strengthening ipc structures through education · •“the current approach to educating and...

StrengtheningIPCStructuresThroughEduationProf. Shaheen Mehtar,StellenboschUniversity,CapeTown,SouthAfrica

AWebberTrainingTeleclass

HostedbyPaulWebberpaul@webbertraining.comwww.webbertraining.com

StrengtheningIPCStructuresThroughEducationCapacityBuildinginAfrica

ProfShaheenMehtarChairInfectionControlAfricaNetwork(ICAN),

andStellenboschUniversity,CapeTown,SouthAfricasmehtar@sun.ac.za

www.webbertraining.com October12,2017

HostedbyPaulWebberpaul@webbertraining.com

Objectives

1. Howtosetupeducationprogrammeswithlowresources2. What,andwhere,tostartsuchprogrammes3. Howdoesonemeasureprogressofsucheducationsystems4. Whyhighincomesystemsdon’talwaysworkinLMICs

TCPWTOct2017 2

ChallengesinsettingupeducationprogrammesinIPCinAfrica

• Levelofbasiceducation(primaryandhighschool)isvaried• Learningisbyrote;criticalthinkingisnotwelldeveloped• Difficulttounderstandconceptswherethereisalackofinfrastructure

• Irregularaccesstotheinternet;selflearningislimited• Littleornoaccesstocurrentliterature• Adoptingconceptsandguidelinesfromothercountrieswithoutbeingabletoadaptthemlocally

• FewpublicationsfromAfrica(nowimproving)toinformlocalguidelines

• Irregularsupplyofwaterandelectricity(WASHinadequate)

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CurrentIPCtraininginAfrica

• Variedprovisionforhealthcaredeliverybyprovince• IPCisnotrecognisedasaspecialityinitsownright• NoestablishedcareerpathinIPCwhichrequiresspecialisedtraining• Consideredanursingspeciality- doctorsarenotinvolved- thereforetherearenoteams!

• Surveillance:informationgatheringislimited• Guidelinesandpoliciesareneitherwelladvertisednorpromoted• TheWHOCoreComponents(2016)recommendsthe“presenceofafullytrainedIPCpractitionerfor250acutebeds”!

12TCPWTOct2017

Typesoftrainingoffered

• Classroomteaching- facetoface• E- learningplatformacrossAfrica• Skillsdevelopment– practicalclassesforallcadresofhealthstaff• Trainthetrainers(MasterTrainers)• Managerscourses• Capacitybuildingandknowledgetransfertocommunities• DevelopingguidelinesandappsspecificallyforAfrica’sneeds

14TCPWTOct2017

FacetoFaceTeaching

Advantagesoffacetoface• Closerelationshipdevelopsbetweentutorsandwithintheclass- networking

• Revisionwhennecessary• Modificationofmethodofteachingifnecessary

• Demonstrationsandvisualteachingisunderstoodbetter

Disadvantagesoffacetoface• Expensiveforbothstudentsandfaculty

• Timeconsuming• Shorttermengagement• Routineandsometimesboring• Tutordependenttransferofknowledge

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Barrierstoteaching

• Cultural– Donotarguewithelders(teachers)– Cannotsayhowmuchyouknow– Cannottellanolderpersonwhattodo.– acceptwhatoneistoldwithoutquestion

• Hierarchical-– “Icannotquestiontheboss”– “IAMTHEBOSS!”

• Language- differentwordsmeandifferentthings!

18TCPWTOct2017

Barrierstolearning- cultural

• Hierarchalbarriers– “Whatyoulearntinclassstaysthere!!Hereyoudowhatyouaretold!”

– “WhydoIneedtoknowthis?Itisnotmyjob”• DespiteknowledgeinIPCdifficultyinmaintainingstandardsduetolackofresources

• Willnotadvisesuperiors- donotwanttoappearaggressiveorashowoff

• So,

20TCPWTOct2017

CostofanIPCprogramme• IntheUSA,areductionofonly6%wouldoffsetthecostIPCbysavingonreducedhospitalisation.

• BSIarethehighestcostingHCAI ofallthetypesofinfection• CostinIndiaofBSIinfectioninacardiachospitalcost$15000moreperpatientcomparedwiththosethatdidnotdevelopinfection.

• ABHR introductionatpointofuseandothercosts=$23.7savedforevery$1spent.(ChenY,ShengW,WangJ,etal.PLoS One2011;6:e27163)

• ABHR islesscostlyandgreatercompliance.

• Communicating(feedback)relatingtoHH activitiesandencouragingeachotherincreasedcompliance(p<0.01)

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TraintheTrainercourse

• Selection- wantstoteachandhaspassedthebasicIPCcoursewithgoodmarks

• Coursestructure– Taughthowtoteachadults(applyingprinciples)– Willreturntoplaceofworkandtrainaminimumof5students

• Examinerswillvisitworkplaceand– examinethe5studentstaught(50%transferofknowledgerequired)– Evaluatetrainingmaterialusedtoteachstudents– Hoursoftraining– Preandpostassessmentofstudentknowledge

• Ifthestudentsget50%ormore,theTutorwillgetacertificateofcompetence(TTT)

• Ifnot,thentheTutorwillonlygetaBasicIPCcoursecertification.• Thestudentswillbecertifiedbytheirlocalinstitutions

TCPWT Oct2017 25

TraininginEbola• 263healthcareworkerstrainedinIPCbyICAN• Backtobasics!• SoundknowledgeaboutthemodeoftransmissionwillgiveconfidencetotreatEVDcasesastheydeservetobetreated

• Contactprecautions– Singleorisolation– Lookafteryourhands- handhygiene&gloves– Protectionfromsplashes- gowns&faceshield

• Noneedtospraywithchlorine!Wipeonly- ifneeded• Managelinenwithheatdisinfection• Managewastewithheatand/orincineration

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e- IPCeducationforAfrica

Advantages• Interactivelectures- exciting• Quizzesinterspersedinthelectures– testofknowledge

• Movementwithinthetalks• Canlearninone’sowntimeandrepeatifnecessary

• Muchmoreuserfriendlyonceyougetusedtoit.

• CanbelinkedtoanSMSprogramme

• Standardisedmeasureofoutcome

Disadvantages• NewconceptforIPC• Accesstotheinternetrestricted

• Theprogrammesmightbetoobigforthebandwidth

• Unfamiliarterritory• Mayberesistancefromlearners

• Resistancefromtutors

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DesigningdistancelearningIPCcourses- forAfricanuniversities

• Usesmoodlewhichisnotonlyeducational,butalsohasstrategiesforteaching–learningandforassessingprogressandperformance.

• DistanceLearningAMScourse–ISC&ICAN

• Alsolookingforprivatepublicpartnership

IPC course

SUN Moodle home page

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Finally.......

• “Thecurrentapproachtoeducatingandtrainingourhealthcareprovidershasoutliveditseffectivenessandutility.

• Withthegrowingcomplexityofhealthcareandtheacceleratedpaceofaccumulationofknowledge,significantreformofhealthprofessionseducationisrequired”.

• “ForLMIcountriesweshouldencourageMultimodalapproaches(whichareculturallysensitivetosustaineffect)Educationalinterventioncouldbeextremelycosteffective-Educatinghealthcareworkerstooptimal(handhygiene)practicesiseffective.”

52TCPWTOct2017

Whatactionscanbetaken

• Applyactivitieswhichtakelessfunding• Betterandcosteffectiveoutcomes• Puteffectivestructuresintoplace.• Mostimportant

– Knowledge– ReducewastebyreducingcostofHAI,environmentalcleaning,purchasingpoorqualityitems

– Donations- becarefulwhatyouwishfor?– ReinvestwhathasbeensavedbyreducingHAI

53TCPWTOct2017

Thinkoutsidethebox……

• Whiletherewillbeshortages,welltrainedIPCpractitionersandHCWcanthink“outside-the-box”anddeliverhealthcarereasonablysafelyforpatientsandthemselves

• Understandthecommunityandworkcloselywiththem• NeedtoreassessteachingmethodsinLMICusingmoreinnovativewaysofgettingthemessageacross- AWhatsAppIPCgroupinSL!

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MBChBgraduatesurvey:IPCcurriculumIIQuestionn=181

Agreetotally/strongly

Agree Disagree/quitestrongly

IPCisimportant 82.9% 17.1% 0%Adequatelycoveredincurriculum?

notatall/inadequate%

basic%

adequate/comprehensive

%Sharpsdisposal 4.5 7.9 87.7Handhygiene 5 12.7 82.3Asepticprocedures 7.9 15.3 76.8UseofPPE 7.9 17.9 74.3Transmission-prec. 10.8 22.6 66.6Decontamination 11.1 22.9 66Wastemanagement 19.4 28.9 51.8

IPCpolicies 28.5 39.7 31.8HCWbehav.change 28.2 37.9 33.9Occup.health 34.4 39.4 26.2

TCPWTOct2017

MedicaleducationinIPC:proposedSUmodel

MB1 MB2 MB3 MB4 MB5 MB6

Foundationphase Earlyclinical

Middleclinical

LateClinical

IPCteachingintheorymodules

IPC teachinginskillslaboratory

IntegratedIPCteachinginclinicaldisciplines

OUTCOME:

understandsIPCprinciples &terminology

OUTCOME:

appliesIPCprinciplestoclinical

scenarios&attainsIPCclinicalskills

OUTCOME:

evaluateshealthcareservices&reducesclinicalriskby

applicationofIPCprinciples

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Conclusion

• Weneedtousealltheavailablefacilitiestoteachandimproveknowledge– Verbalcommunication(facetofacelearning)– Electronicplatforms– MobilePhonesandtelecommunication– Socialmedia

• Thinkofinnovativewaysoftransferringknowledge!• Thinkofwaysofsustainingknowledge!

TCPWTOct2017 60

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