# Evaluating infection prevention and control implementation in hospitals of underdeveloped region of China using the standardized WHO-IPCAF tool

## TL;DR

This study evaluates infection control practices in hospitals in an underdeveloped region of China using a standardized WHO tool, revealing significant gaps in implementation.

## Contribution

The study provides the first comprehensive assessment of WHO-recommended IPC measures in underdeveloped Chinese hospitals using the WHO-IPCAF tool.

## Key findings

- Tertiary hospitals had significantly higher IPCAF scores than secondary hospitals.
- IPC programs (CC1) had the lowest median score, indicating poor implementation of core IPC measures.
- The built environment, materials, and equipment (CC8) received the highest median score with no significant difference between hospital grades.

## Abstract

Healthcare-associated infections (HAIs) represent a major threat to patient safety worldwide. However, the implementation status of core infection prevention and control (IPC) measures in underdeveloped regions of mainland China remains understudied.

Between June and August 2025, the Nosocomial Infection Control and Quality Improvement Center (NICQI) of the Inner Mongolia Autonomous Region conducted an online survey to evaluate IPC implementation in secondary and tertiary general hospitals within its jurisdiction. The survey employed the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) to ensure a standardized and comprehensive assessment.

A total of 128 hospitals submitted valid questionnaires, yielding a response rate of 72.3%. The overall median IPCAF score across all hospitals was 620.0 (interquartile range [IQR]: 522.5–692.5). Median scores were 590.0 (IQR: 496.2–655.5) for secondary hospitals and 722.5 (IQR: 672.5–745.0) for tertiary hospitals, with a statistically significant difference between hospital grades (p < 0.001). Among the eight core components, the highest score was observed for “built environment, materials, and equipment” (CC8), with a median of 95.0 (IQR: 87.5–100.0); no significant difference was found across hospital grades for this component (p = 0.082). In contrast, the lowest score was for “IPC programs” (CC1), with a median of 62.5 (IQR: 44.4–80.0), which differed significantly between hospital grades (p < 0.001).

Approximately 30% of eligible hospitals did not participate in the survey, which may reflect inadequate prioritization of IPC or limited engagement. Additionally, the potential for social desirability bias exists, as some institutions may have overestimated their scores due to concerns about reputational impact. Furthermore, certain complex IPCAF concepts—such as multimodal strategies—may not have been fully understood by all respondents, possibly affecting the accuracy of the submitted data.

While the overall IPCAF scores of secondary and tertiary hospitals in the Inner Mongolia Autonomous Region were relatively high, but more than half of the secondary hospitals demonstrated only intermediate or basic IPC implementation capabilities. This study elucidates the adoption status of the WHO-recommended IPC core components in a underdeveloped region of mainland China, thereby addressing a significant evidence gap in this field and providing a basis for targeted interventions and policy development.