Assessment of the level of implementation of infection prevention and control practices in district and regional hospitals in Dar es Salaam, Tanzania

Background Strict adherence to infection prevention and control (IPC) is the mainstay for preventing and controlling healthcare-associated infections (HCAIs), often caused by multidrug-resistant pathogens. We used the World Health Organization IPC Assessment Framework (WHO IPCAF) to assess the level of implementation of IPC measures in 3 regional referral hospitals, 5 district hospitals, and 1 health center in Dar es Salaam, Tanzania. Results The overall mean IPCAF score for the assessed facilities was 417 out of 800 points (IQR: 408.75–478.6). On average, there was no difference in the level of IPC implementation between Regional and District Hospitals, and both were at an intermediate level. The components that performed well were: CC8 (environment, materials, and equipment; 77.5, IQR 75–80), CC1 (IPC program; 70, IQR 65–70)), and CC2 (IPC guidelines; 75, IQR 75-77.5). CC5 (multi-modal strategies for IPC (60, IQR, 55-67.5) and CC7 (workload, bed occupancy, and staffing (55, IQR, 40–60) had moderate scores, while CC6 (monitoring and feedback (25, IQR 25-31.25), CC4 HCAI surveillance (30, IQR 22.5–50), and CC3 IPC education (40, IQR 35–55) scored lowly. The notable IPC gaps were i) inadequate IPC training programs and lack of surveillance systems and data on antimicrobial consumption, lack of adequate bed spacing (> 1 m), which was seen in all facilities and ii) majority of the facilities (77.8%) were not monitoring IPC indicators. All district healthcare facilities had low-capacity microbiology laboratories. Conclusions With the increasing incidence of hospital-associated multidrug-resistant infections and recent COVID-19, M-pox, Ebola, and Marburg outbreaks, there is an urgent need to address the challenges observed in key components hindering progress in the prevention and control of HCAIs. Based on our findings, special attention should be given to IPC education (CC3), strengthening HCAI surveillance systems (CC4), monitoring and feedback (CC6), and bed occupancy and staffing (CC7).