How Afghanistan is Tackling Infection Control: An In-Depth Evaluation of Practices and Strategies

Abstract

Abstract Background: Infection prevention and control (IPC) practices have been recognized as the most effective strategy to reduce Healthcare-associated infections (HAIs). IPC programs also play a vital role in maintaining patient safety and quality of care. Very little data is available about IPC practices and their competence in Afghanistan. We assessed IPC practices in 15 government hospitals in Afghanistan to assess the strengths and weaknesses of their IPC programs. Methods: A cross-sectional assessment was conducted between July 2021 and June 2022 at 15 governmental hospitals in Afghanistan including 11 tertiary hospitals from Kabul, 3 regional hospitals from Herat, Kandahar, and Nangarhar respectively, and 1 provincial hospital from Laghaman which is the only secondary healthcare facility in this assessment. Two IPC experts from the ministry of public health, conducted hospital assessments. The World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) was used to assess the strengths and weaknesses of all healthcare facilities regarding IPC. Results: Of the 15 hospitals evaluated, most achieved a basic IPC level with only 2 hospitals achieving an intermediate level of IPC standards; compliance levels: ≤25%=inadequate, >25%- ≤50%=basic, >50%-≤75%=intermediate, >75%-≤100%=advanced. None of the hospitals achieved advanced level. The overall hospital compliance scores ranged from 32 percent to 58 percent, with 40 percent as the average. The highest overall IPC standard compliance score was observed with aseptic techniques (63.9%), and the lowest overall scores were observed with control of MDROs (3.3%), isolation precautions (31%), and COVID-19 measures (32%). When average compliance by type of standard was assessed, policy dissemination was observed to score the lowest (9%) and practice/techniques of performing procedures scored the highest (52%). Communication/reminders and infrastructure/supplies and their accessibility scored 33% and 42% respectively. Conclusion: Significant efforts must be made considering the current dismal state of the IPC programs in Afghanistan.