ABSTRACT
Background: Monitoring uptake of infection prevention and control (IPC) interventions is critical for the targeted and rational use of limited resources. A national facility readiness assessment conducted in August 2020 provided key information for targeted interventions to strengthen priority IPC areas. We assessed the level of COVID-19 preparedness in the facilities, identified priority COVID-19 IPC gaps, and generated a baseline report to further guide IPC investments at all levels. Methods: The Kenya Ministry of Health in collaboration with the CDC and International Training and Education Center for Health adapted a WHO Facility Readiness Assessment tool to include COVID-19–specific areas. In August 2020, data were collected using tablets through an Android-based electronic platform and were analyzed using descriptive statistics. Assessments were conducted in public, private, and faith-based health facilities nationally after 4 months of preparedness and investment in the healthcare system. Results: We assessed 684 facilities of the targeted 844 (81%). Overall facility readiness in Kenya was rated above average (61%), and the performance score significantly increased with the Kenya Essential Package for Health level, with level 5 and 6 facilities scoring an average of 83% and 79% respectively. Of the assessed facilities, 82% had an appointed IPC coordinator. Only 14% of the facilities had all the required guidelines, policies, and the appropriate COVID-19 case definitions. 67% of the facilities had updated supply inventories for past week. Only 50% of the facilities had adequate supplies of N95 masks. The assessment revealed that 52% of healthcare facilities had trained their healthcare workforce;morticians were the least trained (only 17% of facilities). Moreover, 41% of the facilities had clear work plans for monitoring healthcare workers exposures to COVID-19, but only 33% of the facilities had policies on the management of infected healthcare workers. Conclusions: The findings provided critical information for stakeholders at all levels to be used for policy decisions, to prioritize key intervention areas in leadership and governance of facility IPC programs, for guideline development, and for capacity building and targeted investment in IPC to improve COVID-19 facility preparedness.Funding: NoneDisclosures: None
ABSTRACT
Background: The COVID-19 pandemic disrupted essential health services (EHS) delivery worldwide;however, there are limited data for healthcare facility (HCF)–level EHS disruptions in low- and middle-income countries. We surveyed HCFs in 3 counties in Kenya to understand the extent of and reasons for EHS disruptions occurring during February 2020–May 2021. Methods: We included 3 counties in Kenya with high burden of COVID-19 at the time of study initiation. Stratified sampling of HCFs occurred by HCF level. HCF administrators were interviewed to collect information on types of EHS disruptions that occurred and reasons for disruptions, including those related to infection prevention and control (IPC). Analyses included descriptive statistics with proportions for categorical variables and median with interquartile range (IQR) for continuous variables. Results: In total, 59 HCFs in Kenya provided complete data. All 59 HCFs (100%) reported EHS disruptions due to COVID-19. Among all HCFs, limiting patient volumes was the most common disruption reported (97%), while 56% of HCFs reduced staffing of EHS and 52% suspended EHS. Median duration of disruptions ranged from 7 weeks (IQR, 0–15) for inpatient ward closures to 25 weeks (IQR, 14–37) for limiting patient volumes accessing EHS. Among HCFs that reported disruptions, the most cited reason (ie, 95% of HCFs) was fewer patients receiving services. The most common IPC-related reason for disruption was diversion of resources to accommodate physical distancing measures (76%) followed by COVID-19 outbreaks among patients or staff (34%);staff shortages due to COVID-19 illness (25%) or perceived infection risk (19%);and lack of adequate personal protective equipment (20%). Conclusions: Most HCFs reported disruptions to EHS during the pandemic, including many that were related to IPC. Some disruptions may be mitigated by strengthening IPC infrastructure and practices, including protecting healthcare personnel to prevent staffing shortages.Funding: NoneDisclosures: None
ABSTRACT
The coronavirus disease pandemic has highlighted the need to establish and maintain strong infection prevention and control (IPC) practices, not only to prevent healthcare-associated transmission of SARS-CoV-2 to healthcare workers and patients but also to prevent disruptions of essential healthcare services. In East Africa, where basic IPC capacity in healthcare facilities is limited, the US Centers for Disease Control and Prevention (CDC) supported rapid IPC capacity building in healthcare facilities in 4 target countries: Tanzania, Ethiopia, Kenya, and Uganda. CDC supported IPC capacity-building initiatives at the healthcare facility and national levels according to each country's specific needs, priorities, available resources, and existing IPC capacity and systems. In addition, CDC established a multicountry learning network to strengthen hospital level IPC, with an emphasis on peer-to-peer learning. We present an overview of the key strategies used to strengthen IPC in these countries and lessons learned from implementation.