Safety of patients and healthcare professionals at heart of second national Infection Prevention and Control action plan

Infection Prevention and Control (IPC), the evidence-based approach to protecting patients and healthcare workers from avoidable infections, is universally recognized as one of the cornerstones of a safe and effective health care delivery system. Thorough implementation of IPC practices not only reduces the risks of hospital-acquired infections (HAIs), it also restricts the spread of antimicrobial resistance (AMR), which is emerging as a global health threat.

Following the successful implementation of its first IPC National Action Plan (NAP), which was developed with the support of WHO, the Ministry of Health and Wellness (MOHW) recently initiated the development of its second NAP, an ambitious document that aims to scale up the country’s IPC activities over the next five years, during a workshop held in the last week of August 2024.

COVID-19 had the merit of helping to put IPC on the health agenda in Mauritius by raising awareness about its importance among stakeholders and decision-makers. Throughout the pandemic, WHO Mauritius worked with the Ministry of Health and Wellness (MOHW) to bolster the country’s IPC capabilities, via various trainings on IPC guidelines and standards, regular IPC assessments of the country’s regional hospitals and key health facilities, and by financing the supply of personal protective equipment, washbasins, medical elbow taps and, most recently,  the refurbishing or construction of  isolation wards at Sir Seewoosagur Ramgoolam National Hospital, Dr AG Jeetoo Hospital, Victoria Hospital and Jawaharlal Nehru Hospital.  

As Dr Dooshanveer Nuckchady, infectious disease specialist and IPC focal point, explains, the scope of the second NAP will be broader than the first one. “We succeeded in completing two thirds of the first NAP on IPC which expired at the beginning of 2024. Now we want to continue with the same momentum and push forward. Due to the circumstances, the previous NAP was shorter (two years) and a bit COVID-centric; this time we want to do something more robust and complete.”

A WHO-led assessment was conducted in 2022 and 2023 to monitor the progress of the implementation of the national guidelines on IPC. Three of the five regional hospitals were scored at Intermediate Level of IPC implementation, while strong progress was noted in IPC training. However, refresher and bedside training sessions and innovative training methods need to be considered for enhanced knowledge management and transfer. An assessment of IPC practices conducted in Rodrigues revealed significant improvements in multiple areas of IPC in 2023 compared to the previous year. HAIs represent a major health burden for countries across the world. The estimated global rate of HAIs for low- and middle-income countries is 15%. In Mauritius, the incidence of HAIs and SSIs increased from 4.9 and 8.2 per 100 patients in 1993, respectively, to 18 and 17 per 100 patients in 2018. The mortality rate was almost four times higher in patients with HAIs and SSIs compared to those who did not suffer from these infections.

“We really want to reduce the incidence and prevalence of these types of infections. First, we need to know how many infections are occurring, as well as where and why they’re occurring. Then we can put in place bundles of care and multimodal strategies to train people, purchase the right equipment and set up the necessary infrastructure to reduce these infections,” says Dr Nuckchady.

HAIs also result in longer hospital stays, long-term disabilities, higher AMR rates and additional financial burdens on patients and health systems. To tackle issues effectively, the authorities are opting for an evidence-based approach underpinned by strengthened surveillance and monitoring.

Professor Babacar Ndoye, the WHO consultant who led the workshop, agrees that the IPC practices are well established. “I’ve been impressed by what I’ve seen in Mauritius, especially in terms of training and the deployment of resources. Globally, various pandemics and COVID-19, in particular, have contributed to a high level of awareness around IPC.”

As an IPC nurse, Tina Soobhug’s responsibilities at Jawaharlal Nehru Hospital in Rose-Belle involve monitoring the nursing staff to ensure that they are adhering to the WHO’s IPC guidelines. She has observed a gradual shift in attitudes towards IPC since the implementation of the first NAP. “Although there is still some resistance, behaviours are changing, but this requires continuous on-the-job training and awareness raising which is something that the second NAP will focus on,” she notes. “Hospital infrastructure also needs to be adapted to IPC guidelines.”

While this second National Action Plan is being developed, work on IPC continues. In September 2024, for example, WHO Mauritius and the MOHW conducted a weeklong training on sterilization practices and the organization of Central Sterile Services Departments to ensure that the health workforce is increasingly equipped to implement IPC guidelines as well as the forthcoming action plan.  This training followed a thorough assessment of sterilization practices in Mauritius conducted in July by a WHO expert.

As the WR, Dr Anne Ancia, highlighted at the opening of the IPC NAP workshop, IPC is an essential pre-requisite for achieving quality health care. With the development of its second NAP, Mauritius is putting in place the right conditions to prevent and control infections, and to protect the health of patients and health care workers alike.