Applying the who twinning partnerships for improvement (TPI) 6-step model to drive infection prevention and control (IPC) during the COVID-19 pandemic: setting objectives and delivering activities to achieve outcomes during crisis

ABSTRACT

Introduction: Implementation of a validated twinning partnership approach with clear objectives while maintaining flexibility of inputs and activities during a pandemic, can yield improvements in IPC as a cornerstone of quality of care. Objectives: To apply the World Health Organisation (WHO) TPI 6-step model to guide twinning partners through a systematic process to drive quality of care in health settings. Methods: A partnership between Macau Health Bureau and Timor-Leste Cabinet of Quality Assurance in Health was initiated, guided by WHO's TPI objectives and 6-step model. The 2-year TPI included partnership formation, a situational analysis, co-developing a quality improvement (QI) action plan, joint implementation of action and bi-directional learning. IPC at the national, subnational and facility level was as prioritized by the partnership. Three Timor-Leste facilities were chosen for IPC improvements. The WHO IPC assessment framework at the facility level (IPCAF) was used to gather data at baseline and at intervals over the 2-year TPI. Results: Based on the IPCAF results, the action plan focused on 4 areas 1) establishing IPC team in each of the facilities;2) training and capacity building in standard precautions;3) facility infrastructure improvements (including water sanitation and hygiene);and 4) hand hygiene advocacy. The structured TPI methodology and direct partner support resulted in clean water being consistently available at the 3 facilities and capacity building in standard precautions, transmission-based precautions and PPE. COVID-19 realities required adaptation and re-scheduled infrastructure and training activities. Conclusion: Implementation of the partnership plan using the structured TPI approach catalyzed IPC improvements at the three facilities and beyond. Although COVID-19 required adjustment of activities, a robust QI plan supported innovation, flexibility and commitment. Lessons from the experience can be applied to other twinning partnerships.