions, indicators, and targets to support Member States in improving national- and facility-level IPC actions.
Going forward, this means:
- That indicators and targets should be met by all countries, such as:
- Proportion of health care facilities with adequate dedicated budget for IPC (to fund the IPC programme and team and the annual action plan, including equipment for IPC practices) – increase of the proportion of health care facilities with adequate dedicated budget for IPC to: 30% by 2026, 50% by 2028, >80% by 2030
- Percentage of WHO’s minimum requirements for IPC met at the national level – increase in the percentage of WHO’s minimum requirements for IPC met at the national level to: 50% by 2026, 75% by 2028, >90% by 2030
- Proportion of tertiary/secondary health care facilities having a surveillance system for HAIs and related AMR, including early warning to detect epidemic- and pandemic-prone pathogens – increase of proportion of tertiary/secondary health care facilities having a surveillance system for HAIs and related AMR to: 30% by 2026, 50% by 2028, >80% by 2030
- SHIP can continue to influence the IPC agenda. The evidence and research agendas must prevail to support country and healthcare facility actions.
- And finally, I hope it means that there will be greater understanding of what the IPC specialty truly is and of its importance for all.
I look forward to more outputs from the SHIP team and to my collaborations with them; as a nurse I am sure that at the start of my career I never imagined I would have such amazing opportunities to be involved in ensuring IPC is recognised and acted upon across all countries of the world.
To find out more about the SHIP team, head on to the GCU website, read the rest of our blogs and follow us on Twitter @SHIPGCU