Unit for Infection Prevention and Control: Overview

Infection prevention and control (IPC) is high on the agenda of the World Health Organisation (WHO) and the National Departments of Health and Quality Assurance.

The Unit for Infection Prevention and Control (UIPC) was established at Tygerberg Hospital in 2002 in response to the need for structured IPC programmes under the leadership of Prof Shaheen Mehtar and has moved to its permanent home this week. Its remit is to evaluate current health practices and service delivery, support relevant hospital policy development to reduce hospital acquired infection (HAI) and offer advice to hospital design and project development-a service which embraces all aspects of infection and its prevention.

The UIPC has three full time Infection Prevention and Control Nurse Practitioners, one of whom is currently enrolled with the Postgraduate Diploma Course in Infection Prevention and Control (PDIC). The data collection and database management is supported from independent research funds. Today the UIPC has a combined (service and research) team of eight members including clerical support.

It is envisaged that by the end of 2006, the UIPC will gain academic recognition by the Faculty of Health Sciences Stellenbosch University, under the Dept of Community Health.

The essence of the UIPC is to provide expertise, advice, education and support for all of the TBH services and staff by assessing the extent of hospital acquired infection, providing adequate training and education and most importantly improving patient care in a cost effective manner.

The essence of the UIPC is to provide expertise, advice, education and support for all of the TBH services and staff by assessing the extent of hospital acquired infection, providing adequate training and education and most importantly improving patient care in a cost effective manner.

In the past three years the UIPC has worked towards reducing unnecessary expenditure and has saved the hospital considerable sums of money. Investigation into various aspects of IPC such as transmission of multiply-antibiotic resistant bacteria, appropriate use of protective clothing such as gloves and reducing needle stick injuries have all contributed to reduced costs.

Sterile services, procurement and waste management are being streamlined and collaboration with the service provision units is underway. The UIPC undertakes targeted surveillance, and using this evidence recommends new or revised protocols towards improved patient and staff care. An active Infection Control Committee at TBH is the conduit through which much of this information is channelled to Management.

The Unit provides extensive training and education programmes for the staff and frequent meetings, ward rounds and informal discussions support good IPC practice.

In recognition of the hard work hard to maintain high standards in clinical care, a Clinical Excellence in Infection Control Shield is presented to the best ward each year by the UIPC.

The UIPC is unique in that it is independent and reports directly to Dr Carter, the CEO of TBH; in this respect it is the only unit of its kind in South Africa.

The UIPC represents TBH, the Western Cape at national, provincial and local level in matters relating to IPC and supports public health initiatives in outbreak control. The activities are reflected in participation and collaboration both nationally and internationally.

The UIPC fulfils its commitment to education and training both locally and nationally via the Post graduate Diploma (PDIC).

The two- year Postgraduate Diploma Course (PDIC) run by the UIPC will proudly produce its first graduates at the end of 2006-the first group of highly trained IPC specialists made up of both nurses and doctors. The lectures have been drawn from both national and international experts in their field and the standard has been of the highest calibre. Taking cognisance of the diversity in educational background, the course is structured to evaluate not only theoretical knowledge but also practical application on the contents of the course. The best student will be sent abroad on a two-week exchange programme. Bursaries are available for the less well resourced provinces in dire need of good IPC programmes, skills and support.

Short courses are run for those who need to manage and understand IPC practices in healthcare. These have proved to be very successful and several members of staff have been trained in sterilization and disinfection in 2005. There is a possibility of expanding training into other parts of Africa.

The UIPC is part of the Centre for Infectious Disease, and the Department of Community Health, Faculty of Health Sciences. It supports IPC training and development programmes in the Western Cape, Free State, Eastern Cape and Pretoria and provides advice on IPC practices when and where ever needed. Collaborations with the Human Sciences Research Council resulted in studies demonstrating the inadequacies of current IPC programmes in some healthcare facilities.

Internationally, the Unit collaborates with the Hospital Infection Society (UK) in the form of bursaries for PDIC students. Research collaborations are envisaged with several countries on training in the prevention of blood borne virus transmission. Education programmes for Namibia, Lesotho and Swaziland are currently being developed. Prof Mehtar has supported development in IPC training and policies in several countries the most recent being Egypt and Pakistan.

An audit of the provision for IPC in the Western Cape was undertaken and the results were used to develop robust training programmes. Targeted surveillance of hospital acquired infection at TBH in the neonatal, burns and respiratory unit was undertaken in 2005 which has highlighted areas which require special attention and are now being addressed. Management support from Dr Carter has resulted in establishing a "model ward" for neonates which is underway currently. A marked reduction in sharps injuries has followed simple interventions at ward level. Improvement to sterile services is being undertaken with new equipment, re-training and improved organisation.

In the future, several short courses have been put in place to improve awareness among managers and healthcare staff. Surveillance, in collaboration with the Dept of Microbiology and Pam McGregor from the hospital statistical department, is ongoing. Service commitment for TBH will increase and more meetings with the clinical and support services are envisaged.

At the recent 7th Congress of International Federation of Infection Control hosted by the Western Cape Infection Forum, the UIPC TBH was visible by its contributions to both the organisation and the high calibre of science presented to the 320 delegates from 42 countries. The UIPC has achieved much but still the IPC programmes have a long way to go to reach the high standards of patient care which TBH will be proud of.