Table 5

Challenges to adherence to IPC in a primary health system

Major challengeHow addressed in December 2014–January 2015Potential additional solutions
Communities are unprepared for the systematic use of IPC and PPE in PHUs.HCWs sensitise community members as they come to PHU.

  • Targeted communication campaign in community to set expectations

  • Counselling approaches for HCWs to use in screening and consultation

HCWs may not initially believe in the high risk of infection.Training to raise awareness of risks for HCW infection.

  • Integrated IPC training in preservice education curricula

  • Reinforcement of in-service IPC training in particular for new staff

  • Ongoing supportive supervision

Low confidence in the identification of suspect cases.Training in screening.

  • Research on new diagnostic techniques (eg, rapid diagnostic tests to increase sensitivity of the case definition and the overall effectiveness of screening)

PPE causes separation in bond between HCWs and patients.HCWs found ways to motivate patients to recognise them.

  • Guidance for HCW to increase communication and bonding with patients

  • Regular meetings between HCW and health committee to discuss issues

Discomfort while using light PPE on a routine basis.Training in PPE use.

  • Technical improvements to light PPE

Poor glove changing practices.
Poor handwashing.		Training in PPE use.
Spot checking.

  • Training that emphasises reasoning for appropriate use of PPE (including risks of not changing gloves)

  • Peer systems that emphasise changing of gloves

  • Monitoring for feelings of high self-efficacy in core behaviours among groups of HCWs

Fear of PPE stock-out hinders use.Routine stocking of PPE.

  • Improved supply chain

  • Training that emphasises reasoning for appropriate use of PPE

Mixed attitudes towards using PPE with fellow HCWs.No specific actions known by the authors.

  • Training that specifies HCW treatment scenarios and addresses doubts

Implementation within a weak and fractured health system.IPC treated as emergency response.

  • Improved supply chain systems

  • Improved payment systems for human resources

  • Improved coverage of functional water and sanitation infrastructure

  • HCWs, healthcare workers; IPC, infection prevention and control; PHUs, peripheral health units; PPE, personal protective equipment.