Friday, 17 April 2015

So what is IPC?

I don’t think I have ever written, spoken or thought about three little letters as much as I have in the last few months: IPC… Infection Prevention & Control. Since mid-December I have been helping establish and initiate implementation of Sierra Leone’s first ever National IPC Programme.

I think one of the most important positive outcomes of the Ebola epidemic has been the general introduction of the backbone of IPC, hand washing, into multiple aspects of people’s lives. In Freetown, as you enter hospitals, shops, restaurants etc, you are often asked to wash your hands using the buckets of chlorine or sometimes ‘Detol’. The other day, I watched a family enter a cafĂ©, and the dad endearingly held up his small children one at a time to wash their hands using the chlorine bucket before entering. This has got to be one positive consequence of Ebola.

In the hospital setting, the changes to daily work have been more visible and intrusive. There is now a generally unspoken understanding amongst all healthcare workers that you should not touch a patient unless you are wearing gloves. All patients who have screened ‘negative’ i.e. they don’t have symptoms that meet the Ebola case definition, are met in A&E by an anonymous muffled voice behind a barrier of PPE – a facemask, gown, double gloves, and apron. This is the national recommendation within the recently approved Standard Operating Procedures for ‘Basic Healthcare in the context of Ebola’. It is just in case Ebola patients slip through the net of the screening process. With the number of healthcare workers who have been infected and lost their lives in the epidemic in the hundreds, just in Sierra Leone, it is completely understandable that they must protect themselves as much as possible. But what impact has this had on the human touch of healthcare? I certainly know that it will initially feel bizarre, almost wrong, to touch a patient without gloves on when I come back to working in the NHS.
Interactive training sessions – IPC Focal Persons from each government hospital attended a 2 week training course in Freetown in March
So I feel like I should explain a bit more about the IPC programme I have been working on so much causing me to neglect my blog (sorry!).  It has been exciting to be part of this programme from almost the very beginning. The Ministry of Health & Sanitation has elected a National IPC lead person in the Ministry and 25 IPC focal persons (mainly nurses) in the 25 government hospitals in the country. Each focal person is responsible for setting up an IPC committee in their facility and rolling out training for all healthcare staff. Each focal person and hospital has an international mentor and partner organisation (that’s where I come in with King’s) to help support the roll out of this programme. The international mentors and the IPC focal persons attended a two-week IPC training programme at the beginning of March. This was a great opportunity to form working relationships between the mentors & focal leads, and also share some teaching tips in how to engage classes in more interactive style of teaching. I met so many incredibly determined and passionate individuals, mostly women :) who are going to be the tour de force for IPC in their hospitals. As IPC is a relatively new concept in Sierra Leone, my hat goes off to these IPC leads who have a huge challenge ahead of them. And yet the training course was full of optimism and momentum for change. Following the training we are in the process of trying to organise training for all staff.  At Connaught, this is nearly 800 people. 

Training – how to clean spills
in a non-Ebola hospital environment
Oh sorry, I still haven’t really explained what those three little letters mean… it’s basically all ways of preventing the spread of infection between patients, from patients to staff and from staff to patients. It includes everything from basic hand washing to making sure used needles are put in ‘sharps boxes’ safely, segregating clinical (possibly infectious) waste from general rubbish, to the provision of Hepatitis B vaccine for staff prophylaxis (something that currently does not happen in Sierra Leone) and appropriate use of antibiotics to prevent resistance developing. It really is a huge topic and in a healthcare system that struggles to get enough gloves per nurse at the beginning of the day, it’s difficult to know where to start!

What it is certain is that behavioural change, like making sure nurses dispose of sharps safely every time, does not happen overnight. There will be trainings and more trainings and more trainings and bit by bit we’ll get there. The other thing that is very clear is that all the trainings in the world are not going to achieve anything unless the systems are in place for implementation. This is a huge project. There are funds available through two different grants (USAID & DFID), in all government hospitals to improve the Water, Sanitation & Hygiene (WASH) infrastructure. Needless to say, if a hospital has no reliable running water then hand washing is going to be quite difficult. All of the four hospital sites with which we have been working with have differing degrees of complex infrastructural problems.  We are lucky to have Gerard, a volunteer Engineer, working with King’s since February who is going to help sort a lot of these issues out. No pressure! 

It has been really interesting to sit in some of the ongoing funding and planning meetings in the last few weeks. There has been a tangible shift and transition away from the acute emergency phase of the Ebola epidemic and towards the long-term recovery into development phase.  What is also interesting is the sheer number of international partners (UNICEF, UNDP, WHO, CDC, OXFAM and smaller NGO’s like ours) all competing for funds and projects and the co-ordination nightmare this creates. Even within the IPC world, there are parallel IPC programmes which cover trainings in hospitals, in peripheral health units, in communities and also setting up IPC focal leads at the District level. I had read that co-ordination of aid can be difficult but until now I had never appreciated the scale of the politics involved in humanitarian, and, increasingly, development aid even at a ground level. Despite this, real tangible improvements are achievable through this programme and it is with a heavy heart that I am leaving Sierra Leone just when trainings & WASH projects are getting going.

I am so pleased to have been part of this important step forward in Sierra Leone’s health system but I need to hand-over to a fantastic team of nurses who will carry on with this project for the whole year. I have met the most amazing people from the Ministry, the co-ordinating NGOs, at King’s and the IPC local leads at the four hospitals through this project. I wish them all the luck in the world in their tremendous challenge of improving the country's healthcare system one step at a time, starting with IPC.