Designing implementation strategies for improving infection prevention and control in acute healthcare facilities in Malawi: A formative study protocol

Background: Healthcare associated infections (HAIs) are infections that patients acquire while receiving treatment and are not present during admission. The prevalence of HAIs is typically higher (15%) in low-and middle-income countries than that in high-income countries (7%). HAIs present a significant burden on patients, families, and health systems as they contribute to longer hospital stays, increased healthcare costs, and antimicrobial resistance. HAIs can be prevented or reduced by implementing infection prevention and control (IPC) measures. However, IPC measures are often poorly implemented due to resource shortages, lack of training, and other systemic challenges. The goals of this formative study were twofold: 1. to carry out a situational analysis of IPC practices for HAI control in three hospitals in Southern Malawi, highlighting specific bottlenecks and enablers of IPC practices; and 2. to co-design tailored implementation strategies based on insights from situational analysis using participatory approaches with key IPC stakeholders to support more consistent and effective IPC implementation at the study sites. Methods: The study will be conducted in three health facilities in Malawi representing different healthcare levels: Queen Elizabeth Central Hospital, Zomba Central Hospital, and Chikwawa District Hospital. For situational analysis, six data collection tools will be used: a desk review of IPC policies and guidelines, the World Health Organization IPC Assessment Framework, participant and non-participant structured observations, interviews, and focus group discussions. The participatory component involves a three-day co-design workshop. Participants in both study components will include healthcare workers, support staff, policymakers, patients, and patient caregivers (guardians). Descriptive statistics will be used to analyse the quantitative data. A thematic framework analysis using NVivo 12 will be done on the qualitative data. The findings will be disseminated through workshops, academic publications, and stakeholder meetings. Conclusion: Multifaceted IPC implementation strategies tailored to the context of each hospital will be designed.