Infection prevention and control in Indonesian hospitals: identification of strengths, gaps, and challenges

Indri Rooslamiati Supriadi*, Cynthia Haanappel, Leli Saptawati, Nani H. Widodo, Gortap Sitohang, Yuslely Usman, Ida Bagus Anom, Ratih Dian Saraswati, Michal Heger, Pieter A. Doevendans, Hindra Irawan Satari, Anne Voor in 't holt, Juliette Severin

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background
Infection prevention and control (IPC) in hospitals is key to safe patient care. There is currently no data regarding the implementation of IPC in hospitals in Indonesia. The aim of this study was to assess the existing IPC level in a nationwide survey, using the World Health Organization (WHO) IPC assessment framework tool (IPCAF), and to identify strengths, gaps, and challenges.

Methods
A cross-sectional study was conducted from July to November 2021. Of all general hospitals in Indonesia, 20% (N = 475) were selected using stratified random sampling based on class (A, B, C and D; class D with a maximum of 50 beds and class A with ≥ 250 beds) and region. The IPCAF was translated into Indonesian and tested in four hospitals. Questions were added regarding challenges in the implementation of IPC. Quantitative IPCAF scores are reported as median (minimum–maximum). IPC levels were calculated according to WHO tools.

Results
In total, 355 hospitals (74.7%) participated in this study. The overall median IPCAF score was 620.0 (535.0–687.5). The level of IPC was mostly assessed as advanced (56.9% of hospitals), followed by intermediate (35.8%), basic (7.0%) and inadequate (0.3%). In the eastern region of the country, the majority of hospitals scored intermediate level. Of the eight core components, the one with the highest score was IPC guidelines. Almost all hospitals had guidelines on the most important topics, including hand hygiene. Core components with the lowest score were surveillance of healthcare-associated infections (HAIs), education and training, and multimodal strategies. Although > 90% of hospitals indicated that surveillance of HAIs was performed, 57.2% reported no availability of adequate microbiology laboratory capacity to support HAIs surveillance. The most frequently reported challenges in the implementation of IPC were communication with the management of the hospitals, followed by the unavailability of antimicrobial susceptibility testing results and insufficient staffing of full-time IPC nurses.

Conclusion
The IPC level in the majority of Indonesian hospitals was assessed as advanced, but there was no even distribution over the country. The IPCAF in combination with interviews identified several priority areas for interventions to improve IPC in Indonesian hospitals.
Original languageEnglish
Article number6
JournalAntimicrobial Resistance and Infection Control
Volume12
Issue number1
DOIs
Publication statusPublished - 3 Feb 2023

Bibliographical note

Funding Information:
This project was supported by The Indonesian Endowment Fund for Education. The funder had no role on the design of the study, in data collection, analysis, interpretation, or writing and approval of the manuscript.

Funding Information:
We thank the Indonesian Endowment Fund for Education (LPDP) for the funding. We acknowledge the input and support from the Ministry of Health of Indonesia and WHO representatives for Indonesia. We would like to sincerely thank all hospitals and IPC committees/teams who participated in the survey and interviews.

Publisher Copyright:
© 2023, The Author(s).

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