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

## TL;DR

This study aims to improve infection prevention in Malawi hospitals by understanding current practices and co-designing tailored strategies with stakeholders.

## Contribution

The study introduces a participatory approach to co-design context-specific infection prevention strategies in Malawi hospitals.

## Key findings

- The study will identify bottlenecks and enablers of IPC practices in three Malawi hospitals.
- Tailored implementation strategies will be co-designed with key stakeholders to improve IPC.
- Findings will be shared through workshops and publications to promote better IPC practices.

## Abstract

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.

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 (WHO) 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.

Multifaceted IPC implementation strategies tailored to the context of each hospital will be designed.

Healthcare associated infections (HAIs) are infections that patients catch while being treated in health facilities. These infections are a significant health problem, especially in low-resource settings, such as Malawi. HAIs can lead to longer hospital stays, cost more money for patients and hospitals, and make it more difficult to treat illnesses and diseases because of drug resistance. Common types of hospital acquired infections include infections after surgery, infections from cannulas and catheters, and pneumonia acquired in hospitals.

The World Health Organization (WHO) has established guidelines on infection prevention and control (IPC) to help hospitals prevent these infections. However, many hospitals in Malawi struggle to follow these guidelines because of challenges such as lack of staff, lack of training, and shortage of necessary supplies.

This study focused on developing context-specific practical ways to improve IPC practices in hospitals in Malawi.

This study will be conducted in three hospitals in Malawi. We aim to: 1. understand how IPC is currently being implemented in hospitals; 2. identify what makes it difficult or easy to follow IPC practices; and 3. involve everyone in creating a plan to improve the IPC. To do so, we will collect data from healthcare workers, policymakers, patients, caregivers, and guardians. We will interview some of these participants and conduct group discussions with others. We will also conduct observations of IPC practices. After learning from the collected data, we will work with some of these participants to develop practical ways to improve IPC practices in these hospitals.

Findings from this research will be shared with hospital staff, the hospital community (patients, guardians, caregivers, and visitors), the government, and the public to promote better IPC practices across the country.