Appraising the infection prevention and control practices at two referral hospitals in Malawi a mixed methods situational analysis

Introduction: Implementation of infection prevention and control (IPC) practices can reduce healthcare associated infections (HAIs). There is limited insight into the implementation of IPC practices in the medical and surgical departments in Malawian hospitals. The study aimed to explore the current state of IPC policy/guidelines and their implementation gaps at two referral hospitals in Malawi. 

Methods: We conducted a cross-sectional mixed-methods situational analysis to understand the IPC landscape in the medical and surgical departments in two tertiary hospitals from September 2023 to April 2024. These methods included: (i) document review; (ii) participant observation; (iii) semi-structured interviews with healthcare workers (HCWs); (iv) key informant interviews with hospital managers; and (v) focus group discussions with cleaning staff and patient-guardians. Quantitative data from participant observations were analysed in Excel to generate descriptive statistics, while framework analysis was used for qualitative data. 

Results: IPC guidelines were theoretically available but inaccessible to most HCWs. Observation revealed low compliance to all five moments of hand hygiene (0–12%) and non-touch technique (9–25%), often due to a lack of IPC supplies and poor knowledge. Adherence to environmental cleaning between procedures in theatre was 50%. Training of HCWs on IPC was inconsistent, and monitoring and feedback mechanisms were largely absent. There was no clear monitoring schedule for aseptic procedures, hand hygiene, or environmental cleaning. There was limited orientation on IPC practices for patient-guardians. 

Conclusion: We observed critical IPC gaps in both hospitals. Addressing these issues requires thoughtful implementation of multiple context-specific IPC strategies that are likely to be sustainable, such as IPC orientation for patient-guardians as they play a critical role in the Malawian healthcare system. Training of HCWs, regular monitoring and feedback on HAI/IPC practices, easily accessible IPC guidelines and improved IPC infrastructure and supplies will facilitate improved IPC practices.