Fourteen years of civil war left Liberia with crumbling infrastructure and one of the weakest health systems in the world. The 2014–2015 Ebola virus disease (EVD) outbreak exposed the vulnerabilities of the Liberian health system. Findings from the EVD outbreak highlighted the lack of infection prevention and control (IPC) practices, exacerbated by a lack of essential services such as water, sanitation, and hygiene (WASH) in healthcare facilities. The objective of this intervention was to improve IPC practice through comprehensive WASH renovations conducted at two hospitals in Liberia, prioritized by the Ministry of Health (MOH). The completion of renovations was tracked along with the impact of improvements on hand hygiene (HH) practice audits of healthcare workers pre- and post-intervention. An occurrence of overall HH practice was defined as the healthcare worker practicing compliant HH before and after the care for a single patient encounter. Liberia Government Hospital Bomi (LGH Bomi) and St. Timothy Government Hospital (St. Timothy) achieved World Health Organization (WHO) minimum global standards for environmental health in healthcare facilities as well as Liberian national standards. Healthcare worker (HCW) overall hand hygiene compliance improved from 36% (2016) to 89% (2018) at LGH Bomi hospital and from 86% (2016) to 88% (2018) at St. Timothy hospital. Improved WASH services and IPC practices in resource-limited healthcare settings are possible if significant holistic WASH infrastructure investments are made in these settings.

Objective: The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network.Setting: A 780-bed, tertiary-level, public teaching hospital in northern India.Methods: After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash.Results: Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified.Conclusions: Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.

Strong infection prevention and control (IPC) programmes are critical to reducing the burden of healthcare-associated infections and antimicrobial resistance (AMR), yet many low- and middle-income countries (LMICs) lack functional IPC programmes at national and health facility levels. Nigeria prioritised the development of a national programme to provide leadership and coordination for IPC activities throughout the country’s healthcare system following a series of outbreaks and gaps identified during the development of the National Action Plan for AMR. We aim to describe the stepwise, evidence-based approach we used to establish and implement Nigeria’s National IPC Programme during its first 5 years. This includes the formation and structure of the IPC Programme within the Nigeria Centre for Disease Control and Prevention; assessment of national and tertiary health facility-level IPC programmes to prioritise interventions; development of a structured implementation strategy (the ‘Turn Nigeria Orange’ programme); publication of national IPC guidelines and revision of the national IPC policy; collaboration with a local university and professional societies to establish a national IPC curriculum and IPC training and mentorship programmes; and establishment of a network of health facilities to strengthen facility-level implementation (the ‘Orange Network’). The development of each was guided by the WHO’s core components of IPC programmes, evidence-based guidelines which aim to inform the development of effective IPC programmes. The implementation approaches, successes and challenges that we share add to the limited existing literature and can serve as a practical example for other countries, particularly LMICs when establishing and implementing IPC programmes.