IPC Project in Sierra Leone
Goal: To strengthening Infection Prevention & Control Programs in a Cross-section of CHASL-member Hospitals in Sierra Leone
Country: Sierra Leone
Implementing partners: Christian Health Association of Sierra Leone
Infection Prevention and Control (IPC) occupy a unique position in the field of patient safety and quality universal health coverage since it is relevant to health workers and patients at every single healthcare encounter. To reduce the escalating number of Coronavirus disease 2019 (COVID-19) cases, globally, WHO recommends strict adherence to IPC measures to minimize risk of community and healthcare-associated transmission of COVID-19. Having dedicated focal persons capacitated with the requisite knowledge and skills on IPC is critical in enhancing compliance and safe practices within their health facilities.
Follow up from recommendations made from a Knowledge Attitude and Practice assessment of six (6) Christian Health Association of Sierra Leone (CHASL) member hospitals in one of EPN projects in Sierra Leone, EPN through Action Medeor supported the Christian Health Association of Sierra Leone to conduct a training of health facility staff as IPC Champions on IPC and basic COVID-19 prevention. The training is part of other activities of the IPC project currently implemented in Sierra Leone.
May 2020: Training: Capacity Building
In May 2020, a total of 18 participants were trained in a 2-phase training conducted between 11th and 15th in Bo, in the Southern region and in Makeni in the Northern region of Sierra Leone respectively. The training broadly aimed to train IPC champions and members on IPC and basic COVID-19 prevention, so as to capacitate them as trainers to cascade knowledge and skills within their facilities. The participants were mostly nurses (matrons, State Registered Nurses-SRN, State Enrolled Community Health Nurses (SECHN) and Laboratory Technicians. They were drawn from 6 selected CHASL member hospitals with each facility represented by three staff members.
The training was conducted at regional levels so that participants needed not to travel out of their regions given the travel restrictions placed to mitigate the spread of the COVID -19 virus. Technical assistant was sought from the National Infection Prevention Unit (NIPCU) of the Ministry of Health and Sanitation (MOHS), Sierra Leone while the Christian Health Association of Sierra Leone (CHASL) administered the course. Through this training, the participants are expected to also ensure that they are able to prevent transmission of infection between staff, patients, and visitors, facilitate the investigation of all cases of healthcare-associated infections and COVID-19 and monitor IPC measures adherence and provide timely feedback for action.
The training methodology included the use of discussions, interactive PowerPoint presentations, videos, case studies, scenarios and practical demonstrations. Pre and post-course assessments and feedback forms were administered at the start and end of the course.
Some of the areas covered in the training were;
- The novel coronavirus (COVID-19), its epidemiology, risk factors, definitions and symptomology
- Chain of transmission and overview of standard precautions
- IPC Standard Operating Procedures for COVID-19
- Rational use of personal protective equipment
- Transmission-based precaution
- Hand hygiene with demonstration and practical sessions on handwashing
- Injection safety
- IPC and Healthcare-Associated Infection (HAIs)
- Triage and Screening
- PPE/Cough Etiquette/Patient Placement
- Waste Management and sharp safety, environmental cleaning, and reprocessing of reusable medical devices
- Demonstrations and practical sessions- Appropriate use of PPE based on risk assessment, donning, and Doffing of PPEs
Post-test assessment of the training showed that participants’ knowledge improved with over 90% of the participants scoring over 50% (which is the pass mark) in the assessment from 50% in the pre-test.
The participants appreciated the different training sessions as relevant, educative and helpful. They also expressed their appreciation of the training commenting on its timeliness, relevance, and rich resources, and committing themselves to serve as agents of change within their institutions. This training also built the capacity of participants to serve as trainers which would enable them to cascade in their respective health facilities.
Testimonies
“The training was really good and educative more especially I now have a clearer knowledge on standard precautions. We pray that you continue with similar training. Thank you.” Participant, Holy Spirit Catholic Hospital.
“This training is very useful I learnt a lot during this training, like how to properly wash my hands and put on and take off my PPEs. I want to say thank you and appreciation to both the facilitators and organizers of this training” Our other work colleagues should benefit from this training”. Participant, Mercy UMC Hospital BO.
“This training brings to mind things learnt back in training school and is quite refreshing. It is very useful. I will use this knowledge gained to pass on to my midwifery students, it is also helpful for me, my family and community to curb the spread of infection during this pandemic. I have leant a lot”, Participant, School of Midwifery.
“This training has brought to light some of the gaps and poor IPC practices. I have leant from them. I am now a change agent and will use this knowledge and skills to work on my practice and strengthen the current IPC structures within my facility”, Participant, Serabu Catholic Hospital,
“This training is superb, rich contents and resource materials, good facilitation and organization, conducive environment for learning. I am opportune to be part of this training. Thank you and God bless. Kindly share training materials with us to enable us cascade this training”. Participant, Kamakwie Wesleyan Hospital.
“The training was very timely and useful at this time of COVID 19. The 5 moments of WHO has been clarified and it’s really a refresher training. The facilitators were very good and topics taught were clear and well understood”, Participant, Bo training site.
” It was very important to take part in this training as it helped refreshed my memories, especially to help me prepare for the COVID fight. We would help others that were not here with us to know what steps to take to prevent infections”, Participants, Bo training site.
Conclusions and Way forward
The CHASL health coordinator in her closing remarks advised the participants to ensure IPC committees are set and functional with them acting as IPC champions, cascade the training to all staff within their facilities, prepare and share action plans, and implement actions to ensure IPC practices and quality of care in their various facilities are improved. She also thanked NIPCU/MoHS for effective facilitation and encouraged the participants to debrief management on the training and expectations post-training. NIPCU representative thanked the organizers for their initiative and emphasized monitoring and supervision of the facilities.
August 2020: Supervisory visits
As part of key activities under this project, in August 2020, six hospitals in Sierra Leone were targeted in a six-day supportive supervision visit carried out by the programs team of the CHASL Secretariat. The objective of the visit was to see first-hand implementation progress per facility, observe IPC practice, learn about their success, challenges faced and ways of addressing these challenges and provide onsite technical support.A structured questionnaire/IPC monitoring tool divided into section with key activities developed with technical support from EPN, Action Medeor and inputs from the CHASL Secretariat was used.
The team was able to meet the objectives of the supportive supervisory visit. Facilities were appreciative of the visit and see it as a means of motivating them to do more and improve on their lapses. Commitments were made by facilities to work harder and recommendation of such regular visit be undertaken by the Secretariat.
IPC structures and activities are generally taking shape within facilities. Facilities have grasped the concept and importance of adherence to IPC practices. In facilities were the administrators and senior managers such as the matron is actively involved progress is easily achieved. More support is needed from the senior management of the hospital to the focal point person who is to act as the champion.
August 2021 – Supervisory visits
From 23 to 28 August 2021, EPN project lead Austine Opiata together with the project staff from CHASL made another monitoring and supervisory visits to various health facilities targeted for the project activities. This visit was intended to track the progress of activities and identify areas of improvement. Findings indicate that progress is being made in most facilities. Despite the effects of Covid-19, the facilities are putting efforts to sustain and strengthen the different measures that have been initiated.
Austine (3rd from right) meeting staff from Serabu Mission Hospital during the health facility visits. The hospital management committed to working with the IPC committee even after the end of the project.
Meeting with health facility workers to assess the progress of project activities towards improving #IPC standards