Assessment of infection prevention and control in public hospitals in the post war Tigray region of Ethiopia using the WHO Infection Prevention and Control Assessment Framework (IPCAF)

BACKGROUND: Strengthening infection prevention and control (IPC) is crucial for mitigating the risks of infections and antimicrobial resistance in healthcare facilities. The conflict in Tigray has had serious repercussions on the health system. This study aimed to assess the implementation of the IPC core components of (CC) public health facilities in post-war Tigray, Ethiopia, using the World Health Organization (WHO) IPC Assessment Framework (IPCAF) and hand hygiene self-assessment framework (HHSAF) standard tools. METHODS: A cross-sectional study was conducted across 35 public health facilities comprising referral, general, and primary hospitals in Tigray state from June to July 2024. Data were collected by interviews of the IPC focal or managers at the accessible hospitals, using standardized WHO IPCAF and HHSAF tools. Descriptive statistics, including mean, median, interquartile range (IQR) and standard deviation, were utilized to summarize the data. Pearson correlation analysis was performed to examine the relationship between IPCAF and HHSAF scores. An independent t-test was employed to compare mean IPCAF scores by type of healthcare facility. RESULTS: From a total of 35 eligible healthcare facilities invited, 33 participated in the survey, resulting in a 94% response rate. The mean age of respondents was 36 years (SD = 8), with an average of 10 service years (SD = 7). Most respondents were IPC focal persons (48.5%), followed by chief executive officers (27.3%). The median IPCAF score was 348 (IQR: 258-439), indicating a basic IPC level. Three facilities (9%) exhibited an inadequate IPC level, which means scores below 200. Twenty-one facilities (63.6%) demonstrated basic IPC levels, 8 facilities (24.2%) had intermediate IPC levels and only 1 facility (3%) achieved an advanced IPC level. A statistically significant positive correlation was identified between IPCAF and HHSAF scores (r = 0.765, p < 0.001). CONCLUSIONS: The levels of implementation of the WHO CC in post-war health facilities in Tigray were found to be unsatisfactory, with limitations evident across all zones and types of facilities. This situation increases the risk of healthcare-associated infections for healthcare personnel, patients, and visitors. A significant positive correlation was observed between IPCAF and HHSAF scores. Addressing the identified gaps through enhancements of IPC core components and capacity building is essential for preventing healthcare-associated infections. Longitudinal studies to monitor IPC implementations are recommended for ongoing assessment and improvement.