Performance Audit of Infection Prevention and Control

The State Audit Office has carried out Infection Prevention and Control system IPC system performance audit to identify how sufficient are the regulations and controls in place in the country for maintaining an effective system of infection prevention and control at health care facilities. The audit has found the shortcomings affecting the effective administration of the system:

The country is missing national infection prevention and control strategy and respective action plan, which would ensure availability of nation-wide policy and measures to be taken to improve IPC system. These issues are only fragmentarily reflected in the 2017-2020 Antimicrobial Resistance and 2016-2020 Hepatitis C Elimination National Strategies which is not sufficient for policy development;
Although the Ministry and NCDC have developed the mechanisms aiming to improve data gathering process on healthcare-associated infections in the country, they are not sufficient for ensuring its credibility. Therefore, the Ministry is not able to get a full picture of the actual situation existing in inpatient care facilities on this matter, which in return would make possible to identify the costs incurred for and to effectively manage nosocomial infections;

The legislation on the one hand requires Reporting or providing data accountability of nosocomial infections by the hospitals and on the other hand does not require having a microbiology laboratory being one of the means of confirmation of infections. Therefore, there is no mechanism developed at the initial stage of practicing the activity, which would enable identification, confirmation and Reporting or providing data of nosocomial infections by the inpatient care facility;

The legislation does not require inspection of whether dental care facilities meet the mandatory requirements at their start-up phase and nor there is a selection criterion of inspectees to inspect a newly opened dental care facility, which increases patient safety risks;
In registering the disinfectants, in some cases documentation is incompletely provided. In addition, it is not specified what contents should be contained in mandatory documentation, which increases the risks of inconsistent approach;
There is no detailed methodology developed which the Regulatory Agency should guide with in controlling hospital and this increases the risk of incomplete identification of the gaps of IPC system at inpatient facilities.

The State Audit Office has made relevant recommendations on the circumstances and gaps identified, and in case they are considered the improved performance of this system would be feasible.

Recommendation №1:

For effective functioning of IPC system at healthcare facilities, it is important to develop a single nation-wide strategy providing for availability of unified policy within the healthcare system and for coordinated work of its subordinated units

Recommendation №2:

By facilitating the expansion and implementation of the existing mechanisms, introducing the new instruments, and improving the coordination between the IPC management units, reliability of information on nosocomial infections existing in the country should be ensured which will facilitate implementation of efficient measures by the Government in prevention and control of infections.

Recommendation №3:

In the conditions of reliable information, the Ministry should identify the costs incurred for the treatment of nosocomial infections to ensure effective management of these costs.

Recommendation №4:

For timely identification and management of nosocomial infections, before inpatient care facility starts practicing its activity, it should be confirmed that microbiology laboratory available.

Recommendation №5:

Due to high prevalence risk of healthcare-associated infections containing increased threat to human life and health, the issue of dental practice as an activity subject to state regulation by permit should be reviewed and its legislative initiative should be made based on the relevant expert findings.

Recommendation №6:

To facilitate safe environment at healthcare facilities, registration of disinfectants should differentiate between the mandatory and preferable list of documentation, and the contents of each document should be specified in detail.

Recommendation №7:

For the purpose of having detailed and unified approach to the control, it’s important to elaborate detailed guidline in order to improve process of inspection of permit conditions at hospitals.