Delivering IPC education systems for Africa-one size does not fit all! · 2019-09-26 · IPC conf...

Delivering IPC education systems for Africa- one size does not fit all!Prof. Shaheen Mehtar, Infection Control Africa Network

Broadcast live from the New Zealand Infection Prevention and Control Nurses College

Live broadcast sponsored by Schulke (www.schuelke.com/au-en)A Webber Training Teleclass

www.webbertraining.com

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Prof Shaheen MehtarInfection Control Africa Network

Delivering IPC education systems for Africa- one size does not fit all!

www.webbertraining.com September 24, 2019

BROADCAST LIVE FROM

Live broadcast sponsored by Schulke

LMICountryResources• Majorchallengeswithinhealthsystems

• Inadequatefinances- GDPspentonhealthverylowinAfrica• Clearassociationbetweensanitationandinfantmortality(Globalfund&WorldBank)

• Skillsgap• NocareerpathorspecifictraininginIPC• Unabletoidentifyoutbreakswithoutsurveillance

• Knowledge-• Community• HCWexperience

• Trainingprovidedbyinstitutionswithrigidparameters-excludesmany!

IPC conf NZ sept 19 2





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IsthereaneedforIPCandAMStraining?

• AnonlinesurveyusingSurveymonkey• QuestionnairedevelopedjointlyICAN/BSAC• 16weekperiod(2018)• Replies=263• 92.3%agreedtoparticipate• RepliesmainlyfromAnglophonecountries• WantedmoreinvolvementinAMS- 238(92%)


TrainingofHCW- howwastrainingdelivered?


onthejob,67.3%

facetoface,65.4%

mixed,31.8%

workshops,29.9%

Work-basedportfolios29.0%

e-learning,10.3% Other,3.7%

N=156





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EducationforSelfinAMS

partofIPC,47.7%

partofpatientsafety,28.4%

singletopic,23.4%

HowshouldAMSbetaught?n=222

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Of 226 replies, 95.1% (n =216) wanted further training in AMS

IPC conf NZ sept 19

Challengesfacedduringdelivery

• Cultural• Rotemethodofteachingandlearning• Cannottellanolderpersonwhattodo.• Traditionalandindigenousknowledgeignored

• Hierarchical• Inadequateknowledgeoftutorsneverchallenged• Seniorsfeelthreatenedbynewinformation

• Languagebarriers• Socialandpoliticalinstability

• Conflictandwar






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Wetrainthemanagers!

Impact of IPC at TBH Maximum4 yr period R

YearInfections avoided (n)

Cost (million)

2007 31 7.72008 154 38.52009 47 11.72010 171 42.75Total saving 356 89Cost per infection in ICU = Min R250,000


649 618

464501

330

0

100

200

300

400

500

600

700

2006 2007 2008 2009 2010

IPC started IPCEducation

Only 1 IPC person to cover 1300 bedded hospital

IPC team with 4 CPC

CurrentIPCtraininginAfrica

• Variedprovisionforhealthcaredeliverybyprovince• IPCisnotrecognisedasaspecialityinitsownright• NoestablishedcareerpathinIPCwhichrequiresspecialisedtraining• Consideredanursingspeciality- doctorsarenotinvolved- thereforetherearenoteamsassuch!

• Researchislimited- informationgatheringisconsideredintrusiveandspying.

• Guidelines/policiesareneitherwelladvertisednorpromoted






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DistributionoftrainedIPCprofessionalsinAfricapercountry(2005- 2017)


Botswana Kenya Namibia Nigeria Rwanda

SierraLeone SouthAfrica Swaziland Zimbabwe

≈ 90% IPC trained professionals are located in South Africa

CourtesyDrABulabula

Expanding IPC Virtual Learning in Africa: ICAN initiatives

Andre N.H. Bulabula | June 14th, 2019

• Face-to-face is the most preferred training format in Africa

• Practical demonstrations necessary for clarification

• ICAN virtual learning via VIDEO- teleconferencing PLATFORMS, where lecturer and participants can see each other.

Face-to-FaceTraining

CourtesyDrABulabula





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Coursestructure• Preandpostknowledgeassessment• Teachingstructure

– Lectures inthemorning–Clinicalroundsandvisitsintheafternoon

–GroupdiscussionfollowedbydraftingapolicyorSOPorguideline

• Examination – spotsandMCQ• Returntoworkplaceandcompletealogbookandprojectforeachmodule

• AWINNINGFORMULA!


HCWcompetenceessentialinoutbreaks

• Highlyexperiencedandconfident

• Preparedtoworklonghoursinitially

• StrictcompliancewithICandprotectiveclothingpolicy

• Immune-competentstaff• Workefficientlywithoutanydangerousshortcuts

• YoumustKNOWWHATYOUAREDOING!






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TraininginEbola• Backtobasics!• SoundknowledgeaboutthemodeoftransmissionwillgiveconfidencetotreatEVDcasesastheydeservetobetreated

• Contactprecautions– Singleorisolation– Lookafteryourhands- handhygiene&gloves– Protectionfromsplashes- gowns&faceshield

• Noneedtospraywithchlorine!Wipeonly- ifneeded• Managelinenwithheatdisinfection• Managewastewithheatand/orincineration


PeerEvaluationofTTT lectures

• Lecturespreparedandgivenbytrainerstotheirpeergroups

• Adulteducationandhavetopresentinnovativemeansofknowledgetransfer

• Peerevaluatedaccordingtosetcriteria.• Presentationskills• Scientificcontent• Interactionwithaudience• Answeringquestions

• Homework.• Totrain5HCWatplaceofworkTutorsexamineknowledgetransfer.


Topic Score(20)

BasicMicrobiology 15

Standard Precautions 12.1

Transmissionbased 14.3

Riskassessment 14

Clinicalservices 14.8





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TraintheTrainercourse(SUN)


TypetoTest Pre Post Increaseinknowledge/speed

Writtentest:maxmarks 50 50

Allocatedtime(min) 30 30 NA

AverageCompletiontime(min) 30 14.7 15minutes

Averagescore 31.15 44 13marks

% score 62.30% 88% 25.70%

Spots- Visualtest 20 20

(10spotsx2min)maxmarks 13.2 15.8 3marks(15%)

ICAN- CapetoCairoEducationProgramme• WeneedtousealltheavailablefacilitiestoteachandimproveknowledgeinIPC

• Verbalcommunication(facetofacelearning)• Electronicplatforms• MobilePhonesandtelecommunication• Socialmedia

• Thinkofinnovativewaysoftransferringknowledge!






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Designinge- IPCeducationforAfrica

Advantages• Interactivelectures- exciting• Quizzesinterspersedinthelectures– testofknowledge

• Movementwithinthetalks• Canlearninone’sowntimeandrepeatifnecessary

• Muchmoreuserfriendlyonceyougetusedtoit.

• CanbelinkedtoanSMSprogramme• Standardisedmeasureofoutcome

Disadvantages• MostlearninginAfricaisrote• AverynewconceptinAfricaforteachingIPC

• Accesstotheinternetmaybelimited• Theprogrammesmightbetoobigforthebandwidth

• Unfamiliarterritory• Mayberesistancefromlearners• Resistancefromtutors


WhatisthetruesizeofAfrica?

CourtesyDrABulabula





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ICAN/SUNTEACHINGINAFRICA- 2005-2019


25 countriesplus2 outside Africa.

FacetofaceIPCTRAININGisexpensive


AnExpensiveEXERCISE

ImmigrationAirfare

Insurance

admission

Tuitionaccommodation Admission

TuitionInsuranceImmigrationAirfareMealsAccommodation

= FEES

IPC Training

CourtesyDrABulabula





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ChallengesindeliveringIPCtraining

• FacetofacetraininginAfricaisexpensiveforthemajorityofAfricans.

• Requirestravellingandstudies’staycosts

• Accessibilityamajorissue:reducedmobilityduetocivilunrest

ICANhadtofindcontextualisedinnovativewaystoprovideIPCtraining:

IPCVirtualLearningplatform!

CourtesyDrABulabula

ExpandingIPCinAfrica:ICAN_VLAndre N.H. Bulabula | June 14th, 2019

Education

StrengtheningofNational

IPCstructuresResearch

The largest IPC organization in Africa

34 countries600 members

International partners: WHO, CDC US,AFRICA CDC, MSF, IPAC Canada, Universities, Ministries of Health, etc.

Website: http://www.icanetwork.co.za/CourtesyDrABulabula





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• Face2FaceIPCtrainingisVERYEXPENSIVEforAfricanprofessionals.

COST

• COST-EFFECTIVE• AccessibleIPCqualitysolutions

• Coverswiderareas

ICANVLICANECHO • Africanhigher

educationinstitutionsofferingIPCtrainingareFARFROMTHENEEDS

DISTANCE

SolutiontoDistanceandCosts

CourtesyDrABulabula

ICAN– VIRTUALLEARNING:HubandNodes

CourtesyDrABulabula





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ICAN _VL: Teaching Platform

Uploading ofmaterialsontheplatformpriortotheliveclass

Lecturerteachesduringtheday

Localtutorreviewsandrunspracticalsessionsinaclinicalenvironmentinthe

afternoon.

CourtesyDrABulabula

ICAN –VL Participating countriesBurundi (UniversityofBurundi– ResearchandInnovationCentre)Cameroon (CameroonBaptistConventionHealthServices)SierraLeone(Njala UniversityandFreetown)DRC: settingupIPCtrainingforEVDteamsIN2020

Uni of Burundi- attending virtual classes

For the 4 nodes, +/- 150 participants attended the inaugural BASIC IPC topic lectures CourtesyDrABulabula





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Demonstrationsincorporatedintothee-learningprogrammes

• Principlesofvacuumandentryofsteaminasteamsterilizer

• Checkingthesameparametersonafunctioningsterilizer


CasebasedlearningAndre N.H. Bulabula | June 14th, 2019

ICANECHOIPCFirst IPC ECHO programme

globally!A multi-country ECHO

program in IPC

CourtesyDrABulabula





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ECHOStructureLearninginAfrica:ICANinitiatives

Spoke

ICANECHO

IPCsolutions=Empowerment

Any health care facility

Presenting a situation/case/problem in IPC

Panel of experts + the invited

Audience (IPC and non-IPC)

INTERNET

CourtesyDrABulabula

ECHO- FlowdiagramAndre N.H. Bulabula | June 14th, 2019

IPCCASE/SCENARIO

PRESENTATION&DISCUSSION

+ DIDACTICLECTURE

EXPERTRECOMMENDATIONS

Time: one hour every week or fortnight usually around lunchtime.Atmosphere: relaxed and conversational- “a comfortable space”Respectful attitude to contributions from the audience

CourtesyDrABulabula





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ICANECHOIPCTeleclinic session

DidacticLecture

CourtesyDrABulabula

ExamplesofclinicalcasesAndre N.H. Bulabula | June 14th, 2019

Examples ofIPC cases presented Didacticlectures

BSIwithCandidaparapsilosis inneonates Candidaparapsilosis –ProfShaheen Mehtar

Proteusmirabilisincaesareansection CaesareanSSI–DrAnneEastaway

Needlestick injury - OccupationalMalaria MalariaasOccupationalDisease–DrJackMeintjes

BSIwithMRSAandEnterococcusfaecalis S.aureus:What’sthefuss…-ProfAndrewWhitelaw

LessonslearnedfromapseudooutbreakofBurkholderia gladioli

Pseudo-outbreakofBurkholderia cepaciaProfShaheen Mehtar

CourtesyDrABulabula





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ExamplesofnonclinicalcasesAndre N.H. Bulabula | June 14th, 2019

ExampleofICANECHOTalk series Presenters

ImplementationofIPCbundles Sr MarinaAucamp,SouthAfrica

IPC,whatistheplaceoflabcapacity?CaseofKenya

Sr Loyce Kihungi,Kenya

ThestateofWASH/IPCinCameroon MrJacobNkwaan,Cameroon

ProgressonIPC/WASHinTanzania,OpportunitiesandChallenges

Dr Hokororo/MrRobertMussa,Tanzania

MDROspreadinaTunisianHospital

IPCinEbolaVirusDisease:therealityinAfrica

ProfBasmaMnif, Tunisia

Prof ShaheenMehtar,SAfrica

CourtesyDrABulabula

ParticipatingcountriesfromAfrica

The 5 AU regions have been participating inICAN ECHO IPC

11 countries from all AU regions participate

More than 100 participants ICAN ECHO IPC sessions

CourtesyDrABulabula





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Helpinaddressing

emergencies:outbreaks

Widenetworkofhospitalsin

differentcountries

Knowledgetransfer



In DR Congo, ICAN ECHO sessions have

helped the local team tocontrol a large

Klebsiella pneumoniae outbreak in an NNU

Participating countries have found a non judgmental space to share challenges

and find solutions from peers in just an hour per week

Growing interest in IPC discussions Africa wide

CourtesyDrABulabula

Establish an ICAN ECHO Outbreak Response Network “on call”

ICAN ECHO …..

ICAN ECHO ….

NextSteps

Lecture series on most relevant IPC matters for Africa- 2020

CourtesyDrABulabula





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Measuringknowledgeimprovement• Preandpostassessment- written

–Multiplechoicequestions– Pairingofquestionsandanswers– TrueorFalse– Shortanswers

• Spots:(2mineach)– AchildwithMDR-TB.CommentonthisslidefromanIPCpointofview.


PreandpostassessmentofIPCtraining






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Assessmentsecondroundoftraining- av.increasefrom13%to72%atpretestlevel


SLHCWIPCTRAINING– studentevaluationoftutors,2015- n=25

2.1

46.3

51.7

6.0

56.5

37.5

0.0

51.148.9

0.7

3.3

44.0

52.0

0

10

20

30

40

50

60

Rate1 Rate2 Rate3 Rate4 Rate5

Totalpercentage

Rateofscore

Excellent/verygood:96%





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Measurableoutcomesthatcanbedoneonline

• Preassessment• Provision• Knowledge• Applicationofknowledgeinclinicalpractice

• Intervention- training,videos,ECHO• Postassessment• CertificateofCompetence


WhatshouldbeincorporatedineducationforLMIcountries• Socialandculturalcontextisimportant• Goodrobustguidelines- easyandsimpletofollow

• Provision- water,handwashsystem,alcoholrub

• Howtoworksafelywhenprovisionsarenotavailable

• Accountability- Linknurses,managers• Surveillance(simple)associatedwithHAI&AMS






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Constantreminders

IPCSurvivalKit• Allclinicalhealthcareworkersunderwenta5dayBasicIPCtrainingcourse

• CoveredtheCoreElementsofIPC

• IssuedwiththeIPCkitasareminderandapersonalreference.

• VeryusefulfortheLinkNurses


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Convertinginformationintoapps- easyaccess






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WELCOME! And thank you!





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Delivering IPC education systems for Africa-one size does not fit all! · 2019-09-26 · IPC conf...

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