WHO-MOOC_COVID-19 IPC_Module1_A.

Simniceanu

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[Slide #1]

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[Slide #2] Hi, my name is Alice Simniceanu and I work in Infection Prevention and Control at the World
Health Organization. Today's course will focus on infection prevention and control for COVID-19. The
course will provide information on what facilities should be doing to be prepared to respond to a case of
an emerging respiratory virus such as the COVID-19 virus, how to identify a case and how to properly
implement IPC measures to ensure that there is no further transmission to health care workers, patients
and others in the health care facility. The training is intended for health care workers and public health
professionals, as it is focused on infection prevention and control.

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[Slide #3] It contains three modules - the first as I mentioned will deal with preparedness, readiness and
infection prevention and control. The second will go into a little bit more detail about the novel corona
virus. Its epidemiology, risk factors and signs and symptoms, and module three will go into the standard
precautions, transmission based precautions and the WHO recommendations for COVID-19.

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[Slide #4] We're going to start with module one. This is preparedness, readiness and infection
prevention and control.

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[Slide #5] The learning objectives of this module are to define infection prevention and control and its
role in the context of preparedness, readiness and response.

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[Slide #6] Preparedness for outbreaks is part of a larger process known as the principles of emergency
management. It begins with prevention and mitigation. These are strategies that can help a facility
prevent and reduce the impact of an emergency. The next step is preparedness and readiness. These are
actions that should take place before an emergency. And once the emergency happens there is
response. These are activities in reaction to a known or suspected event. After response we're going to
recovery. This is where facilities should evaluate the prevention, mitigation, preparedness and response
efforts. Facilities should seek to return back to normal and build back better, meaning they should learn
from their emergency response.
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[Slide #7] So what is preparedness in healthcare? This is the knowledge capacities and organizational
systems developed by governments response and recovery organizations, and communities and
individuals to effectively anticipate, respond to and recover from the impacts of likely imminent,
emerging or current emergencies. These actions will take place before an emergency and increase of
facilities ability to respond when the emergency occurs. This should happen at all levels - national,
regional and facility level.

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[Slide #8] So, why? Because preparedness is an integral part of health systems strengthening, it is crucial
to health emergency disaster risk management. So therefore inadequate IPC measures may lead to
transmission to patients, staff, visitors and within the community.

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[Slide #9] This is when infectious disease outbreaks can be a result of external and internal factors.
Many times healthcare is impacted as a result of a new pathogen, something that we have not seen
before or is new to the region. For example this has happened with merscov and ebola. Or it can be the
spread of an organism throughout multiple countries leading to an epidemic or pandemic. This means a
larger number of cases of an infectious disease. Hospitals that have not put adequate measures in place
to prevent and control infections may amplify or add to the epidemic by allowing transmissions to
patients, staff and visitors. These individuals who are potentially exposed in the hospital may increase
transmission within their communities, making the epidemic more difficult to control. So, infectious
disease emergencies tend to bring infection prevention control practices into the spotlight. Many
outbreaks in the past have revealed breakdowns in IPC practices. Even in institutions and countries that
we assumed to have had strong practices.

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[Slide #10] So what is readiness? This is the capacities in the systems that should be in place to enable a
rapid effective response in case of a health emergency disaster, and to be ready to aggressively contain
the event before further spread.

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[Slide #11] There are eight pillars of the public health response in readiness. The first is country level
coordination, planning and monitoring. The second risk communication and community engagement.
And then we go into the surveillance, epidemiologic investigation, rapid response and case investigation.
Next is the points of entry into the country or health facilities. The national laboratories, infection
prevention and control team and measures put in place by this team, the case management and the
operations support and logistics, including contingency plans and funding mechanisms.
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[Slide #12] These slides go into a little bit more detail about each of the pillars of readiness. So the first
one as I mentioned refers to the multi-sectoral and multi-partner coordination mechanisms that support
the preparedness and response. This is when you should be engaging with national authorities and key
partners to develop a country specific operational plan with estimated resource requirements for COVID
preparedness and response, or preferably adapt, existing pandemic preparedness plans such as an
influenza one if it exists. This is also when you should be conducting initial capacity assessments and risk
analysis including mapping of vulnerable populations. You should also be beginning to establish metrics
and monitoring as part of the evaluation systems that will assess the effectiveness and impact of these
planned measures.

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[Slide #13] The second goes into establishing an incident management team. So this is where you're
including rapid deployment of designated staff from national and partner organizations within a public
health emergency operations centre or equivalent if you have available. This is where you identify, train
and designate spokespeople. You engage with local donors and existing programs to mobilize resources
and capacities, to implement the operational plan. You should also be reviewing regulatory
requirements and legal basis of all potential public health measures. Here you also should be monitoring
the implementation of scoop based on key performance indicators in the SCOP and produce regular
situation reports.

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[Slide #14] The third part is where you should be conducting regular operational reviews to assess the
implementation success and assess the epidemiological situation and adjust operational plans as
necessary. Here you should be conducting after-action reviews in accordance with the IHR policies as
required. And in terms of the COVID outbreak this is where you should be learning from the existing
plans, systems and lesson learning exercises to inform future preparedness and response activities.

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[Slide #15] So what is infection prevention and control? Well IPC is a basic requirement for outbreak
preparedness and a critical element of readiness. It should be an ongoing activity undertaken by the
national programme and by the IPC focal points, IPC team and committee at the health care facility
level.

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[Slide #16] It is a scientific approach with practical solutions designed to prevent harm caused by
infections to patients and health care workers. It is grounded in principles of infectious disease,
epidemiology, social science and health systems strengthening, as well as rooted in patient safety and
health service quality.
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[Slide #17] So who is at risk of infection?

Well everyone.

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[Slide #18] Infection prevention and control measures can protect you as the health care worker, can
protect your patients, and protect your family and the community at large.

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[Slide #19] Some of the IPC goals and outbreak preparedness are to reduce transmission of health care
associated infections to enhance the safety of staff, patients and visitors, to enhance the ability of the
organization or the health facility to respond to an outbreak and to reduce the risk of the health care
facility from amplifying the outbreak.

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[Slide #20] The core components for effective IPC programs in all contexts is displayed here surrounded
by the multi-modal strategies. This figure provides a visual representation of the eight core components
of infection prevention and control, and highlights how the guideline recommendations interconnect
with each other. The outermost layer addresses the multi-modal strategies which are key to effective
implementation. An effective IPC programs must be based on the implementation of all core
components. If no IPC knowledge system, organization and resources are in place it is unlikely that a
country or health care facility is able to respond effectively to an outbreak.

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[Slide #21] Since 2017 WHO has made available the guidelines on core components of IPC programs at
the national and acute health care facility levels. These are a number of supporting documents and
implementation tools and in 2019 the minimum requirements for IPC core components were released
as the minimum measures that need to be in place at both the national and facility levels. These are just
the starting point on the journey to full implementation of the full requirements outlined in the core
components. Thus the minimum requirements represent the starting point for undertaking the journey
to build strong and effective IPC programmes. They should be in place for all countries and all healthcare
facilities to support further progress towards full implementation of the core components.

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[Slide #23] These slides go through some of the specifics of the minimum requirements of the core
components. Core component number one is that there is a functional IPC program in place at the
national level with at least one full time trained IPC focal point and a dedicated IPC budget. At the
facility level this means that for primary care there is one trained IPC link person, at the secondary care
level there is one trained IPC focal point two fifty beds with a dedicated time and budget, at the tertiary
care level this means that there is one full time trained IPC focal point for two-fifty beds with a
dedicated time and budget as well as a multi-disciplinary IPC committee and access to a microbiology
laboratory. Core component number two refers to the evidence based national guidelines that should
be in place at the national level adapted to the local context. And at the facility level these are SOPs at
least on the standard precautions and basics of transmission based precautions. At the secondary and
tertiary care level this means that there are SOPs not just on the basics and the transmission base
precautions but additionally also on surgery, prevention of endemic hospital-acquired infections and
occupational health.

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[Slide #24] Core component number three refers to the education and training. That there should be
national policies that all health care workers are trained in infection prevention and control, that there is
a national curriculum and that there is monitoring of this IPC training effectiveness. At the facility level
this includes IPC training for all clinical front-line staff and cleaners upon hire but also regularly annually
and in specific IPC training for IPC focal points. Core component number four refers to the national
technical group that is responsible for developing plans for healthcare associated infections surveillance
and IPC monitoring. At the facility level this means that hospital-acquired infections surveillance it is not
just a minimum requirement but should also follow the national plans. At the tertiary care level this
means active surveillance of hospital acquired infections and antimicrobial resistance, as well as
feedback as part of a core activity of the IPC program.

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[Slide #25] Core component number five refers to the multi-modal improvement strategies. These
should be implemented for IPC interventions at all levels. At the facility level in primary care the multi-
modal improvement strategies should be in place to implement priority IPC measures. These are hand
hygiene and injection safety decontamination of medical equipment and environmental cleaning. At the
secondary care level the implementation of all standard and transmission based precautions and for
triage. At the tertiary care level it includes all of those above as well as for specific types of health care
acquired infections according to the local risk and epidemiology. Core component number six refers to
the national technical group at the national level that is responsible for IPC monitoring, developing plans
and recommendations and indicators and systems training. At the facility level for primary care this
means monitoring of IPC indicators based on the IPC priorities. At the secondary and tertiary care level
this means a dedicated individual responsible for IPC monitoring and timely feedback, as well as having
hand hygiene as a priority indicator.

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[Slide #26] Core component number seven refers to the workload staffing and bed occupancy levels. At
the national level there should be plans in place for these. At the facility level there should be systems
for patient flow, triage and for the management of consultations. At bare minimum at the primary level
these should be in place to optimize staffing levels and facilities must undertake assessments of facility
appropriate staffing levels to determine what is appropriate for them. At the secondary and tertiary care
levels there should be systems in place to manage the use of space and establish standard bed capacity
for the facility. There should be no more than one patient per bed and at least one meter between the
edges of the beds. To optimize staffing levels facilities must undertake assessments of their appropriate
staffing levels. Core component number eight refers to the built environment, the materials and the
equipment necessary for IPC programs. At the facility level for patient care this refers to patient care
activities that should be undertaken in a clean and hygienic environment. Facilities should include
separate areas for sanitation activities, decontamination and reprocessing medical equipment and have
sufficient IPC supplies and equipment for providing IPC measures. At the secondary and tertiary care
level facilities should have sufficient single isolation rooms or the ability to cohort if appropriate.

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[Slide #27] What is the role of the IPC focal point, team or committee? As an IPC focal point your first
responsibility is your knowledge. You need to have a good understanding of IPC and the strategies
needed to reduce risks and be prepared for outbreak situations. This is acquired through face-to-face or
online courses which you can participate during your academic study, trainings or readings, with
experience research and networking. IPC requires continuous learning. At the healthcare facility level
IPC components that need to be in place are the infrastructure the policy the SOP development as well
as an assessment of its current state of IPC, its preparedness and readiness activities. At the IPC
committee level they should be participating in response and recovering activities, participate in
surveillance and monitoring of hospital-acquired infections or emerging threats, responsible for patient
management and education of healthcare workers, staff, and patients and visitors.

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[Slide #28] So now we have reached the end of module one. Thank you for listening. You can now
continue to module two where we will be diving into more corona virus specific information. Thank you.