Infection Prevention and Control for COVID-19 response in the Rohingya refugee camps: an Intra-Action Review (preprint)

ABSTRACT

Introduction: Infection Prevention and Control (IPC) is key in the control of COVID-19 pandemic and one of the pillars considered in the WHO COVID-19 Strategic Preparedness and Response Plan 2020. We conducted an Intra-Action Review (IAR) of IPC response efforts to COVID-19 pandemic in Rohingya refugee camps in Cox’s Bazar, Bangladesh to identify best practices, challenges, and recommendations for improvement of the current and future responses.Methods: Two meetings were conducted with a total of 54 participants purposively selected from different organizations and agencies that had been involved in frontline implementation of IPC in Cox’s Bazar district. We used the IPC trigger questions from the WHO country COVID-19 IAR trigger question database to guide the discussions. Meetings notes and transcripts were analysed manually using content analysis and results presented in text and quotes.Results: Best practices included assessments, response plan, working group, trainings, early case identification and isolation, hand hygiene in HFs, monitoring and feedback, general masking in HFs, supportive supervision, design, infrastructure and environmental controls in Severe Acute Respiratory Infection Isolation and Treatment Centres (SARI ITCs) and HFs and waste management. Challenges included frequent breakdown of incinerators, limited PPE supply, inconsistent adherence to IPC, lack of working uniforms and lack of culture- and gender adapted work uniforms and Personal Protective Equipment (PPE). Recommendations were institutionalization of IPC, establishment of IPC monitoring mechanisms in all HCFs, strengthening IPC education and training and public health and social measures in communities. Conclusion:  IPC monitoring and continuous training provides critical support in promoting consistent and adaptive IPC implementation. Response to pandemic crisis combined with concurrent emergencies, like a protracted displacement with many, diverse actors, can only be successful with highly coordinated planning, leadership, resource mobilization and close supervision.