Implementation strategies to improve infection prevention and control in healthcare facilities in Sub-Saharan Africa: A scoping review of evidence, practices and gaps

Introduction: Infection prevention and control (IPC) is essential for improving patient safety and reducing healthcare associated infections (HAIs). Many IPC interventions have been implemented across sub-Saharan Africa (sSA), however, implementation strategies used, their processes and reported outcomes have not been synthesised. This scoping review mapped implementation strategies used in health facilities to identify common strategies and approaches, their outcomes and facilitators and barriers to their implementation. Methods : We conducted a scoping review guided by the PRISMA-ScR framework. Peer-reviewed studies conducted in sSA published in English and reporting IPC interventions or implementation strategies across health facilities were included. Data extraction captured study characteristics, IPC practices, implementation strategies and their outcomes and facilitators and barriers of implementation. Descriptive summaries were prepared for each study. Qualitative content analysis was used to synthesise key emergent findings across the studies, ultimately producing a narrative synthesis. Results : Sixty-one studies from 22 countries were included. IPC practices included hand hygiene, environmental cleaning, neonatal IPC bundles and surgical site infection prevention bundles. Five implementation strategies were identified to promote these practices: 1. training and education; 2. monitoring, audit and feedback; 3. quality improvement; 4. improving IPC resources and supplies; and 5. multimodal strategies. Most study interventions used multiple approaches and reported improvements in compliance with IPC practices. Facilitators included leadership support, reliable IPC resources, IPC focal persons and feedback loops. Barriers included staff shortages, high workload, inadequate IPC resources and lack of sustainability if external support to IPC ended. Conclusion : Improvements in IPC practices are feasible when strategies are multifaceted, supported by leadership, IPC resources are provided and continuous monitoring and feedback is established. However, sustainability is still a challenge, as IPC programmes require strong facility-level systems with strong leadership to ensure long-term improvements in IPC practices and reductions in HAIs.