In responding to the “on-ground” challenges in the management of COVID-19, Member States (MS) upgraded their health systems, took emergent decisions, and adopted a” whole-of-government” and “whole-of-society” approach to cope with different stages of the pandemic.
As the pandemic evolved, new variants of the SARS-CoV-2 virus emerged and stretched health care system capacities with every successive pandemic wave. Resultantly, the infection prevention and control (IPC) in health care facilities assumed great importance as a strategy to prevent and control the spread of infection, among patients and for protection of health care workers (HCW).
Challenges experienced by Member States in 2021
- There was an absence of IPC programmes in few MS and implementation of standardized IPC measures at various levels of health care systems. This impacted operational readiness and surge capacity for emergency response in these countries.
- A range of technical uncertainties were noted, especially related to the mode of transmission and associated recommendations for masks.
- An increasing number of HCW infections were seen in many MS, following massive surges in infection, increase in workload and a lack of manpower and trained HCWs.
- Limited data on HCW infections made it difficult for health systems to undertake efficient monitoring of IPC interventions.
- Personal Protective Equipment (PPE) shortages were seen despite making PPE widely available through WHO, other partners and national procurement systems by MS, including strengthening of in-country production.
Response of Member States
Member States undertook several measures to strengthen IPC at health care facilities. They adapted their pre-pandemic guidelines to the pandemic needs. Assessments of existing practices and facilities were carried out to better understand the IPC standards being followed. These were compared with requirements for pandemic response. Readiness assessments were conducted and so were health care facility assessments, followed by optimizing interventions to fill the gaps.
Based on evidence generated through these assessments, IPC practices were strengthened at acute COVID-19 health care facilities using national guidelines. Thereafter, surveillance of HCW infection was put in place.
WHO support
- In addition to providing technical guidance, the IPC pillar of IMST through Country Offices, provided support to adopt the guidance to suit the local context.
- To facilitate response to the rapidly evolving pandemic, training packages and guidance documents were made available by WHO (including virtual trainings) and trainings were organized for HCWs.
- PPE was made widely available nationally through WHO, other partners and by MS themselves (including strengthening in-country production).
- Home-based care assumed significant part of patient care for mild and moderate cases, as the Delta surge overwhelmed health care facilities. Accordingly, evidence-based IPC guidance for home-based care was issued from WHO and adapted at national and sub-national level by all MS.
Priorities for IPC pillar in 2022
Learning from the experience of pandemic response in 2021 and recognizing the continuing uncertainties of the pandemic trajectory, the IPC pillar identified priority actions for 2022, in collaboration with Health System Development (HSD) and Communicable Disease Surveillance (CDS) departments at the WHO’s regional office for South East Asia.
Some of these priorities include the development and regional/national adaptation of global IPC guidance (strategy and/or guidelines) with focus on operational readiness and emergency response. As part of training and capacity building there is also a renewed focus on strengthening IPC in primary health care with the view to improve health security.
Countries are being guided on continuing with their procurement and stockpiling of essential PPE and related materials for emergency response to avoid shortages and gaps in critical care. Technical support for implementation of WHO guidelines of IPC in line with country needs, context and priorities are envisaged on year-round basis.
There is now discussion around ways in which the Regional Office and WHO Country Offices (WCO) can benefit at both regional and national levels from global initiatives such as the Global Strategy for IPC that has been requested by several MS and is now being finalized; an research and development (R&D) blueprint for research priorities on IPC; global IPC surveys that are being coordinated by WHO headquarters; health care waste management guidance; and a roster of waste management consultants that is likely to get identified by WHO headquarters; in addition to best practices in the WHO’s SEA region and beyond.
For example, WCO Nepal is taking the lead in continuing advocacy as fatigue sets in and Cox’s Bazaar has systematically developed and rolled out an IPC programme as part of its COVID-19 response. There is continued contribution to and collaboration with health system strengthening and regional IPC and WASH focal points, WHO headquarter counterparts and WCOs and partners.
Similar efforts are likely to take shape for other MS in the coming months in an effort to strengthen the IPC pillar in the WHO SEA Region.