MinReq-Manual 2019 PDF

MINIMUM REQUIREMENTS
for infection prevention

and control programmes
The starting point for implementing the World Health Organization core components of
infection prevention and control programmes at the national and health care facility level
Minimum requirements for infection prevention and control programmes
ISBN 978-92-4-151694-5
© World Health Organization 2019
Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0
IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the
work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses
any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you
must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work,
you should add the following disclaimer along with the suggested citation: “This translation was not created by the World
Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English
edition shall be the binding and authentic edition”.
Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules
of the World Intellectual Property Organization.
Suggested citation. Minimum requirements for infection prevention and control. Geneva: World Health Organization;
2019. Licence: CC BY-NC-SA 3.0 IGO.
Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.
Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for
commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.
Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures
or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission
from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work
rests solely with the user.
General disclaimers. The designations employed and the presentation of the material in this publication do not imply
the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted,
the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the
published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for
the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from
its use.
Graphic design by Maraltro, Italy.
Printed in Switzerland
CONTENTS Acknowledgements II
Abbreviations and acronyms IV
Glossary of key terms and definitions V
Key to symbols X
Part 1. Introduction 1
1.1 Purpose of the document 2
1.2 Target audience 2
1.3 Document development structure 3
1.4 The role of the minimum requirements 5
in achieving effective infection prevention and control
1.5 References 10
Part 2. Executive summary of the minimum requirements 13

by core component
Part 3: In-depth review of the minimum requirements 23

3.1 Core component 1: Infection prevention and control 23
programmes
guidelines
education and training
3.4 Core component 4: Health care-associated infection 34
surveillance
3.5 Core component 5: Multimodal strategies 38
3.6 Core component 6: Monitoring, audit and feedback 41
of infection prevention and control practices
3.7 Core component 7: Workload, staffing and bed 44
occupancy at the facility level
3.8 Core component 8: Built environment, materials and 46
equipment for infection prevention and control at the facility level
Part 4. Annex 51
4. 1 Summaries of the results of a systematic review and 51
inventory of available infection prevention and control minimum
standards
4.1.1 Overview of the results of the systematic literature review 51
on minimum standards for infection prevention and control
4.1.2 Summary of the global inventory on infection prevention 52
and control minimum standards
4.1.3 References 53
II
ACKNOWLEDGEMENTS
ACKNOWLEDGEMENTS
The Department of Integrated Health Services of the World

Health Organization (WHO) gratefully acknowledges the
contributions that many individuals and organizations have made
to the development of the infection prevention and control (IPC)
minimum requirements, based on the WHO core components for
IPC programmes at the national and health care facility level.
OVERALL COORDINATION, WRITING

AND DESIGN OF THE DOCUMENT
Benedetta Allegranzi (Department of Integrated Health Services,
WHO) coordinated and led the development and writing of this
document and contributed to the systematic review. Anthony
Twyman and Alessandro Cassini (Department of Integrated
Health Services, WHO) significantly contributed towards the
writing of this document and to the systematic review. Julie Storr
(IPC consultant, United Kingdom) and Molly Patrick (Centers for
Disease Control and Prevention [CDC] international IPC team,
United States of America [USA]) also contributed to the writing
of this document. Joost Hopman (Radboud University Hospital
and Médecins Sans Frontières/Doctors Without Borders, The
Netherlands) contributed to the strategic development of this
document and conducted a systematic review on the minimum
standards for IPC programmes together with Daniël Urlings
(Radboud University Hospital, The Netherlands); Anthony
Twyman made a global inventory of available guidance on IPC
minimum standards. Thomas Allen (Library and Information
Networks for Knowledge, WHO) provided assistance with the
search for the systematic review. Rosemary Sudan provided
professional editing assistance. Laura Pearson (Department
of Integrated Health Services, WHO) and Alice Simniceanu
(Antimicrobial Resistance Division, WHO) supported the
finalisation of the designed document. Maraltro provided the
professional graphic design of the document.
EXPERT CONTENT DEVELOPMENT GROUP

Consensus on the contents of this document and the IPC
minimum requirements was first gathered in a technical expert
consultation in Addis Ababa, Ethiopia, in April 2019 with the
participation of the following experts:
III
ACKNOWLEDGEMENTS
Fahmi Ahmed (WHO Country Office for Ethiopia); Romella Paula Coutinho-Rehse (WHO Regional Office for Europe); Nino
Abovyan (National Center for Disease Prevention and Control, Dayanghirang (WHO Regional Office for Africa); Corey Forde
Armenia); Anucha Apisarnthanarak (Thammasat University (Queen Elizabeth Hospital, Barbados); Amy Kolwaite (CDC
Hospital, Thailand); Batyrbek Aslanov (North-Western State international IPC team, USA); Babacar Ndoye (WHO Regional
Medical University, Russia); Sofonias Asrat (WHO Country Office for Africa); Maha Talaat (WHO Regional Office for the
Office for Ethiopia); Mekdim Ayana (WHO Regional Office for Eastern Mediterranean); Shaheen Mehtar (Infection Control
Africa); Gertrude Avortri (WHO Regional Office for Africa); Anjana Network Africa, South Africa); Molly Patrick (CDC international
Bhushan (WHO Regional Office for South-East Asia); Roderick IPC team, USA); Julie Storr (IPC consultant, United Kingdom);
Chen Camano (Caja Seguro Social Hospital, Panama); Christiana Sarah Tomczyk (Robert Koch Institute, Germany); Jay Varma
Agnes Conteh (Ministry of Health and Sanitation, Sierra (Africa CDC, Ethiopia).
Leone); Ana Paula Coutinho-Rehse (WHO Regional Office for
Europe); Nizam Damani (IPC consultant, United Kingdom); Nino EXTERNAL PEER REVIEW GROUP
Dayanghirang (WHO Regional Office for Africa); Lamine Dhidah Emine Alp (Ministry of Health, Turkey); April Baller (World Health
(Sahloul University Hospital, Tunisia); Molla Godif Fisehatsion Emergencies, WHO); Richard Gelting (CDC, USA); Margaret
(Ministry of Health, Ethiopia); Corey Forde (Queen Elizabeth Montgomery (Water, Sanitation, Hygiene and Health Unit, WHO);
Hospital, Barbados); Ghada Abdelwahed Ismail (Supreme Rob Quick (CDC, USA); Wing Hong Seto (University of Hong
Council of University Hospitals, Egypt); Nordiah Awang Jalil Kong, Hong Kong SAR, China); Nalini Singh (George Washington
(Hospital Universiti Kebangsaan, Malaysia); Kushlani Jayatilleke University Schools of Medicine and Health Sciences and Public
(Sri Jayewardenapura General Hospital, Sri Lanka); Ejaz Khan Health and Children’s National, USA); João Toledo (Pan American
(Shifa International Hospital, Pakistan); Amy Kolwaite (CDC Health Organization).
international IPC team, USA); Thabang Masangane (Ministry of
Health, Eswatini); Guy Mbayo (WHO Regional Office for Africa); ACKNOWLEDGEMENTS
Huynh Tuan Minh (University Medical Center, Viet Nam); Awa OF FINANCIAL AND OTHER SUPPORT
Ndir (WHO Regional Office for Africa); Babacar Ndoye (WHO WHO gratefully acknowledges the technical and strategic
Regional Office for Africa); Fernando Otaiza (Ministry of Health, contributions by CDC (USA) and Africa CDC for the
Chile); Atika Swar (Federal Ministry of Health, Sudan); Maha accomplishment of this project and thanks Africa CDC for
Talaat (WHO Regional Office for the Eastern Mediterranean); hosting the technical expert consultation in its premises in Addis
Shaheen Mehtar (Infection Control Network Africa, South Africa); Ababa, Ethiopia. Funding for the development of this document
Benjamin Park (CDC international IPC team, USA); Molly Patrick was provided by the CDC (USA), in addition to WHO core funds.
(CDC international IPC team, USA); Lul Raka (University of However, the views expressed in the manual do not necessarily
Prishtina, Kosovo); Julie Storr (IPC consultant, United Kingdom); reflect the official policies of the CDC.
Lekilay G. Tehmeh (Ministry of Health, Liberia); Le Thi Anh
Thu (Infection Control Society, Viet Nam); Roselyne M.E. Toby
(Hôpital Central de Yaoundé, Cameroon); Sarah Tomczyk (Robert
Koch Institute, Germany); Winifrey Ukponu (Nigeria Centre for
Disease Control, Nigeria); Jay Varma (Africa CDC, Ethiopia);
Daiva Yee (CDC international IPC team, USA).
The content was further developed with the substantial

contribution and/or review by the following experts:
Fahmi Ahmed (WHO Country Office for Ethiopia); Anjana

Bhushan (WHO Regional Office for South-East Asia); Ana
IV
ABBREVIATIONS AND ACRONYMS
ABBREVIATIONS AND ACRONYMS
ABHR alcohol-based handrub
AMR antimicrobial resistance
CDC Centers for Disease Control and Prevention (USA)
CP carbapenemase-producing
CPE carbapenemase-producing Enterobacteriaceae
EQAS external quality assurance system
HAI health care-associated infection
HCW health care worker
IPC infection prevention and control
IPCAF infection prevention and control assessment framework
IPCAT infection prevention and control assessment tool
PPE personal protective equipment
SOP standard operating protocols
UNICEF United Nations Children’s Fund
USA United States of America
WASH water, sanitation and hygiene
WASH FIT water, sanitation and hygiene facility improvement tool
WHO World Health Organization

V
GLOSSARY OF KEY TERMS AND DEFINITIONS
GLOSSARY Cohorting: Grouping of patients who are colonized or

infected with the same resistant organism with the aim to
OF KEY TERMS confine their care to one area and prevent contact with other
AND DEFINITIONS susceptible patients (for example, all patients infected or
colonized with a carbapenem-resistant Enterobacteriaceae in
a specific cohort and all patients colonized with methicillin-
resistant Staphylococcus aureus in a different cohort). Cohorts
Alcohol-based handrub: An alcohol-based preparation designed are created based on clinical diagnosis, microbiological
for application to the hands to inactivate microorganisms confirmation with available epidemiology, and the mode of
and/or temporarily suppress their growth. Such preparations transmission of the infectious agent.
may contain one or more types of alcohol and other active
ingredients with excipients and humectants. Cohorting is reserved for situations where there are insufficient
Source: WHO Guidelines on hand hygiene in health care. 2009 single rooms or where the cohorting of patients colonized or
(https://www.who.int/gpsc/5may/tools/9789241597906/en/, infected with the same pathogen is a more efficient use of
accessed 29 October 2019). hospital rooms and resources. Dedicated equipment, toilets and
staff should be used for patients within the cohorted area for
Antimicrobial stewardship: A coherent set of actions which the required time duration.
promote the responsible use of antimicrobials. This definition Sources: Siegel JD, Rhinehart E, Jackson M, Chiarello L,
can be applied to actions at the individual level, as well as the and the Healthcare Infection Control Practices Advisory
national and global level, and across human health, animal Committee. 2007 Guideline for isolation precautions: preventing
health and the environment. transmission of infectious agents in healthcare settings (http://
Source: Dyar OJ, Huttner B, Schouten J, Pulcini C. What www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf, accessed
is antimicrobial stewardship? Clin Microbiol Infect. 29 October 2019).
2017;23(11):793–8. WHO. Guidelines for the prevention and control of carbapenem-
OR resistant Enterobacteriaceae, Acinetobacter baumannii and
The primary goal of antimicrobial stewardship is to optimize Pseudomonas aeruginosa in health care facilities. 2017 (https://
clinical outcomes while minimizing unintended consequences www.who.int/infection-prevention/publications/guidelines-cre/
of antimicrobial use, including toxicity, the selection of en/, accessed 29 October 2019).
pathogenic organisms (such as Clostridium difficile) and the
emergence of resistance. Carbapenem resistance (including carbapenemase-producing
Source: Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, [CP]): Carbapenem resistance among Enterobacteriaceae,
Weinstein RA, Burke JP, et al. Infectious Diseases Society Acinetobacter baumannii and Pseudomonas aeruginosa may be
of America and the Society for Healthcare Epidemiology of due to a number of mechanisms. Some strains may be innately
America guidelines for developing an institutional program resistant to carbapenems, while others contain mobile genetic
to enhance antimicrobial stewardship. Clin Infect Dis. elements (for example, plasmids, transposons) that result in
2007;44(2):159–77. the production of carbapenemase enzymes (carbapenemases),
which break down most beta-lactam antibiotics, including
Cleaners (also known as environmental cleaning staff or carbapenems. Frequently, CP genes are co-located with other
environmental services’ technicians): individuals responsible resistance genes, which can result in cross-resistance to many
for performing environmental cleaning in health care facilities other antibiotic drug classes (1-3). Thus, while carbapenem-
who play a key role in maintaining a clean and/or hygienic resistant strains of these pathogens are frequently CP (CP-
environment that facilitates practices related to the prevention Enterobacteriaceae [CPE], CP-A. baumannii, CP-P. aeruginosa),
and control of HAI. they may have other carbapenem resistance mechanisms that
VI
make them equally difficult to treat and manage clinically. Thus, PRIMARY, SECONDARY AND TERTIARY HOSPITALS
the term “carbapenem-resistant Enterobacteriaceae” includes
all strains that are carbapenem-resistant, including CPE. For this Primary-level hospital: Few specialties—mainly internal
reason, infection prevention and control actions should focus medicine, obstetrics and gynaecology, paediatrics and general
on all strains of carbapenem-resistant Enterobacteriaceae, A. surgery, or just general practice; limited laboratory services
baumannii and P. aeruginosa, regardless of their resistance available for general, but not specialized, pathological analysis.
mechanism. Adequate infection prevention and control
measures are essential in both outbreak and endemic settings. Secondary-level hospital: Highly differentiated by its function
Source: WHO. Guidelines for the prevention and control of with 5 to 10 clinical specialties; size ranges from 200 to 800
carbapenem-resistant Enterobacteriaceae, Acinetobacter beds; often referred to as a provincial or district hospital.
baumannii and Pseudomonas aeruginosa in health care
facilities. 2017 (https://www.who.int/infection-prevention/ Tertiary-level hospital: Highly specialized staff and technical
publications/guidelines-cre/en/, accessed 29 October 2019). equipment, for example, cardiology, intensive care unit and
specialized imaging units; clinical services highly differentiated
Decontamination of medical devices: Removes soil and by function; may have teaching activities; size ranges from 300
pathogenic microorganisms from objects so they are safe to to 1500 beds; often referred to as a teaching or university or
handle, subject to further processing, use or discard (see also regional hospital.
Reprocessing). Source: WHO. Disease control priorities in developing
Source: United States Centers for Disease Control and countries. 2008 (https://www.who.int/management/facility/
Prevention. Guidelines for disinfection and sterilization ReferralDefinitions.pdf, accessed 29 October 2019).
in healthcare facilities. 2008 (https://www.cdc.gov/
infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf, Improved sanitation facilities: Toilet facilities that hygienically
accessed 29 October 2019). separate human excreta from human contact. Examples include
flush/pour flush to a piped sewer system, septic tank or pit
Hand hygiene: A general term referring to any action of hand latrine,
cleansing, that is, the action of performing hand hygiene for the ventilated pit latrine, pit latrine with slab or composting toilet.
purpose of physically or mechanically removing dirt, organic Source: WHO/UNICEF. Core questions and indicators for
material, and/or microorganisms. monitoring WASH in health care facilities in the Sustainable
Source: WHO guidelines on hand hygiene in health care. 2009 Development Goals. 2018 (https://apps.who.int/iris/bitstream/
(https://www.who.int/gpsc/5may/tools/9789241597906/en/, handle/10665/275783/9789241514545-eng.pdf?ua=1,
accessed 29 October 2019). accessed 29 October 2019).
HEALTH CARE FACILITIES’ CLASSIFICATION Improved water source: Defined by the WHO/UNICEF Fund
Joint Monitoring Programme as a water source that by its
Primary health care facilities: Facilities that provide outpatient nature of construction adequately protects the source from
services, family planning, antenatal care, maternal, newborn and outside contamination, particularly faecal matter. Examples
child health services (including delivery), for example, health include: public taps or standpipes; protected dug wells; tube
centres, health posts and small district hospitals. wells; or boreholes.
Source: WHO. Water and sanitation for health facility Source: WHO/UNICEF. Progress on sanitation and drinking
improvement tool (WASH FIT). 2017 (https://apps.who.int/iris/ water. 2015 update and Millennium Development Goals
bitstream/handle/10665/254910/9789241511698-eng. assessment (https://www.unicef.org/publications/
pdf;jsessionid=0A60107AA8F5A27C5FD16B0823D3F4FA?se- index_82419.html, accessed 29 October 2019).
quence=1, accessed 29 October 2019).
VII
Infection prevention and control (IPC) minimum requirements: pharmacy, microbiology or clinical laboratory, waste
IPC standards that should be in place at both national and management, water, sanitation and hygiene services and quality
health facility level to provide minimum protection and safety and safety, where in place.
to patients, health care workers and visitors, based on the Source: WHO. IPCAF (http://www.who.int/infection-prevention/
WHO core components for IPC programmes. The existence tools/core-components/en/, accessed 29 October 2019).
of these requirements constitutes the initial starting point for
building additional critical elements of the IPC core components IPC structural indicators: Appropriate clean and hygienic
according to a stepwise approach based on assessments of the environment, water, sanitation and hygiene services and
local situation. availability of materials and equipment for IPC, in particular
Source: Definition used in this document and developed by the for hand hygiene, including financial, human and information
expert group. resources compatible with standards set out by government
authorities or other bodies responsible for the control and
IPC professional: Health care professional trained in a certified prevention of health care-associated infections.
postgraduate IPC course or a nationally recognized course. Source: WHO. Guidelines on core components of infection
Source: WHO. Infection prevention and control assessment prevention and control programmes at the national and acute
framework tool (IPCAF) (http://www.who.int/infection- health care facility level. 2016 (https://www.who.int/infection-
prevention/tools/core-components/en/, accessed 29 October prevention/publications/core-components/en/, accessed 29
2019). October 2019).
IPC focal point: Professional (nurse, doctor, or other) appointed IPC process indicators: Measurement of compliance with IPC
to be in charge of IPC at the national or facility level who has a activities currently used within the facility and the presence
specific professional background, that is, formal postgraduate of IPC policies, procedures and protocols. Hand hygiene is an
training in IPC leading to the successful achievement of a essential process indicator to be monitored.
certificate or diploma. Source: WHO. Guidelines on core components of infection
Source: WHO. IPCAF (http://www.who.int/infection-prevention/ prevention and control programmes at the national and acute
tools/core-components/en/, accessed 29 October 2019). health care facility level. 2016 (https://www.who.int/infection-
prevention/publications/core-components/en/, accessed 29
IPC link professional: Nurse or doctor in a ward or facility who October 2019).
has been trained in IPC (using a nationally approved in-service
training package; no postgraduate certificate/diploma required) Multimodal strategy: A multimodal strategy comprises
and links to an IPC focal point/team at a higher level in the several components or elements (three or more, usually five)
organization (for example, IPC focal point/team in the facility implemented in an integrated way with the aim of improving
or at the district level). IPC is not the primary assignment of an outcome and changing behaviour. It includes tools, such
this professional but, among others, he/she may undertake as bundles and checklists, developed by multidisciplinary
the following tasks: support implementation of IPC practices; teams that take into account local conditions. The five most
provide mentorship to colleagues; undertake monitoring common elements include: (i) system change (availability of
activities; and alert on possible infectious risks. the appropriate infrastructure and supplies to enable infection
prevention and control good practices); (ii) education and
IPC committee: A multidisciplinary group with interested training of health care workers and key players (for example,
stakeholders across the facility, which interacts with and managers); (iii) monitoring infrastructures, practices, processes,
advises the IPC team. For example, the IPC committee could outcomes and providing data feedback; (iv) reminders in the
include senior facility leadership; senior clinical staff; leads workplace/communications; and (v) culture change within the
of other relevant complementary areas, such as biosafety, establishment or the strengthening of a safety climate.
VIII
Source: WHO. Improving infection prevention and control at the Source: WHO Guidelines on hand hygiene in health care. 2009
health facility. 2018 (https://www.who.int/infection-prevention/ (https://www.who.int/gpsc/5may/tools/9789241597906/en/,
tools/core-components/facility-manual.pdf, accessed 29 accessed 29 October 2019).
October 2019).
Positive pressure mechanical ventilation system: A mechanical
Negative pressure mechanical ventilation system: ventilation system in which the supply airflow rate is greater than
A mechanical ventilation system in which the exhaust airflow the exhaust airflow rate. The room will be at a higher pressure
rate is greater than the supply airflow rate. The room will be at a than the surrounding areas.
lower pressure than the surrounding areas. Source: WHO. Natural ventilation for infection control in health-
Source: WHO. WHO guidelines on tuberculosis infection care settings. 2009 (https://www.who.int/water_sanitation_
prevention and control. 2019 (https://apps.who.int/iris/ health/publications/natural_ventilation.pdf, accessed 29
bitstream/handle/10665/311259/9789241550512-eng. October 2019).
pdf?ua=1, accessed 29 October 2019).
Protocol: Detailed plan of a scientific or medical experiment,
Patient zone: Concept related to the ‘geographical’ visualization treatment or procedure.
of key moments for hand hygiene. It contains the patient X and
his/her immediate surroundings. This typically includes the Reprocessing of medical devices: All steps that are necessary
intact skin of the patient and all inanimate surfaces that are to make a contaminated reusable medical device ready for its
touched by or in direct physical contact with the patient, such intended use. These steps may include cleaning, functional
as the bed rails, bedside table, bed linen, infusion tubing and testing, packaging, labelling, disinfection and sterilization.
other medical equipment. It also contains surfaces frequently Source: WHO. Decontamination and reprocessing of medical
touched by health care workers while caring for the patient, devices for health care facilities. 2016 (https://www.who.int/
such as monitors, knobs and buttons, and other ‘high frequency’ infection-prevention/en/, accessed 29 October 2019).
touch surfaces.
Source: WHO Guidelines on hand hygiene in health care. 2009 Standard operating procedure: Set of step-by-step instructions
(https://www.who.int/gpsc/5may/tools/9789241597906/en/, compiled by an organization to help workers carry out routine
accessed 29 October 2019). operations in the most effective manner.
Personal protective equipment: Specialized clothing or Standard precautions: A set of activities designed to prevent
equipment worn to protect the health care worker or any other the transmission of organisms between patients/staff for the
person from infection. These usually consist of standard prevention of health care-associated infection. They must be
precautions: gloves, mask and gown. If bloodborne or airborne applied to ALL patients who require health care, by ALL health
infections, these will include face protection, goggles and mask workers in ALL health settings. They include: hand hygiene; use
or face shield, gloves, gown or coverall, head cover and rubber of personal protective equipment; handling and disposal of waste
boots. and sharps; handling and management of clean and used linen;
Source: WHO. Medical devices. 2014 (https://www.who.int/ environmental cleaning; and decontamination of equipment.
medical_devices/meddev_ppe/en/, accessed 29 October Source: The Northern Ireland Regional Infection and Prevention
2019). Control Manual. Standard precautions. Updated 2015 (https://
www.niinfectioncontrolmanual.net/standard-precautions,
Point of care: The place where three elements come together: accessed 29 October 2019).
the patient, the health care worker and care or treatment
involving contact with the patient or his/her surroundings Transmission-based precautions: Additional measures focused
(within the patient zone). on the particular mode of transmission of the microrganism and
IX
always used in addition to standard precautions. They are

grouped into categories according to the route of transmission
of the infectious agent. Transmission-based precautions should
be applied when caring for patients with known infection,
patients who are colonized with an infectious organism, and
asymptomatic patients who are suspected of/under
investigation for colonization or infection with an infectious
microorganism.
Source: The Northern Ireland Regional Infection and Prevention
Control Manual. Transmission-based precautions. Updated
2015 (https://www.niinfectioncontrolmanual.net/transmission-
based-precautions, accessed 29 October 2019).
Water quality: The quality of water is affected by microbial,

chemical and radiological aspects, with microbial aspects
constituting the principle concern for infection control in health
care settings. Water in health care facilities should not present
a risk to health from pathogens and should be protected from
contamination inside the health care setting itself. Water for
drinking, cooking, personal hygiene, medical activities, cleaning
and laundry must be safe for the purpose intended. ‘Safe’
water is water that meets national and/or WHO water quality
guidelines, including zero Escherichia coli or thermotolerant
coliform bacteria in any 100-millilitre sample of drinking water.
Source: WHO. Drinking water quality guidelines. 2017 (https://
www.who.int/water_sanitation_health/publications/drinking-
water-quality-guidelines-4-including-1st-addendum/en/,
accessed 29 October 2019).
X
KEY TO SYMBOLS
KEY TO SYMBOLS
Visual representation of the WHO core components of

infection prevention and control (IPC) programmes at
the national and health care facility level.
Visual representation of minimum versus full

requirements of the core components to achieve
effective IPC programmes.
Key people to be involved in an activity.
Process undertaken to develop the document.
How the document is structured.
Achieving the effective implementation of the IPC

core components.
Content relevant for the national level.
Content relevant for the health care facility level.

1
PART 1. INTRODUCTION
Preventing harm to patients, health workers and visitors due to infection in

health care facilities is fundamental to achieve quality care, patient safety,
health security and the reduction of health care-associated infections (HAIs)
and antimicrobial resistance (AMR). Similarly, preventing and reducing
the transmission of infectious diseases that pose global threats, such as
pandemic influenza, Ebola virus disease and other viral haemorrhagic fevers,
Why should health
is paramount. Clean, safe care is a patient right and should also be the
systems have strong
duty and pride of all those working in the health care sector. Supported by
infection prevention and many stakeholders in the field of IPC, WHO has issued recommendations
control (IPC) programmes? and specifications for effective IPC programmes. These are included in the
evidence-based WHO Guidelines on core components of IPC programmes (1)
and the approach for their implementation is presented in associated manuals
for both the national and facility levels (2, 3).
IPC is a cross-cutting issue in health care. Strong, effective IPC programmes

have the ability to influence the quality of care, improve patient safety and
protect all those providing care in the health system. The implementation of all
WHO recommendations on core components is required to build functioning
programmes leading to the effective reduction of HAIs and AMR. However,
fulfilment of all IPC core components takes time. For some countries, it may be
a demanding journey that will need to build upon a realistic, stepwise approach.
In particular for countries where IPC is limited or inexistent, it is critical to start
by ensuring that at least minimum requirements for IPC are in place as soon as
possible, both at the national and facility level, and to gradually progress to the
full achievement of all requirements of the IPC core components according to
local priority plans. Patients and health care workers (HCWs) need to be safe
and protected at all times, no matter where and irrespective of the context.
The eight core components of IPC are the ‘wheels of the cart’ that will ensure
patients have a safe journey while in a health care facility.
2
1.1 PURPOSE OF THE DOCUMENT
The purpose of this document is to present and promote the minimum

requirements for IPC programmes at the national and health care facility level,
identified by expert consensus according to available evidence and in the
What are the minimum context of the WHO core components.
requirements for IPC
programmes?
The minimum requirements are defined as:
IPC standards that should be in place at the national and

facility level to provide minimum protection and safety
to patients, HCWs and visitors, based on the WHO core
components for IPC programmes.
1.2 TARGET AUDIENCE
The main target audience of this document are IPC and

Who should implement AMR focal points/leads, policy-makers, senior managers
the minimum requirements and other professionals with the mandate of or interested
for IPC programmes? in developing or strengthening IPC programmes at the
national, sub-national and facility level.
IPC teams and committees are also the critical target audience of this
document. Key players in addressing each of the minimum requirements are
also indicated in the specific chapters related to each core component.
The document could also be helpful to other stakeholders, such as those

responsible for health care quality improvement, patient safety, health
facility accreditation/regulation, public health, infectious disease control
and surveillance, water, sanitation and hygiene (WASH), occupational
3
health, antimicrobial stewardship programmes, clinical microbiology and

environmental health interventions, as well as additional categories of
health care professionals involved in care delivery. WHO staff, partners
in nongovernmental organizations and donors involved in supporting the
development or implementation of IPC and WASH capacity building, AMR
national action plans and, the core capacities of the International Health
Regulations at country level (4), will also benefit from using this document.
Of note, IPC implementation is the responsibility of all HCWs and not the sole
responsibility of the IPC teams or policy-makers. Therefore, it is important that
all HCWs are made aware of the IPC minimum requirements. Consideration
should be given to providing an active orientation on IPC minimum
requirements (for example, pre-service training, updates within annual in-
service training, etc.) to health workers, based on the different areas of work
and functions.
1.3 DOCUMENT DEVELOPMENT AND STRUCTURE
A group of international experts and professionals working at national and

How was this document facility levels in the field of IPC was convened by WHO, with support by the
developed? United States Centers for Disease Control and Prevention and the Africa
Centre for Disease Control and Prevention. Plenary sessions were held to
identify the objectives and scope of the project and to define the concept of
minimum requirements. Working groups were formed to identify minimum
requirements for each IPC core component at the national and the health
facility levels, based on existing IPC and WASH recommendations and
standards. For the purpose of this work, health facilities were categorized
as primary health care facilities, secondary health care facilities (including
primary and secondary hospitals) and tertiary health care facilities (tertiary
hospitals). Based on proposals by the working groups, all participants
expressed their opinion on the minimum requirements by voting. Only
those identified with >70% consensus was accepted and included in this
document. The cut-off of 70% was based on evidence from studies on
consensus building to ensure a high consensus rate among the expert group
(5-7). Mention is made of requirements with a lower level of consensus in
the rationale (‘why’) sections of each minimum requirements’ chapter. A
second round of review of the minimum requirements’ content and language
was undertaken with the participants after the international meeting. Finally,
international experts and WHO staff not participating in the meeting were
asked to provide an external review and input to the final draft document.
4
The document includes four parts.

Part 1 is an introduction that includes sections of paramount importance
to understand the remaining content of the document and the minimum
requirements for IPC programmes.
The minimum requirements are summarized in Part 2 of this document,
How is this document together with the WHO evidence-based recommendations for each IPC core
structured? component (1).
Part 3 is an in-depth review exploration of each core component and its
minimum requirements for the national and health care facility levels (Box 1).
Part 4 includes summaries of the results of a systematic review and
inventory of available pubblications IPC minimum standards, used as the
evidence basis for the development of this document.
BOX 1 STRUCTURE OF THE MINIMUM REQUIREMENTS (PART 3)
FULL
WHAT WHO HOW WHY
REQUIREMENTS
Rationale and
Minimum Is responsible To measure additional details Full core component
requirements for action progress on the minimum requirements
requirements
Text of the minimum Identification of Indicators to be Explanations Comprehensive

requirements for each those who have the used to track about the reasons list of the actions
IPC core component mandate to ensure implementation and for selecting the and requirements*
identified by expert that the minimum progress for each agreed minimum to achieve full
consensus according requirements are put minimum requirement requirements implementation
to national and health in place and sustained are available from (rationale) and of each IPC core
care facility level and or can play a role. different WHO additional details component.
based on existing monitoring tools. explaining their Note that these
IPC and WASH content and exist only for acute
recommendations importance. care hospitals
and standards. because the WHO
recommendations on
IPC core components
apply mainly to these
facilities and not
specifically to primary
care facilities.
* Note that in some cases, there are no major differences compared to the minimum requirements.
5
1.4 ROLE OF THE MINIMUM REQUIREMENTS
It is important to note that the gold standard in any country

How can the minimum is to achieve the full implementation of all requirements of
requirements help achieve the WHO core components of IPC programmes (Fig. 1) (1).
effective implementation of
the IPC core components?
For this reason, governments and facilities should take steps to work towards
this goal, including in the context of national action plans for AMR, quality of
care and health security.
Fig. 1
Visual representation
of the WHO core components
of IPC programmes.
IPC PROGRAMMES
and all relevant programme linkages
MONITORING,
GUIDELINES EDUCATION SURVEILLANCE AUDIT AND
AND TRAINING
FEEDBACK
ENABLING ENVIRONMENT
WORKLOAD, STAFFING, AND BED OCCUPANCY
BUILT ENVIRONMENT, MATERIALS AND EQUIPMENT
MUL ES
TI M O D AL S TR ATE GI
6
The approach to facilitate implementation of the WHO core components,

together with real-life examples from countries and facilities around the world,
is described in the WHO practical manuals developed for the national and
facility levels (2, 3).
Anyone interested in understanding and implementing

the minimum requirements should read the WHO
Guidelines on core components of IPC programmes (1)
and the manuals supporting their implementation at the
national and facility levels (2, 3).
However, it is recognized that countries may be at different levels of progress,

with different capacities, available opportunities and resources.
Thus, the minimum requirements represent the starting

point for undertaking the journey to build strong and
effective IPC programmes at the national and facility
level (Fig. 2) and SHOULD be in place for all countries
and health care facilities to support further progress
towards full implementation of all core components.
Fig. 2
Minimum versus full
requirements to achieve
effective IPC programmes.
7
Whether applying the minimum requirements or full requirements, the

implementation of the IPC core components should always be tackled using
a stepwise approach, based on a careful assessment of the status of the
IPC programme and activities locally. A country or a health facility may not
be able to aim at putting in place all core components or even all minimum
requirements at the same time. Therefore, when preparing to improve IPC, it
is essential to start by using standardized tools and indicators developed and
validated for assessing the status of the core components at the national
or health facility in any country worldwide, regardless of the geographical
location and level of income. Depending on the strengths (core component
requirements/features already in place) and the gaps (requirements/features
not available or in place) identified through the assessment, a prioritization
exercise can then help to identify which core components and minimum or
full requirements need to be targeted through an improvement action plan
tailored to the local context, expertise and resources available. To undertake
this process, WHO proposes a five-step cycle of implementation (Fig. 3 and Box
2) to support any IPC improvement intervention or programme as described
further in the practical manuals (2, 3, 8).
Fig. 3
The five-step cycle to IPC
improvement.
Step 5
Sustaining the
Step 1
programme
Preparing for
over the
action
long term
Multimodal
improvement strategy
embedded within each step
in the cycle of
continuous Step 2
Step 4
improvement Baseline
Evaluating
assessment
impact
Step 3
Developing
and executing
an action plan
8
BOX 2 THE FIVE-STEP CYCLE TO INFECTION PREVENTION AND CONTROL IMPROVEMENT
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5
Developing Sustaining
Baseline
Preparing for action and executing Assessing impact the programme
assessment
an action plan over the long term
This step aims to Conducting an Developing a tailor- Conducting a follow- Further review of the
ensure that all of the objective baseline made action plan that up assessment using long term impact
prerequisites that assessment of the addresses the local the same tools as and acceptability of
need to be in place current situation reality and focuses in step 2 is crucial the ongoing action
for the success of of the IPC core on the priority areas to determine the plan, and ensuring
an IPC intervention components for improvement effectiveness of the its sustainability, are
or programme are and minimum identified through the plan and achievement important steps in the
considered. These requirements is baseline assessment. of the minimum cycle of improvement.
include starting critical for the The development and requirements. This allows also an
to think about the identification of execution of an action evaluation of the next
identification of key existing strengths and plan should be based steps and priorities
players and their roles gaps. Standardized upon a multimodal for implementation
and responsibilities, and validated improvement strategy of all minimum
as well as the assessment and supported by a requirements and the
necessary resources indicators and dedicated budget. IPC core components
(human and financial), tools available from in full.
infrastructure/s, WHO are listed in
planning and Part 3. The national
coordination of and facility level
activities. Of note, standardized tools to
the preparations assess the IPC core
made can be refined components and
through step 3 after WASH are described
conducting step 2. in Boxes 3-5.
BOX 3 NATIONAL INFECTION PREVENTION AND CONTROL ASSESSMENT TOOL 2 (IPCAT2) (9)
Type of tool Who should

Structure
and purpose complete it
Standardized assessment tool IPCAT2 includes six sections correspond- The tool is intended to be used for
designed to determine the IPC ing to the six core component recommen- self-assessment by the national IPC
core components already in place dations targeted at the national level, with team and/or committee, but it can
(existing strengths) and to identify an associated scoring system. also be used for joint assessments
gaps or weaknesses at the national with external experts or external
level. The main purpose of IPCAT2 is assessments.
to support implementation, thereby
providing a road map to guide IPC
actions.
9
BOX 4 FACILITY INFECTION PREVENTION AND CONTROL ASSESSMENT FRAMEWORK (IPCAF) (10)

Structure
Validated assessment tool designed Structured, closed-formatted The tool is meant to be completed
to measure the IPC situation of a questionnaire with an associated by health care professionals
health care facility and determine the scoring system, which includes eight responsible for organising and
core components already in place sections corresponding to the eight core implementing IPC measures and
(existing strengths) and to identify component recommendations targeted at who have in-depth knowledge of IPC
gaps or weaknesses to guide action the facility level. at the facility level (IPC focal point or
planning. team or committee), but it can also
be used for joint assessments with
or external assessments by external
experts.
BOX 5 WASH FIT (11)

Structure
Improvement tool to be used on WASH FIT covers four broad areas: The tool is meant to be used by
a continuous and regular basis water, sanitation (including health care health care facility managers and
to help health care facility staff waste management), hygiene (hand staff including the chief medical
and administrators prioritize and hygiene and environmental cleaning) and officer, the financial administrator,
improve WASH and health care management. doctors, nurses and persons in
waste management infrastructures charge of managing water and
and services in facilities in low- and waste. Other people outside the
middle-income countries; and to facility may also be involved, such
inform broader district, regional and as local, district and regional WASH
national efforts to improve quality and/or public works authorities,
health care. WASH FIT complements representatives from the community,
the IPCAF and provides a greater local and regional government
depth of information on the built authorities involved in implementing
environment. national quality health care, IPC
and maternal, newborn and child
health strategies, donors, and
nongovernmental organizations
(NGOs).
10
1.5 REFERENCES
1. Guidelines on core components of infection prevention and control

programmes at the national and acute health care facility level. Geneva:
World Health Organization; 2016 (http://www.who.int/infection-prevention/
publications/ipc-components-guidelines/en/, accessed 29 October 2019).
2. Interim Practical Manual supporting national implementation of the
WHO guidelines on core components of infection prevention and control
programmes. Geneva: World Health Organization; 2017 (http://www.who.int/
infection-prevention/tools/core-components/cc-implementation-guideline.
pdf, accessed 29 October 2019).
3. Improving infection prevention and control at the health facility: Interim
practical manual supporting implementation of the WHO guidelines on core
components of infection prevention and control programmes. Geneva: World
Health Organization; 2018 (http://www.who.int/infection-prevention/tools/
core-components/facility-manual.pdf, accessed 29 October 2019).
4. International Health Regulations (2005). Assessment tool for core capacity
requirements at designated airports, ports and ground crossings. Geneva:
World Health Organization; 2009 (https://www.who.int/ihr/ports_airports/
PoE/en/, accessed 29 October 2019).
5. Vogel C ZS, Griffiths C, Hobbs M, Henderson E, Wilkins E. A Delphi study to
build consensus on the definition and use of big data in obesity research. Int
J Obesity 2019; Jan 17 [Epub ahead of print].
6. Slade SC, Dionne CE, Underwood M, Buchbinder R. Standardised method for
reporting exercise programmes: protocol for a modified Delphi study. BMJ
Open. 2014: e006682.
7. Diamond IR, Grant CR, Feldman BM, Pencharz PB, Ling SC, Moore AM, et al.
Defining consensus: a systematic review recommends methodologic criteria
for reporting of Delphi studies. J Clin Epidemiol. 2014;67:401–09.
8. Infection prevention and control: core components for IPC - implementation
tools and resources. Geneva: World Health Organization; 2019 (https://www.
who.int/infection-prevention/tools/core-components/en, accessed 29
October 2019).
9. Infection prevention and control assessment tool (IPCAT2). Geneva: World
Health Organization; 2017 (http://www.who.int/infection-prevention/tools/
core-components/IPCAT2.xls, accessed 29 October 2019).
10. Infection prevention and control assessment framework. Geneva: World
Health Organization; 2018 (https://www.who.int/infection-prevention/tools/
core-components/IPCAF-facility.PDF, accessed 29 October 2019).
11. Water and sanitation for health facility improvement tool (WASH FIT).
Geneva: World Health Organization; 2018 (https://apps.who.int/iris/
bitstream/handle/10665/254910/9789241511698-eng.pdf?sequence=1,
13
PART 2. EXECUTIVE SUMMARY OF THE MINIMUM REQUIREMENTS BY CORE COMPONENT
PART 2. EXECUTIVE SUMMARY OF THE MINIMUM REQUIREMENTS

BY CORE COMPONENT
CORE COMPONENT 1:
IPC PROGRAMMES
NATIONAL LEVEL FACILITY LEVEL
Active, stand-alone, national IPC programmes The panel recommends that an IPC programme
CORE COMPONENT with clearly defined objectives, functions and with a dedicated, trained team should be in
RECOMMENDATION activities should be established for the purpose place in each acute health care facility for the
of preventing HAI, promoting patient safety and purpose of preventing HAI and combating AMR
combating AMR through IPC good practices. through IPC good practices.
National IPC programmes should be linked
with other relevant national programmes and
professional organizations.
A functional IPC programme should be in PRIMARY CARE:

MINIMUM
place, including at least: IPC trained health care officer
REQUIREMENTS
• one full-time focal point trained in IPC. • Trained IPC link person, with dedicated
• a dedicated budget for implementing IPC (part-) time in each primary health care
strategies/plans. facility.
• One IPC-trained health care officer
at the next administrative level (for
example, district) to supervise the IPC
link professionals in primary health care
facilities.
SECONDARY CARE:
functional IPC programme
• Trained IPC focal point (one full-time trained
IPC Officer [nurse or doctor]) as per the
recommended ratio of 1:250 beds with
dedicated time to carry out IPC activities
in all facilities (for example, if the facility
has 120 beds, one 50% full-time equivalent
dedicated officer).
• Dedicated budget for IPC implementation.
TERTIARY CARE:
functional IPC programme
• At least one full-time trained IPC focal
point (nurse or doctor) with dedicated time
per 250 beds.
• IPC programme aligned with the national
programme and with a dedicated budget.
• Multidisciplinary committee/team.
• Access to microbiology laboratory.
14
CORE COMPONENT 2:
IPC GUIDELINES
NATIONAL LEVEL AND FACILITY LEVEL
The panel recommends that evidence-based guidelines should be developed and implemented for
CORE COMPONENT the purpose of reducing HAI and AMR. The education and training of relevant HCWs on the guideline
RECOMMENDATION recommendations and the monitoring of adherence with guideline recommendations should be
undertaken to achieve successful implementation.
National IPC guidelines PRIMARY CARE:

MINIMUM
REQUIREMENTS
• Evidence-based, ministry-approved facility-adapted standard operating
guidelines adapted to the local context and procedures (SOPs) and their monitoring
reviewed at least every five years. • Evidence-based facility-adapted SOPs
based on the national IPC guidelines.
• At a minimum, the facility SOPs should
include:
‐ hand hygiene
‐ decontamination of medical devices
and patient care equipment
‐ environmental cleaning
‐ health care waste management
‐ injection safety
‐ HCW protection (for example, post-
exposure prophylaxis, vaccinations)
‐ aseptic techniques
‐ triage of infectious patients
‐ basic principles of standard and
transmission-based precautions.
• Routine monitoring of the implementation
of at least some of the IPC guidelines/
SOPs.
SECONDARY AND TERTIARY CARE:

all requirements as for the primary health
care facility level, with additional SOPs on:
• standard and transmission-based
precautions (for example, detailed, specific
SOPs for the prevention of airborne
pathogen transmission);
• septic technique for invasive procedures,
including surgery;
• specific SOPs to prevent the most
prevalent HAIs based on the local context/
epidemiology;
• occupational health (specific detailed
SOP).
15
CORE COMPONENT 3:
IPC EDUCATION AND TRAINING
The national IPC programme should support The panel recommends that IPC education
CORE COMPONENT education and training of the health workforce should be in place for all HCWs by using team-
RECOMMENDATION as one of its core functions. and task-based strategies that are participatory
and include bedside and simulation training to
reduce the risk of HAI and AMR.
National training policy and curriculum PRIMARY CARE:

MINIMUM
REQUIREMENTS
• National policy that all HCWs are trained in IPC training for all front-line clinical staff
IPC (in-service training). and cleaners upon hiring
• An approved IPC national curriculum aligned • All front-line clinical staff and cleaners
with national guidelines and endorsed by the must receive education and training on
appropriate body. the facility IPC guidelines/SOPs upon
• National system and schedule of monitoring employment.
and evaluation to check on the effectiveness • All IPC link persons in primary care
of IPC training and education (at least facilities and IPC officers at the district
annually). level (or other administrative level) need to
receive specific IPC training.
SECONDARY CARE:
IPC training for all front-line clinical staff
and cleaners upon hire
• All front-line clinical staff and cleaners
must receive education and training on
the facility IPC guidelines/SOPs upon
employment.
• All IPC staff need to receive specific IPC
training.
TERTIARY CARE:
IPC training for all front-line clinical staff
and cleaners upon hire and annually
• All front-line clinical staff and cleaners
must receive education and training on
the facility IPC guidelines/SOPs upon
employment and annually.
• All IPC staff need to receive specific IPC
training.
16
CORE COMPONENT 4:
HAI SURVEILLANCE
The panel recommends that national HAI The panel recommends that facility-based HAI
CORE COMPONENT surveillance programmes and networks surveillance should be performed to guide IPC
RECOMMENDATION that include mechanisms for timely data interventions and detect outbreaks, including
feedback and with the potential to be used for AMR surveillance, with timely feedback of results
benchmarking purposes should be established to HCWs and stakeholders and through national
to reduce HAI and AMR. networks.
IPC surveillance and a monitoring technical PRIMARY CARE

MINIMUM
REQUIREMENTS
group • HAI surveillance is not required as a
• Establishment by the national IPC focal point minimum requirement at the primary
of a technical group for HAI surveillance and facility level, but should follow national
IPC monitoring that: or sub-national plans, if available (for
‐ is multidisciplinary; example, detection and reporting of
‐ develops a national strategic plan for outbreaks affecting the community is
HAI surveillance (with a focus on priority usually included in national plans).
infections based on the local context)
and IPC monitoring. SECONDARY CARE
• HAI surveillance should follow national or
sub-national plans.
TERTIARY CARE:
functional HAI surveillance
• Active HAI surveillance should be
conducted and include information on
AMR:
‐ enabling structures and supporting
resources need to be in place (for
example, dependable laboratories,
medical records, trained staff),
directed by an appropriate method of
surveillance;
‐ the method of surveillance should be
directed by the priorities/plans of the
facility and/or country.
• Timely and regular feedback needs to be
provided to key stakeholders in order to
lead to appropriate action, in particular to
the hospital administration.
17
CORE COMPONENT 5:
MULTIMODAL STRATEGIES
The panel recommends that national IPC The panel recommends that IPC activities using
CORE COMPONENT programmes should coordinate and facilitate multimodal strategies should be implemented to
RECOMMENDATION the implementation of IPC activities through improve practices and reduce HAI and AMR.
multimodal strategies on a nationwide or sub-
national level.
Multimodal improvement strategies for IPC PRIMARY CARE:

MINIMUM
interventions multimodal strategies for priority IPC
REQUIREMENTS
• Use of multimodal strategies to implement interventions
IPC interventions according to national • Use of multimodal strategies – at the
guidelines/SOPs under the coordination very least to implement interventions
of the national IPC focal point (or team, if to improve hand hygiene, safe injection
existing). practices, decontamination of medical
instruments, devices and environmental
cleaning.
SECONDARY CARE:
multimodal strategies for priority IPC
interventions
• Use of multimodal strategies – at the
very least to implement interventions to
improve each one of the standard and
transmission-based precautions, and
triage.
TERTIARY CARE:
multimodal strategies for all IPC
interventions
• Use of multimodal strategies to implement
interventions to improve each one of
the standard and transmission-based
precautions, triage, and those targeted
at the reduction of specific infections
(for example, surgical site infections or
catheter-associated infections) in high-
risk areas/patient groups, in line with local
priorities.
18
CORE COMPONENT 6:
MONITORING, AUDITING AND FEEDBACK
The panel recommends that a national IPC The panel recommends that regular monitoring/
CORE COMPONENT monitoring and evaluation programme should audit and timely feedback of health care practices
RECOMMENDATION be established to assess the extent to which according to IPC standards should be performed
standards are being met and activities are to prevent and control HAI and AMR at the health
being performed according to the programme’s care facility level. Feedback should be provided to
goals and objectives. Hand hygiene monitoring all audited persons and relevant staff.
with feedback should be considered as a key
performance indicator at the national level.
IPC surveillance and monitoring technical PRIMARY CARE

MINIMUM
REQUIREMENTS
group • Monitoring of IPC structural and process
• Establishment by the national IPC focal point indicators should be put in place at
of a technical group for HAI surveillance and primary care level, based on IPC priorities
IPC monitoring that: identified in the other components. This
‐ is multidisciplinary; requires decisions at the national level
‐ develops a national strategic plan for HAI and implementation support at the sub-
surveillance and IPC monitoring and, for national level.
IPC indicators monitoring:
· develops recommendations for SECONDARY AND TERTIARY CARE
minimum indicators (for example, • A person responsible for the conduct of
hand hygiene); the periodic or continuous monitoring
· develops an integrated system for the of selected indicators for process and
collection and analysis of data (for structure, informed by the priorities of the
example, protocols, tools) facility or the country.
· provides training at the facility level to • Hand hygiene is an essential process
collect and analyse these data. indicator to be monitored.
• Timely and regular feedback needs to be
provided to key stakeholders in order to
lead to appropriate action, particularly to
19
CORE COMPONENT 7:
WORKLOAD, STAFFING AND BED OCCUPANCY (FACILITY LEVEL ONLY*)
FACILITY LEVEL*
The panel recommends that the following elements should be adhered to in order to reduce the risk
CORE COMPONENT
RECOMMENDATION of HAI and the spread of AMR: (1) bed occupancy should not exceed the standard capacity of the
facility; (2) HCW staffing levels should be adequately assigned according to patient workload.
PRIMARY CARE
MINIMUM
REQUIREMENTS
• To reduce overcrowding: a system for patient flow, a triage system (including referral system)
and a system for the management of consultations should be established according to existing
guidelines, if available.
• To optimize staffing levels: assessment of appropriate staffing levels, depending on the
categories identified when using WHO/national tools (national norms on patient/staff ratio),
and development of an appropriate plan.
SECONDARY AND TERTIARY CARE

• To standardize bed occupancy:
‐ establish a system to manage the use of space in the facility and to establish the standard
bed capacity for the facility;
‐ hospital administration enforcement of the system developed;
‐ no more than one patient per bed;
‐ spacing of at least one metre between the edges of beds;
‐ overall occupancy should not exceed the designed total bed capacity of the facility.
• To reduce overcrowding and optimizing staffing levels: same minimum requirements as for
primary health care.
* The national health system, IPC programme and any other relevant body should coordinate and support the implementation of this core component at the facility level.
20
CORE COMPONENT 8: BUILT ENVIRONMENT, MATERIALS

AND EQUIPMENT FOR IPC (FACILITY LEVEL ONLY*)
FACILITY LEVEL
Patient care activities should be undertaken in a clean and hygienic environment that facilitates
CORE COMPONENT practices related to the prevention and control of HAI, as well as AMR, including all elements around
RECOMMENDATION WASH infrastructure and services and the availability of appropriate IPC materials and equipment.
The panel recommends that materials and equipment to perform appropriate hand hygiene should
be readily available at each point of care.
PRIMARY CARE:
MINIMUM • Water should always be available from a source on the premises (such as a a deep borehole or
REQUIREMENTS a treated, safely managed piped water supply) to perform basic IPC measures, including hand
hygiene, environmental cleaning, laundry, decontamination of medical devices and health care
waste management according to national guidelines.
• A minimum of two functional, improved sanitation facilities should be available on-site, one for
patients and the other for staff; both should be equipped with menstrual hygiene facilities.
• Functional hand hygiene facilities should always be available at points of care/toilets and include
soap, water and single-use towels (or if unavailable, clean reusable towels) or alcohol-based
handrub (ABHR) at points of care and soap, water and single-use towels (or if unavailable, clean
reusable towels) within 5 metres of toilets.
• Sufficient and appropriately labelled bins to allow for health care waste segregation should
be available and used (less than 5 metres from point of generation); waste should be treated
and disposed of safely via autoclaving, high temperature incineration, and/or buried in a lined,
protected pit.
• The facility layout should allow adequate natural ventilation, decontamination of reusable
medical devices, triage and space for temporary cohorting/isolation/physical separation if
necessary.
• Sufficient and appropriate IPC supplies and equipment (for example, mops, detergent,
disinfectant, personal protective equipment (PPE) and sterilization) and power/energy (for
example, fuel) should be available for performing all basic IPC measures according to minimum
requirements/SOPs, including all standard precautions, as applicable; lighting should be available
during working hours for providing care.
SECONDARY AND TERTIARY CARE:

• A safe and sufficient quantity of water should be available for all required IPC measures and
specific medical activities, including for drinking, and piped inside the facility at all times - at a
minimum to high-risk wards (for example, maternity ward, operating room/s, intensive care unit).
• A minimum of two functional, improved sanitation facilities that safely contain waste available
for outpatient wards should be available and one per 20 beds for inpatient wards; all should be
equipped with menstrual hygiene facilities.
• Functional hand hygiene facilities should always be available at points of care, toilets and
service areas (for example, the decontamination unit), which include ABHR and soap, water and
single-use towels (or if unavailable, clean reusable towels) at points of care and service areas,
and soap, water and single-use towels (or if unavailable, clean reusable towels) within 5 metres
of toilets.
• Sufficient and appropriately labelled bins to allow for health care waste segregation should be
available and used (less than 5 metres from point of generation) and waste should be treated
and disposed of safely via autoclaving, incineration (850° to 1100°C), and/or buried in a lined,
protected pit.
* The national health system, IPC programme and any other relevant body should coordinate and support the implementation of this core component at the facility level.
21
• The facility should be designed to allow adequate ventilation (natural or mechanical, as

needed) to prevent transmission of pathogens.
• Sufficient and appropriate supplies and equipment and reliable power/energy should be
available for performing all IPC practices, including standard and transmission-based
precautions, according to minimum requirements/SOPs; reliable electricity should be available
to provide lighting to clinical areas for providing continuous and safe care, at a minimum to
high-risk wards (for example, maternity ward, operating room/s, intensive care unit).
• The facility should have a dedicated space/area for performing the decontamination and
reprocessing of medical devices (that is, a decontamination unit) according to minimum
requirements/SOPs.
• The facility should have adequate single isolation rooms or at least one room for cohorting
patients with similar pathogens or syndromes, if the number of isolation rooms is insufficient
23
PART 3. IN-DEPTH REVIEW OF THE MINIMUM REQUIREMENTS
CORE COMPONENT 1:
IPC PROGRAMMES
WHAT (minimum requirements)
A functional IPC programme should be in place, including at least: PRIMARY CARE

• one full-time focal point trained in IPC; IPC-trained link person and health care officer
• a dedicated budget for implementing IPC strategies/plans. • Trained IPC link person, with dedicated (part-) time in each
primary health care facility.
• One IPC-trained health care officer at the next administrative
level (for example, district) to supervise the IPC link
professionals in primary health care facilities.
SECONDARY CARE
Functional IPC programme
• Trained IPC focal point (one full-time trained IPC Officer [nurse
or doctor]) as per the recommended ratio of 1:250 beds
with dedicated time to carry out IPC activities in all facilities
(for example, if the facility has 120 beds, one 50% full-time
equivalent dedicated officer).
• Dedicated budget for IPC implementation.
TERTIARY CARE
Functional IPC programme
• At least one full-time trained IPC focal point (nurse or doctor)
with dedicated time per 250 beds.
• IPC programme aligned with the national programme and with a
dedicated budget.
• Multidisciplinary committee/team.
• Access to microbiology laboratory.
WHO (is responsible for action)
• Minister of health or other assigned senior authority within • All key players mentioned at the national level can influence and/
the ministry of health (for example, Director General of Health or mandate the establishment of IPC link persons, IPC focal points
Services) at national and/or state level. and IPC committees at the health care facility level and of IPC
• Minister of finances may also have an important role in allocating officers at the next administrative level.
a dedicated budget for IPC. • Directors of health or health management teams (or other
• Leads of other programmes where links can be useful for decision-making role) at the district or province or state level (or
synergistic action (for example, HAI, AMR, WASH). other administrative level depending on the country).
• National IPC committee or technical working group, depending on • At secondary and tertiary health care facility level, hospital director,
the country situation as in some countries the committee exists, medical director, chief nurse and finance office director have a
but there is no national IPC focal point or team to take action. critical role in the decision to establish the minimum requirements
Thus, the IPC committee can have a critical role in advocating for for core component 1.
establishing a national IPC focal point. • Existing IPC committee (or similar) at the facility or next
• IPC technical partners have an important role in advocating for and administrative level.
supporting (also financially in some cases) the establishment of an • Local partners have an important role in advocating for and
IPC focal point (for example, WHO country office, WHO Regional supporting (also financially in some cases) the establishment of
Office, UNICEF, United States Centers for Disease Control and IPC minimum requirements at the facility level.
Prevention [CDC], and other organizations with competence and
activities in the field of IPC).
24
HOW (to measure progress)
NATIONAL LEVEL INDICATORS (YES/NO) FACILITY LEVEL INDICATORS (YES/NO)
• IPC assessment tool 2 (IPCAT2) – 1.1.1: an active national IPC PRIMARY CARE
programme exists. • A trained IPC link person, with dedicated time is available in each
• IPCAT2 – 1.1.2: an appointed infection prevention focal person in primary health care facility.
charge of the IPC programme can be identified. • IPC interventions included in the facility annual plan.
• IPCAT2 – 1.1.4: the appointed infection prevention focal person • A trained IPC health care officer is available at the next
has undergone training in IPC in the prevention of HAI. administrative level (for example, district) to supervise the IPC
• IPCAT2 – 1.1.7: there is a dedicated budget allocated to the IPC link professionals.
programme.
SECONDARY CARE
• Infection prevention and control assessment framework tool
(IPCAF) – 1.1: an IPC programme exists.
• IPCAF – 1.3: at least one full-time trained IPC focal person (nurse
or doctor) is in place per 250 beds.
• IPCAF – 1.4: the IPC focal point has dedicated time for IPC
activities in all facilities regardless of the number of beds.
• IPCAF – 1.9: there is a dedicated budget specifically for the IPC
programme, that is, covering IPC activities, including salaries.
TERTIARY CARE
• IPCAF – 1.1: an IPC programme exists.
• IPCAF – 1.3: at least one full-time trained IPC focal person (nurse
or doctor) is in place per 250 beds.
• IPCAF – 1.6: there is a multidisciplinary IPC committee actively
supporting the IPC team.
• IPCAF – 1.9: there is a dedicated budget specifically for the IPC
programme, that is, covering IPC activities, including salaries.
• IPCAF – 1.10: the IPC programme has access to a
microbiological laboratory, either present on- or off-site for
routine day-to-day use.
NATIONAL LEVEL SOURCES AND RESOURCES1 FACILITY LEVEL SOURCES AND RESOURCES
Sources Sources
• IPCAT2 results (where available; use the autogenerated results and • IPCAF results report (where available; use the template
graphics available in the Excel file of IPCAT2); https://www.who. presentation); https://www.who.int/infection-prevention/tools/
int/infection-prevention/tools/core-components/en/. core-components/IPCAF-template.pdf?ua=1.
• WHO. State Party Self-assessment Annual Reporting Tool.
International Health Regulations (2005). 2018; https://www.who. Tools and resources
int/ihr/publications/WHO-WHE-CPI-2018.16/en/. • WHO. Guidelines on core components of IPC programmes at the
• WHO. Joint External Evaluation (JEE) report (where available) 2nd national and acute health care facility level. 2016; https://www.
edition, 2018; https://www.who.int/ihr/procedures/joint-external- who.int/infection-prevention/publications/core-components/en/.
evaluations/en/. • WHO. Improving infection prevention and control at the health
• Food and Agriculture Organization of the United Nations; facility: Interim practical manual supporting implementation of
Organisation for Animal Health; WHO. Global monitoring of the WHO guidelines on core components of infection prevention
country progress on antimicrobial resistance (AMR): Tripartite and control programmes. 2018; https://www.who.int/infection-
AMR country self-assessment survey (TrACSS), version 3.0, report prevention/tools/core-components/facility-manual.pdf.
(where available). 2018; https://www.who.int/antimicrobial- • Twinning partnerships for improvement; https://www.who.int/
resistance/global-action-plan/Tripartite-antimicrobial-resistance- servicedeliverysafety/twinning-partnerships/en/.
country-self-assessment-questionnaire-2018-EN.pdf?ua=1.
1
Sources refers here to possible information that may be available from existing sources that can be used to extract relevant information in order to address each indicator.
Resources lists available relevant implementation tools and resources.
25
Tools and resources

• WHO. Guidelines on core components of IPC programmes at the
national and acute health care facility level (2016); https://www.
who.int/infection-prevention/publications/core-components/en/.
• WHO. Interim practical manual supporting national
implementation of the WHO guidelines on core components of
infection prevention and control programmes. 2018; https://www.
who.int/infection-prevention/tools/core-components/facility-
manual.pdf.
• Association for Professionals in Infection Control and
Epidemiology (APIC). HAI cost calculator; https://apic.org/
resources/cost-calculators/.
• European Centre for Disease Prevention and Control. Core
competencies for infection control and hospital hygiene
professionals in the European Union. 2013; https://ecdc.europa.
eu/sites/portal/files/media/en/publications/Publications/
infection-control-core-competencies.pdf.
WHY (rationale and additional details on the minimum requirements)
• At least one professional (nurse or doctor) must be given the PRIMARY CARE
responsibility of IPC at the national level. He/she should have • The primary health care level is the first main point of entry of
at least basic knowledge and training on IPC (ideally, an IPC infectious pathogens to the health system and it is where IPC is
postgraduate certificate) and some practical experience. usually weakest.
• Once the person is in place, having some resources (budget) is • It is critical to establish at least a basic level of IPC and triage in
essential to operate. primary care (that is, the minimum requirements) to avoid infection
• Based on this, the objectives, functions and activity plan will and AMR spread through the health system, including health care-
be developed by the IPC focal point in collaboration with other associated outbreaks caused by human-to-human transmission of
national programmes and institutions, as well as external partners. emerging or re-remerging pathogens.
• It is important to have professionals in charge of IPC at different
levels (facility and at the next administrative level) to support a
programmatic approach based on coordination, supervision and
accountability through monitoring and evaluation.
• The existence of an IPC programme and practices at the primary
care level will contribute to patient safety and quality of care and
facilitate linkages to the community and dissemination of basic
prevention principles among families, as well as patient and family
engagement.
• The link person should be a staff member at the primary health
care facility level, trained in IPC and with dedicated time (part-time).
• In facilities with more than 10 HCWs, the IPC link person should be
in charge of the following functions: advising on procurement and
maintenance of equipment and consumables for IPC; monitoring
and supervising IPC activities; liaising with the relevant next
administrative level IPC coordinators on the implementation of IPC
activities; liaising with the regular disease notification system for
the reporting of unusual events.
• In facilities with less than 10 HCWs, the link person could have
some of the above-mentioned functions but, overall, more support
from the district officer will be needed, especially for monitoring
activities.

• A comprehensive and functioning IPC programme should be
in place in all acute health care facilities because evidence
demonstrates a large effect on HAI reduction.
• The existence of an IPC focal point and budget are necessary
conditions for building an IPC programme with objectives and
plans, and the necessary premise for any IPC action.
• The number of staff needed depends on patient acuity and the
complexity of care in the facility, as well as the multiple roles and
responsibilities of IPC professionals.
26
Full core component requirements
• Active, stand-alone, national IPC programme with clearly defined PRIMARY CARE
objectives, functions and activities. Not applicable.
• Technical trained IPC team (medical and nursing professionals)
with allocated time, budget and authority to make decisions. SECONDARY AND TERTIARY CARE
• Strong linkages of the national IPC programmes with other • IPC programmes with clearly defined objectives based on local
relevant national programmes and professional organizations. epidemiology and priorities according to risk assessment and
• Supported by at least one national external quality assurance functions that align with and contribute to the prevention of HAI and
system (EQAS) microbiological reference laboratory. the spread of AMR in health care.
• Supported by an official multidisciplinary IPC committee. • Dedicated, trained professionals in every acute care facility.
• A minimum ratio of one full-time or equivalent IPC professional
(nurse or doctor) per 250 beds or a higher ratio (one IPC
professional per 100 beds) due to increased patient acuity
and complexity, as well as the multiple roles and increasing
responsibilities of the IPC professional.
• External quality control system support of the microbiological
laboratory is important for an effective IPC programme.
27
CORE COMPONENT 2:
IPC GUIDELINES
National IPC guidelines PRIMARY CARE

• Evidence-based, nationally-approved guidelines adapted to the Facility-adapted SOPs and their monitoring
local context and reviewed at least every five years. • Evidence-based facility-adapted SOPs based on the national IPC
guidelines.
• At a minimum, the facility SOPs should include:
‐ hand hygiene
‐ decontamination of medical devices and patient care
equipment
‐ environmental cleaning
‐ health care waste management
‐ injection safety
‐ HCW protection (for example, at least post-exposure
prophylaxis, vaccinations)
‐ aseptic techniques
‐ triage of infectious patients
‐ basic principles of standard and transmission-based
precautions.
• Routine monitoring of the implementation of at least some of
the IPC guidelines/SOPs.

all requirements as for the primary health care facility level, with
additional SOPs on:
• standard and transmission-based precautions (for example,
detailed, specific SOPs for the prevention of airborne pathogen
transmission);
• aseptic technique for invasive procedures, including surgery;
• specific SOPs to prevent the most prevalent HAIs based on local
context/epidemiology;
• occupational health (detailed).
• National IPC focal point (and IPC team or committee, if existing) PRIMARY CARE
as guideline development and implementation are key activities in • Trained IPC link person, with dedicated (part-) time and/or
their mandate. support from an appointed IPC person at the next administrative
• In a country where the IPC focal point/team is newly established level.
and has limited experience/expertise, consider external IPC • If the expertise at the facility and next administrative level is
technical support as needed for initial guideline development/ limited, external support should be sought.
review.
• Another national responsible body (for example, the national centre SECONDARY AND TERTIARY CARE
for disease control, institute of public health) or an academic • The IPC focal point is responsible for writing and adapting the
institution collaborating with the ministry of health may also play SOPs, promoting their adoption and monitoring adherence. If
an important role in developing IPC guidelines/SOPs. the expertise of the IPC focal point is limited, external support
should be sought.
• The development and implementation of the SOPs requires
a functioning IPC programme and associated expertise to
ensure that local recommended procedures refer to national or
28
international evidence-based guidelines and standards and are

adapted to the context.
• Relevant stakeholders (for example, link nurse or doctors, leading
doctors, nurses, health care facility managers, champions,
quality managers) should be involved in the development and
adaptation of the SOPs.
• Involvement of front-line HCWs should be considered in the
development and implementation of SOPs.
• The IPC focal point should also be responsible for organizing
staff training on the SOPs and for monitoring adherence to the
recommended procedures, in collaboration with others who may
be in charge of training and assessment at the local level.
• IPCAT2 – 2.1.1: the national IPC focal point has a mandate to PRIMARY CARE
work with key players to produce guidelines for the prevention and • IPCAF – 2.2: facility-adapted SOPs are available for hand
control of HAI. hygiene, decontamination of medical devices and patient
• IPCAT2 – 2.1.6: the national IPC focal point actively addresses care equipment, environmental cleaning, health care
guideline adaptation to reflect local conditions. waste management, injection safety, HCW protection (for
• IPCAT2 – 2.1.3: the guidelines are reviewed at least every 5 years example, at least post-exposure prophylaxis, vaccinations),
and updated to reflect the current evidence base. aseptic techniques, triage, basic principles of standard and
transmission-based precautions.
• IPCAF – 2.3: The guidelines/SOPs are consistent with national/
international IPC guidelines (if they exist).
• IPCAF – 2.8: Routine monitoring of the implementation of at
least some of the guidelines/SOPs is undertaken.

• IPCAF – 2.2: facility-adapted SOPs/guidelines are available for
hand hygiene, decontamination of medical devices and patient
care equipment, environmental cleaning, health care waste
management, injection safety, HCW protection (for example, at
least post-exposure prophylaxis, vaccinations), aseptic technique
for invasive procedures, including surgery, triage, standard and
transmission-based precautions, specific SOPs to prevent the
most prevalent HAIs based on local context/epidemiology, and
occupational health.
• IPCAF – 2.3: the guidelines/SOPs are consistent with national/
international IPC guidelines (if they exist).
• IPCAF – 2.8: routine monitoring of the implementation of at least
some of the SOPs is undertaken.
NATIONAL LEVEL SOURCES AND RESOURCES FACILITY LEVEL SOURCES AND RESOURCES
Source Sources
graphics available in the Excel file of IPCAT2); https://www.who.int/ presentation); https://www.who.int/infection-prevention/tools/
infection-prevention/tools/core-components/en/. core-components/IPCAF-template.pdf?ua=1.
• Primary Health Care Performance Initiative. Primary health care
Tools and resources progression model assessment tool report (where available). 2018;
• WHO. Guidelines on core components of IPC programmes at the https://improvingphc.org/primary-health-care-progression-model.
national and acute health care facility level (2016); https://www.
who.int/infection-prevention/publications/core-components/en/. Tools and resources
• WHO. Improving infection prevention and control at the • WHO Guidelines on core components of IPC programmes at the
health facility. Interim practical manual supporting national national and acute health care facility level; https://www.who.int/
implementation of the WHO guidelines on core components of infection-prevention/publications/core-components/en/.
infection prevention and control programmes. 2018; https://www. • WHO. Improving infection prevention and control at the health
who.int/infection-prevention/tools/core-components/facility- facility: Interim practical manual supporting implementation of
manual.pdf. the WHO guidelines on core components of infection prevention
29
and control programmes. 2018; https://www.who.int/infection-

prevention/tools/core-components/facility-manual.pdf.
• CDC IPC guidelines library; https://www.cdc.gov/infectioncontrol/
guidelines/index.html.
• APIC: list of IPC guidelines; https://apic.org/Professional-Practice/
Scientific-guidelines.
• Asia Pacific Society for Infection Control IPC guidelines; http://
apsic-apac.org/guidelines-and-resources/apsicguidelines/.
• The availability of national guidelines contributes to a reduction PRIMARY CARE

in the risk of HAIs and AMR, especially when implemented in • At the facility level, it is not necessary to have the expertise required
combination with HCW education and training. to develop evidence-based guidelines. It is important to develop
• The development of IPC guidelines/protocols/SOPs and related SOPs for the implementation and monitoring of available national
implementation strategies is a key function of the national IPC or international guidelines.
focal point (or IPC team/programme if they exist). • IPC link professionals at the facility level should work with the IPC
• National guidelines are necessary to indicate the IPC standards focal points at the next administrative level (for example, district)
and measures that should be adhered to and monitored, including to develop adapted SOPs based on the national (or international)
the appropriate training of HCWs at all levels. guidelines for primary care.
• National IPC guidelines should be evidence-based (that is, based • Monitoring adherence to SOP implementation is essential to
on systematic reviews of the scientific literature and other evaluate its adoption and effectiveness to achieve the desired
existing guidelines) and ideally refer to/adapted from international outcomes and to assist with adjustments and improvements of the
standardized guidelines, if available. implementation strategies. IPC monitoring and supervision should
• Guideline content should be prioritized locally, based on the most be assured by the health care officer in charge of IPC at the next
frequent practices and/or types of HAI and adapted to local administrative level (for example, district).
circumstances (for example, use of indwelling catheters and other • Adaptation to local conditions should be considered for the most
devices, surgery and other invasive procedures). However, at a effective uptake and implementation.
minimum, the guidelines should cover the following topics:
‐ hand hygiene SECONDARY AND TERTIARY CARE
‐ decontamination of medical devices and patient care articles • See all points indicated for the primary health care facility level.
‐ environmental cleaning • A higher level of IPC expertise is required to develop SOPs in
‐ health care waste management secondary and tertiary health care facilities due to the increase in
‐ transmission-based precautions acuity and complexity of care provided.
‐ injection safety • Facility-adapted SOPs should be prioritized locally, based on the
‐ HCW protection most frequent practices and/or with practices associated with an
‐ aseptic techniques increase in the risk of HAI and adapted to local circumstances (for
‐ triage example, use of indwelling catheters and other devices, surgery and
‐ development and implementation of strategies for training other invasive procedures).
on and dissemination of the IPC guidelines are part of the
minimum requirements.
• Regular updates (that is, at least every 5 years) are required to
ensure that the guidelines reflect current evidence and remain
topical and practical to the evolution of health care delivery.
• Development of national guidelines and related implementation PRIMARY CARE

strategies are a function of the national IPC team or focal point Not applicable.
and require IPC expertise. Requirements (which are under the
responsibility of the national programme) for developing and SECONDARY AND TERTIARY CARE
implementing effective national IPC guidelines: No major differences to be noted compared to the minimum
‐ IPC expertise for development or adaptation; requirements.
‐ local prioritization;
‐ providing resources, infrastructures and supplies for enabling
implementation;
30
‐ HCW education on recommended practices;

‐ monitoring implementation and adherence;
‐ regular updates.
• To fully accomplish core component 2, guidelines on all the
following topics should be developed at the national level (either
in one main guideline or in specific guidelines, as feasible and
appropriate according to the local context):
‐ standard precautions:
· hand hygiene
· use of PPE
· sterilization and medical device decontamination
· safe handling of linen and laundry
· health care waste management
· patient placement
· respiratory hygiene and cough etiquette
· environmental cleaning
· injection safety
· HCW protection, safety and post-exposure prophylaxis.
‐ transmission-based precautions;
‐ aseptic technique and device management for clinical
procedures;
‐ specific guidelines to prevent the most prevalent HAIs (for
example, catheter-associated urinary tract infection, surgical
site infection, central line-associated bloodstream infection,
ventilator-associated pneumonia), depending on the context
and complexity of care.
• Early engagement and participation of stakeholders in the
development and production of guidelines is vital to ensure
consensus and better buy-in.
31
CORE COMPONENT 3:
IPC EDUCATION AND TRAINING
National training policy and curriculum PRIMARY CARE

• National policy that all HCWs are trained in IPC (in-service IPC training for all frontline clinical staff and cleaners upon hire
training). • All front-line clinical staff and cleaners must receive education
• An approved IPC national curriculum aligned with national and training on the facility IPC guidelines/SOPs upon
guidelines and endorsed by the appropriate body. employment.
• National system and schedule of monitoring and evaluation to • All IPC link persons in primary care facilities and IPC officers at
check on the effectiveness of IPC training and education (at the district level (or other administrative level) need to receive
least annually). specific IPC training.
SECONDARY CARE
IPC training for all front-line clinical staff and cleaners upon hire:
• All front-line clinical staff and cleaners must receive education
and training on their IPC guidelines/SOPs upon employment.
• All IPC staff need to receive specific IPC training.
TERTIARY CARE
IPC training for all front-line clinical staff and cleaners upon
employment and annually
• All front-line clinical staff and cleaners must receive education
and training on the facility IPC guidelines/SOPs upon
employment and annually.
• All IPC staff need to receive specific IPC training either on-line or
participate in courses.
• IPC focal point (and IPC team or committee if they exist) at the PRIMARY CARE
ministry of health or other national responsible body as IPC • Trained IPC officer at the next administrative level (for example,
education and training are key activities in their mandate. district) is responsible for training IPC link persons, front-line
• Senior leads in key positions at the ministry level, including HCWs and cleaners in primary care facilities, according to a plan
ministries of health and education. and strategy developed at the national level.
• Local academic institutions, including universities and others • IPC officers at the next administrative level (for example, district)
with a mandate on health workforce education, have a key role in should be trained by the national or sub-national level.
curricula development and endorsement, and in training delivery. • IPC expertise is required to lead IPC training.
• It is important to include all other relevant programmes and • If the expertise at the next administrative level is limited, external
national actors and identify key joint areas of work across support should be sought.
education and training efforts. • IPC link persons should provide on-the-job supervision/
• In a country where the IPC focal point/team is newly established mentorship to HCWs and cleaners in their facility.
and has limited experience/expertise, consider external IPC
technical support as needed for initial IPC curriculum development SECONDARY AND TERTIARY CARE
and implementation. • The IPC focal point (or IPC team if it exists) is responsible for
training front-line HCWs and cleaners.
• IPC expertise is required to lead IPC training.
• If the expertise of the IPC focal point is limited, external support
should be sought, for example, at the regional or national level.
• In addition, non-IPC personnel with adequate skills (for example,
link nurses/practitioners or champions and opinion leaders)
could play a role of mentorship to refresh IPC principles and
champion IPC practices at the ward level.
32
• IPCAT2 – 3.1.1: the national IPC programme provides guidance PRIMARY CARE
and recommendations for in-service training at the facility • All new front-line HCWs receive orientation education and
level (for example, frequency, expertise required, requirements training on IPC guidelines/SOPs.
for new employee orientation, monitoring and evaluation • All new cleaning staff receive orientation education and training
approaches). on IPC guidelines/SOPs.
• IPCAT2 – 3.1.2: the national IPC programme provides content and • Specific IPC training/education is offered for IPC link
support for IPC training of all HCWs at the facility level. professionals in primary care facilities.
• IPCAT2 –3.2.5: IPC training is integrated into continuing medical, • Specific IPC training/education is offered for IPC staff at the
nursing and allied health professional education and training. district level.
• IPCAT2 – 3.3.1: a national system and schedule of monitoring and
evaluation is in place to check on the effectiveness of training and SECONDARY CARE
education, for example, at least annually. • IPCAF – 3.3: all new front-line HCWs receive orientation
education and training on IPC guidelines/SOPs.
Possible additional indicators • IPCAF – 3.4: all new cleaning staff receive orientation education
• National policy on HCW training developed. and training on IPC guidelines/SOPs.
• National IPC curriculum for HCWs developed, approved and • IPCAF – 3.10: specific IPC training/education is offered for IPC
endorsed by an appropriate professional society/body. professionals.
TERTIARY CARE
• IPCAF – 3.3: all new front-line HCWs receive orientation and at
least annual education and training on IPC guidelines/SOPs.
• IPCAF – 3.4: all new cleaning staff receive orientation and at
least annual education and training on IPC guidelines/SOPs.
• IPCAF – 3.10: specific IPC training/education is offered for IPC
professionals.
Sources Source
Tools and resources Tools and resources

• WHO. Guidelines on core components of IPC programmes at the • WHO Guidelines on core components of IPC programmes
national and acute health care facility level (2016); https://www. at the national and acute health care facility level (2016) for
who.int/infection-prevention/publications/core-components/en/. more information; https://www.who.int/infection-prevention/
• WHO. Improving infection prevention and control at the publications/core-components/en/.
health facility: Interim practical manual supporting national • WASH FIT; https://apps.who.int/iris/bitstream/hand
implementation of the WHO guidelines on core components of le/10665/254910/9789241511698-eng.pdf?sequence=1.
infection prevention and control programmes. 2018; https://www. • WHO. Improving infection prevention and control at the health
who.int/infection-prevention/tools/core-components/facility- facility: Interim practical manual supporting implementation of
manual.pdf. the WHO guidelines on core components of infection prevention
and control programmes. 2018; https://www.who.int/infection-
prevention/tools/core-components/facility-manual.pdf.
• When coupled with national IPC guidelines, training contributes to PRIMARY CARE
a reduction in HAI and AMR and a more skilled health workforce. • IPC education and training are critical to developing a competent and
• Supporting and facilitating training at all levels should be skilled workforce. At a minimum, an emphasis on a basic level of IPC
considered an important indicator for assessing the impact of IPC and triage in primary care to avoid infection and AMR spread through
programmes. the health system, including health care-associated outbreaks.
33
• The IPC focal point/team should be specifically trained on the use • Basic concepts of multimodal strategies implementation should be
of multimodal strategies for implementing IPC interventions. included in the training of IPC link professionals and IPC staff.
• Training and curricula content should be based on the national • Ensuring an orientation upon employment will provide a baseline
guidelines and SOPs and then prioritized locally, based on the most knowledge to all front-line staff and cleaners, while recognizing that
frequent practices and/or types of HAI. ongoing educational opportunities are the gold standard.
• Patient and visitor education remains an important consideration.
In particular, whenever family members assume care activities, they
should receive tailored IPC training in order to protect themselves
and their loved ones and thus minimize any possibility of cross-
transmission. Patient and family education at the facility level can
also stimulate the use of appropriate hygiene measures in the
community, such as handwashing with soap.

• IPC education that involves front-line HCWs in a practical, hands-on
approach and incorporates individual experiences is associated
with decreased HAI and increased hand hygiene compliance.
• Three categories of human resources were identified as targets
for IPC training and requiring different strategies and training
content: IPC specialists; all HCWs involved in service delivery
and patient care; and other personnel that support health service
delivery (administrative and managerial staff, auxiliary service staff,
cleaners, etc.).
• The IPC focal person/team should be specifically trained on the use
of multimodal strategies for implementing IPC interventions.
• Patient and family education remains an important consideration
(see above).
• In particular for tertiary care facilities, providing training refreshers
annually is a minimum requirement.
• The national IPC programme should: PRIMARY CARE

‐ develop IPC pre- and postgraduate and in-service curricula in Not applicable.
collaboration with local academic institutions for:
· IPC specialists SECONDARY AND TERTIARY CARE
· all HCWs involved in service delivery and patient care • Mandatory IPC training should be ensured for all HCWs, including
· other personnel (administrative and managerial staff, those providing direct patient care (for example, doctors, nurses,
auxiliary service staff, cleaners); nurse aides, midwives, attendants, personal support workers, etc.)
‐ develop some standardized training tools to support curricula and administrative and managerial staff, auxiliary service staff, and
implementation, aligned with national technical guidelines and cleaners, based on their functions and facility-adapted SOPs. This
international IPC standards. includes:
• In addition to the curricula and tool development, appropriate steps ‐ new employee orientation
should be undertaken for the approval, adoption and roll-out of the ‐ continuous educational opportunities for existing staff (at
curricula by all health faculties (for example, medicine, nursing, least annually).
midwifery, dentistry, laboratory, etc.). • In-service training should be practical and complementary to WASH
• Clear career pathways for IPC professionals should be established and other training areas (for example, quality improvement).
at the national level. • IPC education and training should be a part of an overall health
• Consideration should be given to the teaching methods and facility education strategy, including new employee orientation and
modalities and grounded in adult education principles. The the provision of continuous educational opportunities for existing
following training methods could be included: problem-based staff, regardless of level and position (for example, including also
learning; hands-on workshops; focus groups; peer-to-peer training; senior administrative and housekeeping staff).
classroom-based simulation; and bedside training. • IPC staff should be trained on specific IPC functions specific to the
tertiary care level and in line with facility-adapted IPC SOPs. Periodic
evaluations of both the effectiveness of training programmes and
assessment of staff knowledge should be undertaken on a routine
basis.
34
CORE COMPONENT 4:
HAI SURVEILLANCE
IPC surveillance and monitoring technical group PRIMARY CARE

• Establishment by the national IPC focal point of a technical group • HAI surveillance is not required as a minimum requirement at
for HAI surveillance and IPC monitoring that: the primary facility level, but should follow national or sub-
‐ is multidisciplinary national plans, if available (for example, detection and reporting
‐ develops a national strategic plan for HAI surveillance (with of outbreaks affecting the community is usually included in the
a focus on priority infections based on the local context) and national plans).
IPC monitoring.
SECONDARY CARE
• HAI surveillance should follow national or sub-national plans.
TERTIARY CARE
• Active HAI surveillance should be conducted and include
information on AMR.
• Enabling structures and supporting resources need to be in
place (for example, dependable laboratories, medical records,
trained staff), directed by an appropriate method of surveillance.
• The method of surveillance should be directed by the priorities/
plans of the facility and/or country (for example, point
prevalence studies to gather a quick snapshot of the situation, or
longitudinal prospective surveillance of surgical site infection if
this was identified as a problem).
• Timely and regular feedback needs to be provided to key
stakeholders in order to lead to appropriate action, in particular
to the hospital administration.
• The national IPC lead/focal point (and IPC technical team or PRIMARY AND SECONDARY CARE
committee, if existing) at the ministry of health or national body • If HAI surveillance is conducted, a trained IPC link person/focal
responsible for IPC should take action to convene the technical point, according to national or sub-national plans.
group for HAI surveillance and IPC monitoring.
• Ideally, the technical group should include microbiologists, TERTIARY CARE
clinicians, laboratory technicians, epidemiologists, professionals • The IPC focal point (or IPC team/committee if existing)
working in other surveillance systems, statisticians, data is responsible for putting together a team for HAI/AMR
managers and information technology experts, and monitoring and surveillance, and then planning and conducting surveillance, and
evaluation experts. analysing, interpreting and disseminating the collected data.
• Linkage to other relevant surveillance programmes should be • The team should be multidisciplinary, ideally including
established, in particular alignment with surveillance of AMR. epidemiologists, statisticians, infection control, data managers
and information technology experts with the appropriate
capacity. At least some of this expertise should be available.
• The IPC focal point should be trained in basic epidemiology and
surveillance methods.
• Linkage to other relevant surveillance programmes should be
established, in particular alignment with surveillance of AMR.
35
• A multidisciplinary technical group for HAI surveillance is PRIMARY CARE

established at the national level. • Note: HAI surveillance is not required, but should follow national
• A national strategic plan for HAI surveillance (with a focus on or sub-national plans, if available.
priority infections based on the local context) is in place. • If conducted, HAI surveillance is undertaken in accordance with
• IPCAT2 – 4.1.3: the national IPC programme (or collaborating national plans (yes/no/not applicable).
partner) leads are designated to coordinate the national HAI
surveillance programme and network. SECONDARY CARE
• HAI surveillance is undertaken in accordance with national plans.
TERTIARY CARE
• IPCAF – 4.1: active surveillance is a defined component of the
IPC programme
• IPCAF – 4.2: do you have personnel responsible for surveillance
activities?
• IPCAF – 4.3: staff responsible for surveillance activities have
been trained in basic epidemiology, surveillance and IPC (that
is, capacity to oversee surveillance methods, data management
and interpretation).
• IPCAF – 4.5: a prioritization exercise is used to determine the
method of surveillance according to the local context (that is,
identifying infections that are major causes of morbidity and
mortality in the facility).
• IPCAF – 4.8: reliable surveillance case definitions (defined
as numerator and denominator according to international
definitions, for example, CDC National Healthcare Safety
Network/European Centre for Disease Prevention and Control)
are used or adapted through an evidence-based adaptation
process and expert consultation.
• IPCAF – 4.14: timely and regular feedback (for example,
quarterly/half-yearly/annually) is provided to key stakeholders in
order to lead to appropriate action, in particular to the hospital
administration.
• Enabling structures and supporting resources (for example,
EQAS microbiological reference laboratory, medical records with
sufficient clinical information to determine HAI case definitions,
dedicated staff time) are in place to support HAI surveillance.
• Active surveillance is conducted for colonization or infections
caused by multidrug-resistant pathogens according to the local
epidemiological data.
Source Source

• WHO. Guidelines on core components of IPC programmes at the • WHO. Guidelines on core components of IPC programmes at the
national and acute health care facility level for more information. national and acute health care facility level for more information.
2016; https://www.who.int/infection-prevention/publications/ 2016; https://www.who.int/infection-prevention/publications/core-
core-components/en/. components/en/.
• WHO. Improving infection prevention and control at the • WHO. Improving infection prevention and control at the health
health facility: Interim practical manual supporting national facility: Interim practical manual supporting implementation of
implementation of the WHO guidelines on core components of the WHO guidelines on core components of infection prevention
infection prevention and control programmes. 2018; https://www. and control programmes. 2018; https://www.who.int/infection-
who.int/infection-prevention/tools/core-components/facility- prevention/tools/core-components/facility-manual.pdf.
manual.pdf.
36
• HAI surveillance is the first step (minimum requirement) to PRIMARY CARE

assess the magnitude of the burden of disease by the systematic • The detection and reporting of outbreaks affecting the community
collection of data in targeted wards/unit. As a first step, when to national authorities should be included in national or sub-national
a HAI surveillance system is not in place, a multidisciplinary plans.
technical group should develop a plan for surveillance.
• This group will have the task of identifying: SECONDARY CARE
‐ priorities and methods for surveillance; • Given the low level of specialized care, HAI surveillance in
‐ a comprehensive surveillance plan for HAIs and IPC secondary care was not strictly considered by expert consensus
monitoring; as a minimum requirement; monitoring of IPC indicators was
‐ a centralized, national reporting mechanism; considered more important.
‐ a minimum set of data (outcomes, indicators or other • Some secondary facilities may decide to conduct surveillance of
information) for surveillance, including providing a baseline relevant HAIs, such as surgical site infections, depending on the
assessment; type of care delivered and the facility’s capacity and prioritization of
‐ roles and responsibilities for the implementation of HAI the core components.
surveillance at facility level. • Reporting outbreaks in the health care facility or affecting the
• Prioritization should not only be based on vertical systems (for community to national authorities should be included in national or
example, human immunodeficiency virus, tuberculosis, malaria, sub-national plans.
influenza, Salmonella spp., etc.), but should consider essential
targets of HAI prevention, for example, reduction of the number of TERTIARY CARE
surgical site or bloodstream infections. • HAIs and AMR are a burden in intensive care units and other highly
• The national level could also consider the development of a policy/ specialized units/wards where invasive interventions carry more
regulations to mandate HAI surveillance in facilities, according to risks for HAIs and patients have a higher risk of death due to these
the minimum requirements specified below. infections.
• Surveillance of HAIs should be aligned with the priorities of the • For this reason, targeted HAI surveillance is necessary at tertiary
AMR national action plan. health care level.
• To ensure implementation of the national surveillance plan, a HAI
surveillance team should be in place in every tertiary hospital.
• Prioritization is also the responsibility of the IPC team, and a
prioritization exercise should be conducted in line with national
recommendations.
• The team should develop a surveillance strategic plan according to
present capacities including:
‐ purpose;
‐ target sample and infection outcomes;
‐ identification of a national reference laboratory and quality
assurance capacities;
‐ development/careful adaptation of case definitions.
• Timely feedback to hospital leadership and front-line HCWs is
considered as one the most critical parts of surveillance and
monitoring. Facilities should consider defining the timeliness of
feedback (for example, monthly or bi-monthly).
• The IPC focal team should tailor its surveillance methodology
to available resources and priorities in line with national
recommendations.
• A national HAI surveillance programme and networks that include PRIMARY CARE
mechanisms for the timely feedback of monitoring and evaluation Not applicable.
data feedback should be established, with the potential to be used
for benchmarking purposes. SECONDARY AND TERTIARY CARE
• Surveillance programmes should be supported by: • Facility-based HAI surveillance should be performed to guide IPC
‐ engaged governments and other respective authorities; interventions and detect outbreaks, including AMR.
‐ allocated human and financial resources; • Hospital-based infection surveillance systems should be linked to
‐ microbiology and laboratory capacity (at least one national integrated public health infection surveillance systems.
37
reference laboratory), with standardized definitions and • Feedback of results to HCWs and stakeholders through national
laboratory methods; networks should be timely.
‐ an informatics system for data collection and analysis. • Surveillance should be based on national recommendations and
• Surveillance programmes should meet the following criteria: standard definitions and customized to the facility, according to
‐ demonstrate clear objectives, a standardized set of case available resources with clear objectives and strategies.
definitions, methods for detecting HAIs (numerators) and the • Methods for detecting infections should be active. Different
exposed population (denominators), including a process for surveillance strategies could include the use of prevalence
the analysis of data and reports and a method for evaluating or incidence rates of HAI and AMR pathogens. A system for
the quality of the data; surveillance data quality assessment should be in place.
‐ establish clear regular reporting lines of HAI surveillance data • Surveillance should be based on clinical and/or microbiology data
from the local facility to the national level; and supported by laboratory capacity with EQAS
‐ adapt international guidelines on HAI definitions at country • The IPC committee and IPC team are responsible for planning
level before implementing them; and conducting HAI surveillance and analysing, interpreting and
‐ include a national training programme for performing disseminating the data collected. For this reason, surveillance
surveillance to ensure the appropriate and consistent activities should be conducted by trained staff (ideally full-time) able
application of national surveillance guidelines and protocols; to plan, collect and manage the data and convene meetings with
‐ provide data to guide the development and implementation of the team, the committee and other key players.
effective control interventions. • Surveillance should provide information for:
• The surveillance programme should provide data on infections: ‐ describing the status of infections associated with health
‐ that may become epidemic in the health care facility (early care (that is, incidence and/or prevalence, type, aetiology
detection of outbreaks); and, ideally, data on severity and the attributable burden of
‐ commonly observed in vulnerable populations (for example, disease);
neonates, burn patients, patients in intensive care units and ‐ identification of the most relevant AMR susceptibility
immunocompromised hosts); patterns;
‐ that may cause severe outcomes, such as high case fatality ‐ identification of high-risk populations, procedures and
and patient morbidity and suffering; exposures;
‐ caused by resistant microorganisms with an emphasis on ‐ early detection of clusters and outbreaks (that is, early
multidrug- resistant pathogens; warning system);
‐ associated with selected invasive devices or specific ‐ evaluation of the impact of interventions.
procedures, such as the use of intravascular devices,
indwelling urinary catheters and surgery;
‐ that may affect HCWs (for example, hepatitis B and C and
human immunodeficiency virus).
38
CORE COMPONENT 5:
MULTIMODAL STRATEGIES
Multimodal improvement strategies for IPC interventions PRIMARY CARE

• Use of multimodal strategies to implement IPC interventions Multimodal strategies for priority IPC interventions
according to national guidelines/SOPs, under the coordination of • Use of multimodal strategies – at the very least to implement
the national IPC focal point (or team, if existing). interventions to improve hand hygiene, safe injection practices,
decontamination of medical instruments and devices and
environmental cleaning.
SECONDARY CARE
Multimodal strategies for priority IPC interventions
• Use of multimodal strategies – at the very least to improve each
item of standard and transmission-based precautions and triage.
TERTIARY CARE
Multimodal strategies for all IPC interventions
• Use of multimodal strategies to implement interventions
to improve each item of standard and transmission-based
precautions, triage, and those targeted at the reduction of
specific infections (for example, surgical site or catheter-
associated infections) in high-risk areas/patient groups,
according to local priorities.
• The IPC focal point (and IPC technical team or committee, if PRIMARY, SECONDARY AND TERTIARY CARE
existing) at the ministry of health or national body responsible for • Trained IPC link person and IPC focal point with the support
IPC, as multimodal interventions are key activities in their mandate. of an IPC-trained health care officer at the next administrative
• Senior leads in key positions at the ministry level. Convincing level are responsible for using a multimodal approach for the
high level senior managers and key professionals of the value of implementation of IPC interventions/SOPs.
employing multimodal strategies at the national and facility level • Successful multimodal strategies include the involvement of
is important and dependent on effective communication and champions or role models.
advocacy. • Collaboration with colleagues in quality improvement and patient
• Key members and teams of all other relevant programmes and safety to develop and promote multimodal strategies should be
national actors who will be responsible for the implementation of addressed.
the IPC programme, including possible joint areas of work.
• National and local experts on implementation science, as well as
those from the fields of behavioural science and communication.
• IPCAT2 – 5.1.1: the appointed IPC focal point is trained and PRIMARY CARE
competent in implementation science and multimodal behaviour • IPCAF – 5.1: multimodal strategies are used to implement
change strategies. priority IPC interventions (at the very least to improve hand
39
• IPCAT2 – 5.1.2: promotion of multimodal strategies through the hygiene, safe injection practices, decontamination of medical
inclusion of the approach in the development of IPC guidelines, instruments and devices and environmental cleaning).
education and training.
SECONDARY CARE
• IPCAF – 5.1: multimodal strategies are used to implement
priority IPC interventions (at the very least to implement
interventions to improve standard and transmission-based
precautions and triage).
TERTIARY CARE
• IPCAF – 5.1: multimodal strategies are used to implement all
IPC interventions and to improve standard and transmission-
based precautions, triage, and those targeted at the reduction of
specific infections in high-risk areas/vulnerable patient groups,
in line with local health priorities.
Source Source

• WHO. Guidelines on core components of IPC programmes at the • WHO Guidelines on core components of IPC programmes
national and acute health care facility level (2016); https://www. at the national and acute health care facility level (2016);
who.int/infection-prevention/publications/core-components/en/. https://www.who.int/infection-prevention/publications/core-
• WHO. Improving infection prevention and control at the components/en/.
health facility: Interim practical manual supporting national • WHO. Improving infection prevention and control at the health
implementation of the WHO guidelines on core components of facility: Interim practical manual supporting implementation of
infection prevention and control programmes. 2018; https://www. the WHO guidelines on core components of infection prevention
who.int/infection-prevention/tools/core-components/facility- and control programmes. 2018; https://www.who.int/infection-
manual.pdf. prevention/tools/core-components/facility-manual.pdf.
• WHO multimodal improvement strategy leaflet; https://www.
who.int/infection-prevention/publications/ipc-cc-mis.pdf?ua=1.
• According to the available scientific evidence, multimodal PRIMARY CARE

strategies are the most effective approach to implement hand • Multimodal strategies should be used for any IPC intervention at
hygiene programmes and other IPC interventions (for example, to all levels of the health care system because their effectiveness is
reduce central line-associated bloodstream infections and surgical supported by strong evidence.
site infections) in order to achieve the key elements for success • However, it is recognized that multimodal strategies are complex
that support IPC progress and, ultimately, a measurable impact approaches to be put in place. Thus, the interventions included in
that benefits patients and HCWs, such as system change, creation the minimum requirements are the priority ones among those that
of an enhanced patient safety climate and HCW behavioural should be included in SOPs and training for the primary health care
change. level (see minimum requirements for core components 2 and 3).
• The IPC focal point/team should be specifically trained on the
use of multimodal strategies for the implementation of IPC SECONDARY AND TERTIARY CARE
interventions. • Multimodal strategies should be used for any IPC intervention at
• Multimodal strategies for implementing IPC interventions should all levels of the health care system in order to provide safe and
be explicitly indicated in the national IPC action plans, including effective health care delivery.
all 5 key elements identified by WHO as needed for each IPC • Complexity of care and human resources (including in the IPC
intervention selected and according to the local context. team) vary across secondary and tertiary care facilities and the
• The national IPC focal person or team should develop a national scope of the minimum requirements may vary according to the
multimodal strategy framework to facilitate implementation of the local context.
prioritized IPC interventions at facility level in the context of quality • Specialized/complex services are provided in tertiary care
improvement. facilities.
• In tertiary care facilities, there is an increased potential for
transmission of infection due to prolonged hospital stay, more
40
complex procedures being performed and the admission of

high-risk vulnerable populations.
• Compelling evidence is available on the effectiveness of
multimodal strategies to reduce infections in high-risk areas/patient
groups.
• It is the mandate of the national IPC programme to ensure that all PRIMARY CARE
IPC interventions are implemented using multimodal strategies. Not applicable.
• The national IPC programme should facilitate the use of
multimodal strategies by ensuring that the following elements are SECONDARY AND TERTIARY CARE
in place to support their use: • Multimodal strategies must be used for implementing any IPC
‐ expertise and necessary resources including policies, intervention at all levels of the health care system.
regulations and tools; • Overall organizational culture change is a key element to prioritize
‐ overall organizational culture change to achieve an enhanced within multimodal strategies as effective IPC can be a reflector
patient safety climate; of quality care, a positive organizational culture, and an enhanced
‐ coordination and teamwork; patient safety climate.
‐ linkages with quality improvement initiatives and health facility • Successful multimodal strategies include the involvement of
accreditation; champions or role models.
‐ local adaptation. • Implementation of multimodal strategies within health care
institutions needs to be linked to national quality aims and
initiatives, including health care quality improvement initiatives or
health facility accreditation bodies.
41
CORE COMPONENT 6:
MONITORING, AUDIT AND FEEDBACK
IPC surveillance and monitoring technical group PRIMARY CARE

• Establishment by the national IPC focal point of a technical group • Monitoring of IPC structural and process indicators should
for HAI surveillance and IPC monitoring that: be put in place at primary care level, based on IPC priorities
‐ is multidisciplinary; identified in the other components. This requires decisions at the
‐ develops a national strategic plan for HAI surveillance and IPC national level and implementation support at the sub-national
monitoring; level.
‐ develops an integrated system for the collection and analysis
of data (for example, protocols, tools); SECONDARY AND TERTIARY CARE
‐ provides training at the facility level to collect and analyse • A person responsible for the conduct of the periodic or
these data; continuous monitoring of selected indicators for process and
‐ develops recommendations for minimum process indicators structure, informed by the priorities of the facility or the country.
(for example, hand hygiene). • Hand hygiene is an essential process indicator to be monitored.
• Timely and regular feedback needs to be provided to key
stakeholders in order to lead to appropriate action, particularly to
• The IPC lead/focal point (and IPC technical team or committee at PRIMARY, SECONDARY AND TERTIARY CARE
the ministry of health or national body responsible for IPC) should • Trained IPC link person/focal point/ IPC officer (or IPC
take action to convene the technical group for HAI surveillance and committee/team if existing) are responsible for audit and
IPC monitoring (same group as for core component 4). feedback and should be trained in auditing technique plans.
• Ideally, the technical group should include microbiologists,
laboratory technicians, epidemiologists, professionals working
in other surveillance systems, statisticians, data managers and
information technology experts and monitoring and evaluation
experts.
• Liaison should be ensured with:
‐ senior leads in key positions at the ministry level;
‐ team members of all other relevant programmes and national
actors who are involved in the implementation and monitoring
of the IPC programme, including national quality and patient
safety leaders.
• A multidisciplinary technical group for IPC monitoring is PRIMARY CARE

established at the national level. • IPCAF – 6.2: a well-defined monitoring plan with clear goals/
• IPCAT2 – 6.2: A well-defined plan focusing on IPC outcomes, objectives, targets and activities focused on IPC structural and
processes and strategies, with clear goals, targets and operational process indicators (including tools to collect data in a systematic
plans is in place. way) is in place based on IPC priorities identified in the other
• IPC indicators integrated with national monitoring systems, for components and, importantly, informed by decisions at the
example, health management information systems. national level and implementation support at the sub-national level.
42
• A mechanism to train national and local auditors is in place. SECONDARY AND TERTIARY CARE
• Hand hygiene compliance monitoring and feedback is identified as • IPCAF – 6.1: A trained person responsible for conducting
a minimum indicator, at the very least for reference hospitals. periodic or continuous monitoring/audit of selected indicators
for process (for example, hand hygiene) and structure is in place
and informed by the priorities of the facility or country.
• Monitoring of hand hygiene compliance is undertaken using the
WHO hand hygiene observation tool or equivalent.
• IPCAF – 6.4: monitoring of hand hygiene strategies is
undertaken using the WHO Hand Hygiene Self-Assessment
Framework Survey.
• IPCAF – 6.5: timely and regular feedback of auditing reports
(for example, feedback on hand hygiene compliance data or
other processes) on the state of IPC activities/performance
is provided to key stakeholders, in order to lead to appropriate
action, particularly to the hospital management and senior
administration.
Source Source

• WHO. Guidelines on core components of IPC programmes at the • WHO. Guidelines on core components of IPC programmes at the
national and acute health care facility level (2016); https://www. national and acute health care facility level (2016); https://www.
who.int/infection-prevention/publications/core-components/en/. who.int/infection-prevention/publications/core-components/
• WHO. Improving infection prevention and control at the en/.
health facility: Interim practical manual supporting national • WHO. Improving infection prevention and control at the health
implementation of the WHO guidelines on core components of facility: Interim practical manual supporting implementation of
infection prevention and control programmes. 2018; https://www. the WHO guidelines on core components of infection prevention
who.int/infection-prevention/tools/core-components/facility- and control programmes. 2018; https://www.who.int/infection-
manual.pdf. prevention/tools/core-components/facility-manual.pdf.
• WHO hand hygiene monitoring and feedback tools (updated • WHO hand hygiene monitoring and feedback tools (updated
in 2009); https://www.who.int/gpsc/5may/tools/evaluation_ in 2009); https://www.who.int/gpsc/5may/tools/evaluation_
feedback/en/. feedback/en/.
• WHO Hand Hygiene Self-Assessment Framework; https://www.
who.int/gpsc/5may/hhsa_framework/en/.
• Setting up national monitoring of indicators of IPC practices, PRIMARY CARE

processes and infrastructures is usually more feasible than • IPC monitoring is critical to identify improvement action needed
establishing HAI surveillance as a first step for gathering data to and should be in line with national recommendations and priorities.
inform IPC action. • Monitoring of indicators of IPC practices, processes and
• The technical group indicated as the minimum requirement for infrastructures should be feasible at the primary care level, whereas
core component 4 should be the same group responsible for core HAI surveillance is not applicable.
component 6. • Hand hygiene infrastructure (for example, hand hygiene stations at
• Monitoring IPC practices and providing feedback to concerned the point of care or ABHR consumption) could be considered as a
stakeholders are critical to achieve behaviour change or other first step to monitoring.
process modifications that improve the quality of care and reduce • Hand hygiene compliance monitoring according to the WHO
HAIs and AMR. observation method is considered the gold standard.
• Monitoring and feedback are also aimed at engaging stakeholders, • In many primary care facilities, one person responsible for the
creating partnerships and developing working groups and monitoring of indicators should be identified and this activity
networks. requires support at the sub-national level (for example, district).
• Consideration should be given to policies that create incentives • The selection of indicators to be monitored should be driven at
(positive or negative) tied to indicators in order to generate buy-in national level, with input at regional/sub-national level.
from hospital administrators. • Any decision should be in line with decisions on other core
• Data from existing data sources (for example, Joint External components.
43
Evaluation or Service Availability and Readiness Assessment) SECONDARY AND TERTIARY CARE
should be considered, particularly at the beginning when • IPC monitoring is critical to identify improvement action and
identifying priorities. should be combined with HAI surveillance and in line with national
• If possible, integration with existing national health information recommendations and priorities.
systems and routine facility monitoring would be critical for • Principles and minimum requirements for monitoring and auditing
streamlining data collection and making linkage/correlations. should not change between secondary and tertiary care; more
• Hand hygiene (including compliance monitoring and/or indicators might be monitored in tertiary care.
infrastructure indicators) is considered a crucial indicator • It is important to monitor both process indicators (prone to
according to WHO recommendations. This activity should be limitations related to observation bias) and infrastructure
decided upon at national level according to the highest standards indicators.
to avoid any misrepresentation of compliance levels. • Hand hygiene (including compliance monitoring and/or
• Surveillance of other structure and process indicators should be infrastructure indicators) is considered a crucial indicator according
considered, prioritizing those that drive action. to WHO recommendations. This activity should be decided upon at
• Other indicators to be monitored should also provide information national level and according to the highest standards to avoid any
on IPC enablers (for example, related to WASH, availability of misrepresentation of compliance levels.
structures) and be considered as basic essentials for IPC. • Timely feedback to hospital leadership and front-line HCWs is one
• Data gathered through IPC monitoring should guide priority setting of the most effective parts of surveillance and monitoring. Facilities
in the national IPC strategic plan. should consider defining the timeliness of feedback.
• Based on all these considerations, a plan for regular monitoring at
the facility level should be developed at the national level, including
plans for feedback and for supervision to assist in the development
and implementation of improvement plans.
• Establishment of a national IPC monitoring and evaluation PRIMARY CARE

programme with goals, objectives and defined performance Not applicable.
indicators for:
‐ IPC standards SECONDARY AND TERTIARY CARE
‐ IPC activities • Regular monitoring/auditing of practices and other indicators
‐ hand hygiene compliance monitoring and feedback (strongly should be according to IPC standards and include timely
recommended as a national performance indicator). feedback to:
• National level monitoring and evaluation should have mechanisms ‐ all audited persons and relevant staff (individual change);
in place that: ‐ hospital management and senior administration
‐ provide regular reports on the state of national goals (organizational change);
(outcomes and processes) and strategies; ‐ IPC team and committee (or quality of care committees).
‐ regularly monitor and evaluate the WASH services, IPC • Monitoring extends to the evaluation of the facility IPC
activities and structure of the health care facilities through programme to:
audits or other officially recognized means; ‐ assess if objectives are met;
‐ promote the evaluation of the performance of local IPC ‐ assess if goals/objectives are accomplished;
programmes in a non-punitive institutional culture. ‐ assess whether the IPC activities are being performed
according to requirements;
‐ identify aspects that may need improvement.
• Important information that may be used for this purpose
includes:
‐ the results of the assessment of compliance with IPC
practices;
‐ other process indicators (for example, training activities);
‐ dedicated time by the IPC team;
‐ resource allocation.
• Monitoring should include regular assessments of staff
knowledge about IPC.
44
CORE COMPONENT 7:
WORKLOAD, STAFFING AND BED OCCUPANCY (FACILITY LEVEL ONLY*)
PRIMARY CARE
• To reduce overcrowding: a system for patient flow, a triage system (including referral system) and a system for the management of
consultations according to existing guidelines should be established.
• To optimize staffing levels: assessment of appropriate staffing levels, depending on the categories seen when using WHO/national tools
(national norms on patient/staff ratio), and development of an appropriate plan.

• To standardize bed occupancy:
‐ establish a system to manage the use of space in the facility and establish the standard bed capacity for the facility;
‐ hospital administration enforcement of the system developed;
‐ no more than one patient per bed;
‐ spacing of at least 1 metre between the edges of beds;
‐ overall occupancy should not exceed the designed total bed capacity of the facility.
• To reduce overcrowding and optimize staffing levels: same minimum requirements as for primary health care.
PRIMARY, SECONDARY AND TERTIARY CARE

• Decisions regarding workload, staffing and bed occupancy are not directly within the responsibility of the IPC link person, focal point or
programme, but rather lie with senior managers and directors. Nevertheless, the IPC link nurse, officer or programme should understand
the evidence supporting this core component in order to be able to help influence decision-makers at the facility and ministry level, with the
assistance of an IPC-trained health care officer at the next administrative level. Therefore, the development of IPC skills in negotiation and
advocacy are important considerations.
• The successful implementation of this core component should be supported by a national plan for human resource development.
INDICATORS (YES/NO)
PRIMARY CARE
• Systems are in place to reduce overcrowding (for example, a system for patient flow, a triage system including a referral system, and a system
for the management of consultations) according to existing guidelines/SOPs.
• IPCAF – 7.3: appropriate staffing levels are assessed according to patient workload using national/international standards or staffing needs
assessment tools and action plans developed based on results.

• IPCAF – 7.3: appropriate staffing levels are assessed according to patient workload using national/international standards or staffing needs
assessment tools and action plans developed based on results.
• IPCAF – 7.4: the design of wards is in accordance with international standards regarding bed capacity.
• IPCAF – 7.5: bed occupancy in the facility is kept to one patient per bed.
• IPCAF – 7.7: adequate spacing of more than 1 metre between patient beds is ensured in the facility.
• IPCAF – 7.8: a system is in place, including clear lines of responsibility, to assess and respond when adequate bed capacity exceeds the
designed total bed capacity of the facility (for example, the hospital administration/management assume responsibility).
* Facility level only. However, the national health system, IPC programme and any other relevant body should coordinate and support the implementation of this core
component at the facility level.
45
SOURCES AND RESOURCES
Source
• IPCAF report (where available; use the template presentation); https://www.who.int/infection-prevention/tools/core-components/IPCAF-
template.pdf?ua=1.
Tools and resources

• WHO Guidelines on core components of IPC programmes at the national and acute health care facility level. 2016; https://www.who.int/
infection-prevention/publications/core-components/en/.
• WHO. Improving infection prevention and control at the health facility: Interim practical manual supporting implementation of the WHO guidelines
on core components of infection prevention and control programmes. 2018; https://www.who.int/infection-prevention/tools/core-components/
facility-manual.pdf.
• WHO Essential environmental health standards in health care. 2008; https://www.who.int/water_sanitation_health/publications/ehs_hc/en/.
• WHO. Workload indicators of staffing need (WISN). 2015; https://www.who.int/hrh/resources/wisn_user_manual/en/.
PRIMARY CARE
• Overcrowding and lack of triage and patient flow systems are recognized as a public health issue that can lead to disease transmission.

• Bed occupancy exceeding the standard capacity of the facility is associated with an increased risk of HAI in acute care facilities, in addition to
inadequate HCW staffing levels.
• Intended capacity may vary from original designs and across facilities and countries. For these reasons, the original ward/unit design
regarding bed capacity should be adhered to and in accordance with standards.
• In exceptional circumstances where bed capacity is exceeded, hospital management should act to ensure appropriate staffing levels that
meet patient demand and an adequate distance between beds. These principles apply to all units and departments with inpatient beds,
including emergency departments.
• The WHO Workload Indicators of Staffing Need method provides health managers with a systematic way to determine how many HCWs of a
particular type are required to cope with the workload of a given health facility and decision making.
• It is recognized that in special circumstances, adherence to this recommendation may need to be balanced against the immediate need to
provide clinical care to as many patients as possible.
PRIMARY CARE
Not applicable.

Same as for minimum requirements.
46
CORE COMPONENT 8: BUILT ENVIRONMENT, MATERIALS AND

EQUIPMENT FOR IPC AT THE FACILITY LEVEL (FACILITY LEVEL ONLY*)
PRIMARY CARE
• Water should always be available from an improved source on the premises to perform basic IPC measures, including hand hygiene,
environmental cleaning, laundry, decontamination of medical devices and health care waste management.
• A minimum of two functional, improved sanitation facilities should be available on-site, one for patients and one for staff; both should be
equipped with menstrual hygiene facilities.
• Functional hand hygiene facilities should always be available at points of care/toilets and include soap, water and single-use towels (or if
unavailable, clean reusable towels) or ABHR at points of care and soap, water and single-use towels (or if unavailable, clean reusable towels)
within 5 metres of toilets.
• Sufficient and appropriately labelled bins to allow for health care waste segregation should be available (less than 5 metres from point of
generation); waste should be treated and disposed of safely via autoclaving, incineration, and/or buried in a lined, protected pit.
• The facility layout should allow adequate natural ventilation, decontamination of reusable medical devices, triage and space for temporary
cohorting/isolation/physical separation if necessary.
• Sufficient and appropriate IPC supplies and equipment (for example, mops, detergent, disinfectant, PPE and sterilization) and power/energy
(for example, fuel) should be available for performing all basic IPC measures according to minimum requirements/SOPs, including all standard
precautions, as applicable; lighting should be available during working hours (usually, 8 am-5 pm) for providing care.

• A safe and sufficient quantity of water should be available for all required IPC measures and specific medical activities, including for drinking,
and piped inside the facility at all times, at a minimum to high-risk wards (for example, maternity ward, operating room/s, intensive care unit).
• A minimum of two functional, improved sanitation facilities that safely contain waste should be available for outpatient wards and one per 20
beds for inpatient wards should be available; all should be equipped with menstrual hygiene facilities.
• Functional hand hygiene facilities should always be available at points of care, toilets and service areas (for example, the decontamination
unit), which include ABHR and soap, water and single-use towels (or if unavailable, clean reusable towels) at points of care and service areas,
and soap, water and single-use towels (or if unavailable, clean reusable towels) within 5 metres of toilets.
• Sufficient and appropriately labelled bins to allow for health care waste segregation (including for needle and sharps disposal) should
be available and used (less than 5 metres from point of generation) and waste should be treated and disposed of safely via autoclaving,
incineration (850° to 1100°C), and/or buried in a lined, protected pit.
• The facility should be designed to allow adequate ventilation (natural or mechanical, as needed) to prevent transmission of infectious
pathogens.
• Sufficient and appropriate supplies and equipment and reliable power/energy should be available for performing all IPC practices, including
standard and transmission-based precautions, according to minimum requirements/SOPs; reliable electricity should be available to provide
lighting to clinical areas for providing continuous and safe care, at a minimum to high-risk wards (for example, maternity ward, operating
room/s, intensive care unit).
• The facility should have a dedicated space/area for performing decontamination and reprocessing of reusable medical devices (that is, a
decontamination unit) according to minimum guidelines/SOPs.
• The facility should have adequate single isolation rooms or at least one room for cohorting patients with similar pathogens, if the number of
isolation rooms is insufficient.
PRIMARY
• Trained IPC link person/focal point (see minimum requirements for core component 1), as well as facility manager/in-charge and ancillary staff
(for example, cleaning staff, incinerator operators).

• Trained IPC link person/focal point (see minimum requirements for core component 1) and district/local WASH environmental health officer.
• Facilities manager and ward or department leads/in-charge staff.
• Additionally, at the national level, the IPC lead/focal point (and IPC technical team or committee, if existing) at the ministry of health or national
body responsible for IPC, as well as the national body (for example, ministry of water or ministry of the environment or ministry of rural
development) and the technical team or committee responsible for WASH (if separate), should take action to convene a technical group for the
implementation of IPC and WASH requirements for all health care facilities and implementation tools.
• Ideally, the technical group should include clinicians, engineers, environmental health officers and procurement managers.
• Financial manager at the facility and the next administrative level (for example, district), and the ministry of finances at the national level.
* Facility level only. However, the national health system, IPC programme and any other relevant body should coordinate and support the implementation of this core
component at the facility level.
47
INDICATORS (YES/NO)
PRIMARY CARE
• IPCAF – 8.1: water services available at all times and of sufficient quantity for all uses (for example, hand washing, drinking, personal hygiene,
medical activities, sterilization, decontamination, cleaning and laundry).
• IPCAF – 8.3: functioning hand hygiene stations (that is, ABHR or soap and water and clean single-use towels) available at all points of care.
• IPCAF – 8.4: there are more than or equal to four toilets or improved latrines available for outpatient settings or more than or equal to one per
20 users for inpatient settings.
• Modified IPCAF – 8.5: sufficient energy/power supply available at least during working hours for all uses (for example, pumping and boiling
water, sterilization and decontamination, incineration or alternative treatment technologies, electronic medical devices, general lighting of
areas where health care procedures are performed to ensure safe provision of health care and lighting of toilet facilities and showers).
• IPCAF – 8.6: functioning environmental ventilation (natural or mechanical) available in patient care areas.
• IPCAF – 8.8: appropriate and well-maintained materials for cleaning (for example, detergent, mops, buckets, etc.) available.
• IPCAF – 8.9: single patient rooms or rooms for the cohorting/physical separation of patients with similar pathogens or syndrome if the
number of isolation rooms is insufficient (for example, tuberculosis, measles, cholera, Ebola, severe acute respiratory syndrome).
• IPCAF – 8.10: PPE is available at all times and in sufficient quantity for all uses for all HCWs.
• IPCAF – 8.11: functional waste collection containers for non-infectious (general) waste, infectious waste and sharps waste in close proximity
to all waste generation points.
• IPCAF – 8.15: a dedicated decontamination area and/or sterile supply department (either present on- or off-site and operated by a licensed
decontamination management service) for the decontamination and sterilization of medical devices and other items/equipment.
• IPCAF – 8.16: sterile and disinfected equipment ready for use and reliably available.

(in addition to primary care indicators above) (from the water and sanitation for health facility improvement tool (WASH FIT**):
• Hygiene – 3.1: essential indicator 1. Functioning hand hygiene stations are available at all points of care (yes/no). Stations present, but no
water and/or soap or ABHR present (yes/no).
• Hygiene – 3.2: essential indicator 2. Hand hygiene promotion materials clearly visible and understandable at key places (yes/at some places,
but not all/none).
• Hygiene – 3.3: advanced indicator 1. Functioning hand hygiene stations are available in service areas (yes/stations present, but no water and/
or soap or ABHR present).
• Hygiene – 3.4: advanced indicator 2. Functioning hand hygiene stations available in waste disposal area (yes/stations present, but no water
and/or soap present).
• Hygiene – 3.5: advanced indicator 3. Hand hygiene compliance activities are undertaken regularly (yes/compliance activities in facility policy,
but not carried out with any regularity/no compliance activities).
SOURCES AND RESOURCES
Sources
• IPCAF results report (where available; use the template presentation); https://www.who.int/infection-prevention/tools/core-components/
IPCAF-template.pdf?ua=1.
• WASH FIT results report (where available). https://www.who.int/water_sanitation_health/publications/water-and-sanitation-for-health-
facility-improvement-tool/en/.
Tools and resources

• WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene. Joint Monitoring Programme definitions of improved
water/sanitation. 2019; https://www.unwater.org/publication_categories/whounicef-joint-monitoring-programme-for-water-supply-sanitation-
hygiene-jmp/.
• WHO. Guidelines on sanitation and health. 2018; https://www.who.int/water_sanitation_health/publications/guidelines-on-sanitation-and-
health/en/.
• WHO. Essential environmental health standards in health care. 2008; https://www.who.int/water_sanitation_health/publications/ehs_hc/en/.
• WHO. Safe management of wastes from health care. 2014; https://www.who.int/water_sanitation_health/publications/wastemanag/en/
• WHO and Pan American Health Organization. Decontamination and reprocessing of medical devices for health-care facilities. 2016; https://www.
who.int/infection-prevention/publications/decontamination/en/.
• WHO. Guidelines on tuberculosis infection prevention and control. 2019 update; https://www.who.int/tb/publications/2019/guidelines-
tuberculosis-infection-prevention-2019/en/.
• WHO. Natural ventilation for infection control in health-care settings. 2009; https://www.who.int/water_sanitation_health/publications/natural_
ventilation/en/.
• WHO. Guidelines on core components of IPC programmes at the national and acute health care facility level. 2016; https://www.who.int/
infection-prevention/publications/core-components/en/.
** NOTE: most of these indicators have three possible responses, not simply ‘yes/no’.
48
• WHO. Improving infection prevention and control at the health facility: Interim practical manual supporting implementation of the WHO guidelines
on core components of infection prevention and control programmes. 2018; https://www.who.int/infection-prevention/tools/core-components/
facility-manual.pdf.
• WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene. WASH in health care facilities: global baseline report. 2019;
https://www.unwater.org/publications/wash-in-health-care-facilities-global-baseline-report-2019/.
• WHO. WASH in health care facilities: practical steps to achieve universal access to quality care. Actions and solutions. 2019; https://www.who.
int/water_sanitation_health/publications/wash-in-health-care-facilities/en/.
PRIMARY CARE
• Adequate infrastructures and availability of adequate WASH support are essential to perform any health care services and IPC activities (for
example, water is absolutely critical for hand hygiene, cleaning and key services such as delivery).
• Improved water sources are those which by nature of their design and construction have the potential to protect water from external contamination
(for example, microorganisms, dirt). While drinking water is not required for basic IPC measures, water from improved sources may better facilitate
performing IPC measures according to guidelines/SOPs, for example, water from groundwater sources that is non-turbid can generally enable the
effective preparation of disinfectant solutions for environmental cleaning and decontamination of medical devices. The chlorine concentration in all
disinfectant solutions should be regularly monitored and the dose adjusted as necessary to meet chlorine concertation targets.
• Improved sanitation facilities are those designed to hygienically separate human excreta from human contact, which is critical for reducing the
transmission risk from enteric pathogens and, in addition to menstrual hygiene facilities, help maintain a hygienic environment; separate toilets for
patients and staff also helps to minimize indirect contact between patients and staff that may pose an infection risk.
• When there is a risk of soiling, ABHR is not a substitute for soap and water for hand hygiene after toileting or when hands are visibly soiled (for
example, while assisting childbirth).
• If ABHRs are available, it is essential to have these accessible at all points of care, given the proven advantages of ABHRs over soap and water, but
it is also essential that soap, water and single-use towels are available in clinical services.
• Adequate ventilation throughout the facility contributes to maintaining a hygienic environment and can be minimally accomplished via the presence
of functional windows (preferably equipped with insect traps) and doors, that allow at least 6-8 air changes per hour for natural ventilation (for
example, by opening opposite windows).
• Sufficient energy/power and a stand-by ‘back-up’ arrangement (including solar, wind, stand-by generator or others) and fuel should be available on-
site for lighting clinical practices and basic IPC measures (for example, for performing decontamination of medical devices, if needed).
• If the facility performs any procedures (for example, deliveries or other basic gynaecological procedures) requiring reusable medical devices (for
example, vaginal specula), at a minimum it is essential to create dedicated areas that allow proper workflow from dirty to clean for performing the
decontamination and reprocessing of medical devices.
• A small space to assess patients regarding the disease/reason for accessing the facility (that is, triage), including any infectious disease
transmission risk, and to allow them to be directed to different areas according to priority and type of disease can be accomplished with minimal
resources.
• Adequate space for temporary cohorting/isolation can also be accomplished with minimal resources by the creation of a physical separation or
barrier between suspected/infected patients and other patients, staff and visitors, and is critical for ensuring transmission-based precautions. If
resources allow, a room should be designated for this function.

• It is critical for water to be available 24 hours on-site from an improved source and piped into the facility to clinical areas, at a minimum to
high-risk wards (for example, maternity ward, operating room/s, intensive care unit), points of care and service areas (for example, sterile
services department) as patients in these areas may require 24-hour clinical care where water-related IPC is critical (for example, hand hygiene,
environmental cleaning, reprocessing of medical devices).
• The use of safe water (according to WHO drinking-water quality standard, that is, no Escherichia coli detectable in 100 mL and/or 0.5 mg/L free
chlorine residual) for water-related IPC interventions minimizes the risk of direct and indirect exposure to water-related pathogens of enteric and
environmental origin (for example, Pseudomonas, Legionella) and should be available for all clinical services; at a minimum, it should be provided to
high-risk wards where the burden of HAI and AMR are high.
• Sufficient quantities of water are required to ensure that all water-related IPC interventions can be performed. This quantity varies and is dependent
on the particular service or ward. To avoid any frequent service gaps/water shortages, it is required that there be sufficient on-site water storage
capacity to provide services for a minimum of 48 hours.
• Ensuring an adequate quantity of toilets for inpatient users to prevent crowding and overuse and ensuring regular cleaning are critical to maintain a
hygienic environment and minimize the transmission risk from enteric pathogens, at a minimum in the ratio defined previously.
• Positive mechanical ventilation is needed for clean areas such as operating rooms and clean areas in decontamination units and the sterile
services department, while negative pressure ventilation may be required for isolation facilities, for example, multidrug-resistant tuberculosis (see
tuberculosis references in ‘resources’). The requirement for mechanical ventilation is most applicable to tertiary care facilities.
• Reliable power means that a constant (that is, 24-hour) source of power and/or back-up power is available for high-risk wards (for example,
maternity ward, operating room/s, intensive care unit). Without reliable power, it is not possible to operate decontamination (sterilization) equipment
and waste treatment equipment when needed, or to have lighting in clinical areas in order to provide continuous and safe care.
• Reliable power can be achieved via an on-site source of energy/power and fuel (for example, wind, solar, stand-by generator/s) to provide back-up
as needed.
• Given the increased risk for HAIs and AMR at secondary and tertiary health care facilities, there should be at least one isolation room per 20-bedded
ward in secondary care facilities, and 1:10 in the tertiary level as a minimum.
• Cohorting can be carried out in a dedicated area of a general ward. It can be done in any well-ventilated area as long as hand hygiene and
transmission-based precautions are strictly adhered to.
49
• As improving access to WASH services and IPC materials and equipment is resource intensive, the first step (minimum requirement) is to establish
a multidisciplinary technical group to develop standards and implementation tools.
• This group will have the task of:
‐ reviewing the requirements for WASH services, environmental hygiene, and IPC materials and equipment, according to the national context;
‐ developing a monitoring plan and reporting mechanism for assessing and improving WASH services and IPC materials and equipment in all health
care facilities against national standards; use of existing tools (for example, WASH FIT or WHO/UNICEF JMP indicators for WASH in health care
facilities) may be of help in these efforts;
‐ identifying roles and responsibilities for the implementation and management of WASH services, environmental hygiene and IPC materials and
equipment at the facility level at all health care facilities.
• The national level could also consider the development of a policy/regulations to mandate WASH services in facilities, according to the minimum
requirements specified above.
ALL HEALTH CARE FACILITIES

• Central government and national IPC and WASH programmes should develop standards and national action plans to ensure adequate WASH services,
a hygienic environment, and the availability of IPC materials and equipment in all health care facilities, including primary care.
• Ensuring an adequate hygienic environment should be the responsibility of senior facility managers and local authorities.
• To implement the full requirements of the core component 8, all health care facilities should provide the following:
‐ water from an improved source located on premises with sufficient water available at all times for drinking, hand washing, food preparation,
personal hygiene, medical activities, cleaning and laundry;
‐ improved sanitation facilities located on premises that are functional with safe management of sewage/faecal waste, including the use of well-
managed septic tanks and leach fields, disposal into functioning sewers or off-site removal, and include at least one toilet designated for women/
girls to manage menstrual hygiene needs, at least one separated for staff, and at least one meeting the needs of people with limited physical
disabilities; also, sanitation facilities for infants and children that are adapted for their use (with for example, smaller seats, child-sized bed pans),
segregated by sex for older children, appropriately lit and accessible to people with limited mobility;
‐ adequate drainage of storm and wash water to prevent vector breeding;
‐ continuous access to hand hygiene facilities equipped with ABHRs and (where appropriate) with water, soap and disposable or clean towels at the
point of care, within 5 metres of toilets, and other areas such as the sterile services departments, laboratories and mortuaries;
‐ continuous adequate supply of sharps’ containers and containers for segregating other types of health care waste and equipment to ensure that
health care waste is treated and disposed of safely, including autoclaving, incineration or removal for off-site treatment;
‐ continuous adequate supplies to ensure regular cleaning of examination rooms, waiting areas, surfaces and toilets;
‐ continuous adequate supply of appropriate PPE for both clinical care and health care waste handling and cleaning;
‐ adequate ventilation to meet comfort requirements and reduce the risk of transmission of airborne pathogens;
‐ adequate power for sterilization, incineration and medical devices; sufficient energy for pumping water, sterilization and operating health care
waste equipment (that is, incinerators); well-lit areas where health care procedures are performed and in toilet facilities, including at night.
• The IPC team or committee should be involved in planning all these activities and systems and in the design of buildings and infrastructures and
construction in health care facilities.
• Practical actions to improve WASH in health care facilities should include:
‐ conduct situational analysis and assessment
‐ define roadmap and set targets
‐ establish national standards and accountability mechanisms
‐ improve and maintain infrastructure
‐ monitor and review data
‐ develop health workforce
‐ engage communities and
‐ conduct operational research and learning.

(in addition to primary care)
• A dedicated centralized decontamination area and/or sterile supply department for the decontamination and sterilization of medical devices and other
items/equipment should be available and supplied with sufficient water and power.
• A dedicated clean storage area for patient care items and equipment, including sterile material, and a separate area for the storage of clean linen should
be available as outlined in the WHO manual on decontamination and reprocessing of medical devices for health-care facilities (see ‘resources’).
• An adequate number of single rooms (with private toilet facilities and including some rooms with negative pressure mechanical ventilation system)
and/or rooms suitable for patient cohorting for the isolation of suspected /infected patients, including those with tuberculosis, other airborne
pathogens and multidrug-resistant organisms, should be available to prevent transmission to other patients, staff and visitors.
• Proper ventilation systems should be available in general and in the operating room, including either negative or positive air pressure conditions,
depending on the situation.
• Risk assessment systems and measures should be developed to ensure protection during building and renovation work for patients, their families and
staff, especially in high-risk areas, such as units where severely immunocompromised patients (transplant, patients with profound neutropenia, etc.) are
managed, as well as in intensive care, neonatal and burn units and operating rooms.
51
PART 4. ANNEX
PART 4. ANNEX
4.1 Annex 1. Summaries of the results of a systematic review

and inventory on available IPC minimum standards
4.1.1 Overview of the results of the systematic literature review on

minimum standards for IPC
The systematic review on IPC minimum standards was conducted as a basis
for the expert consultation on the IPC minimum requirements. It focused on
the question: “What are the minimum standards of effective IPC programmes
aimed at reducing health care-associated infections at the national and health
care levels?” The Cumulative Index of Nursing and Allied Health Literature
(CIHAHL), PubMed, GIM (WHO Global Index Medicus) and EMBASE databases
were searched to identify reported minimum standards. IPC interventions were
categorized as either horizontal (for example, IPC programme, education) or
vertical (for example, prevention of surgical site infections). Hand hygiene,
injection safety and education are examples of horizontal IPC interventions,
while the prevention of surgical site infections, hospital-associated pneumonia
and catheter-related bloodstream infections were categorized as vertical IPC
interventions.
Horizontal interventions were more frequently mentioned compared to vertical
interventions as being a minimum requirement (Fig. 1). Hand hygiene (91%),
transmission-based precautions (including triage) (87%), surveillance (85%),
education/training (81%) and the built environment/infrastructure (77%) were
the five most frequently mentioned horizontal critical IPC measures, followed
by guidelines (70%), decontamination (70%) and monitoring/audits/feedback
(66%).
Facility level
Fig. 1 Top 5 vertical interventions

Top 5 horizontal and vertical
interventions mentioned as a Hand hygiene 91%
Top 5 horizontal interventions
Prevention of CAUTI or CRO 19%
minimum requirement at the facility

level.
Prevention of VAP/HAP 26%
Transmission-based precautions 87%

Prevention of CR-BSI 36%
Prevention of MRSA 32%
Prevention of SSI 21%
Surveillance 85%
Education/training 81%
Built environment/infrastructure 77%
ABBREVIATIONS
CR-BSI, catheter-related bloodstream infection; MRSA, methicillin-resistant
Staphylococcus aureus; VAP/HAP, ventilator-associated pneumonia/hospital-
acquired pneumonia; SSI, surgical site infection; CAUTI, catheter-associated urinary
tract infection; CRO, carbapenem-resistant organisms.
52
PART 4. ANNEX
Compliance with standard precautions is usually low and it is therefore

important to investigate implementation strategies to improve this key
measure. Existing competencies of IPC practitioners, as well as existing
indicators, will be useful to define minimum standards. It will be critical to draw
on lessons learned from the past and to engage hospital leadership in further
discussions regarding the importance of implementation of IPC programmes.
The review also highlighted the low quality of studies reviewed (systematic
reviews and before-after studies), a very great number of studies from high-
income countries, a high percentage of systematic reviews on methicillin-
resistant Staphylococcus aureus and Clostridium difficile from high-income
countries, and an elevated number of facility-based studies.
4.1.2 Summary of the global inventory on IPC minimum standards

The aim of developing the global inventory of IPC minimum standards was
to produce a catalogue of already available guidance on these standards
(especially from the perspective of low-resource settings) from WHO regional
and country offices, other organizations and countries directly. This was
to complement the systematic review and country experiences gathered
previously and to provide insights into what could be considered as ‘minimum
standards’ for IPC at the national and facility level. A global call was made to
relevant networks, as well as a search for any publicly available IPC-related
documents. The database used for the guidelines on the core components of
IPC was also searched for any relevant documents. A total of 23 documents
were reviewed in full (1-23), but only nine included approved national IPC
standards defined as ‘minimum’ for health care facilities (1-9).
Overall, these documents provided validation of the WHO guidelines on

core components for IPC programmes as all reviewed documents could be
categorized and related to the eight core components. Most notably, core
components 1 (IPC programmes), 3 (education and training) and 8 (built
environment) were the most referred to, while core component 7 (workload,
staffing and bed occupancy) was the least reported. The limitations of the
final inventory had already been acknowledged as it was taken from direct
submissions and those that were publicly available. However, despite some
countries specifically identifying IPC minimum standards, the majority lacked
any standard definition of minimum standards and their approach remained
broad with a lack of specificity.
53
PART 4. ANNEX
4.1.3 References
1. Ethiopian hospital services transformation guidelines, volume 2. Ethiopian
hospitals management initiative. Addis Ababa: Federal Democratic
Republic of Ethiopia Ministry of Health; 2016.
2. Ministry of Health Social Services Namibia. Hospital
standards and criteria, 1st edition (Draft 2). 2018 (http://
www.mhss.gov.na/documents/119527/659098/
MoHSS+Namibia+Hospital+Standards+and+Criteria+DRAFT.
pdf/13271616-e30e-4a0d-b3d9-54d17c283eeb, accessed 29 October
2019).
3. Infection Prevention and Control (IPAC) Canada. Infection Prevention
and Control (IPAC) Program Standard. Can J Infect Control. 2016;
30(Suppl):1-97 (https://ipac-canada.org/photos/custom/CJIC/
Vol31No4supplement.pdf, accessed 29 October 2019).
4. Swaziland standards authority. Swaziland national standard. General
hospitals and health centres – requirements. 2011 (https://www.swasa.
co.sz/standards.php, accessed 29 October 2019).
5. Infection prevention and control manual, 2nd edition. Riyadh (Saudi
Arabia): National Guard Health Affairs Infection Prevention and Control
Department. Gulf Cooperation Council – Centre for Infection Control;
2013 (https://www.moh.gov.sa/CCC/Documents/GCC%20Infection%20
control%20manual%202013%20revisedOPT.pdf, accessed 29 October
2019).
6. New Zealand standard. Health and disability services (infection prevention
and control) standards. Wellington: Standards New Zealand; 2008 (https://
www.standards.govt.nz/assets/Publication-files/NZS8134.3-2008.pdf,
7. Normas para la prevención y control de infecciones en los
establecimientos de salud. Santo Domingo: Ministry of Public Health,
Dominican Republic; 2013 (http://digepisalud.gob.do/docs/vigilancia%20
epidemiologica/Reglamentos%20y%20Normas/2013%20-%20Normas%20
control%20infeccion.pdf, accessed 29 October 2019).
8. Botswana national health quality standards for hospitals. 9. Prevention and
control of infection. Republic of Botswana Ministry of Health; 2014 (https://
www.moh.gov.bw/Publications/standards/Botswana%20National%20
Health%20Quality%20Standards%20for%20Hospitals/Botswana%20
HOSPITAL%20Standards%20SE%209%20Prevention%20and%20
Control%20of%20Infection.pdf,accessed 29 October 2019).
9. Patient safety assessment manual: second edition. World Health
Organization. Regional Office for the Eastern Mediterranean; 2016 (https://
apps.who.int/iris/handle/10665/249569, accessed 29 October 2019).
10. Norma técnica no 124 de los programas de prevención y control de las
infecciones asociadas a la atención en salud (IAAS). Republica de Chile
54
Ministerio de Salud; 2011 (http://digepisalud.gob.do/docs/vigilancia%20

epidemiologica/Reglamentos%20y%20Normas/2013%20-%20Normas%20
control%20infeccion.pdf, accessed 29 October 2019).
11. Normas institucionales para la prevención y control de infecciones
intrahospitalarias. Caja Costarricense de Seguro Social. Dirección Técnica
de Servivios de Salud. Departamento de Saneamiento Básico y Ambiental
Institucional. Sección de Infecciones Intrahospitalarias; 2002 (http://
aesscr.com/Normas%20institucionales%20para%20la%20prevención%20
y%20control%20de%20infecciones%20intrahospitalarias.pdf, accessed 29
October 2019).
12. Ministry of Health and Population Egypt. National guide for infection
control (second part, 3rd edition). 2016.
13. Normas de prevención y control de las infecciones nosocomiales.
Ministerio de Salud Publica del Ecuador; 2006 (https://aplicaciones.msp.
gob.ec/salud/archivosdigitales/documentosDirecciones/dnn/archivos/
manual%20de%20normas%20de%20infecciones%20nosocomiales.pdf,
14. Société Française de Hygiène Hospitalière. Surveillance and prevention of
healthcare-associated infections. HygièneS. 2010; 18(4): 3-175 (https://
sf2h.net/wp-content/uploads/2016/04/SF2H_surveillance-and-prevention-
guidelines-2010.pdf, accessed 29 October 2019).
15. Personelle und organisatorische Voraussetzungen zur Prävention
nosokomialer Infektionen Empfehlung der Kommission für
Krankenhaushygiene und Infektionsprävention [Personnel and
organizational requirements for the prevention of nosocomial infections:
recommendations from the Commission for Hospital Hygiene and
Infection Prevention]. Bundesgesundheitsbl [German Federal Health
Bulletin] 2009;52:951–962 [in German] (https://www.rki.de/DE/
Content/Infekt/Krankenhaushygiene/Kommission/Downloads/Rili_
Hygmanagement.pdf?__blob=publicationFile, accessed 30 October 2019).
16. Hospital infection control manual for small healthcare organizations. New
Delhi (India): National Accreditation Board for Hospitals and Healthcare
Providers (https://nabh.co/Images/PDF/HIC_Guidebook.pdf, accessed 29
October 2019).
17. National infection prevention and control guidelines for health care
services in Kenya. Nairobi: Kenya: Ministry of Public Health and Sanitation
and Ministry of Medical Services, Republic of Kenya; December 2010
(http://www.ashcott.com/images/IPC_GUIDELINES.pdf, accessed 29
October 2019).
18. American University of Beirut Medical Centre. Standard precautions. 2015.
19. Rapid evaluation guide for hospital programs for prevention and control
of nosocomial infections. Washington (DC): Pan American Health
Organization; 2011 (https://www.paho.org/hq/dmdocuments/2011/HAI-
55
Evaluation-guide-2011-ENG.pdf, accessed 29 October 2019).

20. Ministère de la Santé et l’Action Sociale du Sénégal. Programme national
de lutte contre les infections nosocomiales (PRONALIN). Fiche de
supervision. 2011.
21. Sri Lanka College of Microbiologists. Empirical and prophylactic use
of antimicrobials. National guidelines. 2016 (http://slmicrobiology.lk/
download/National-Antibiotic-Guidelines-2016-Web.pdf, accessed 30
October 2019).
22. National Institute for Health and Care Excellence (United Kingdom).
Infection prevention and control. Quality standard (QS61). April 2014
(https://www.nice.org.uk/guidance/qs61/chapter/Introduction, accessed
30 October 2019).
23. United States of America Centers for Disease Prevention and Control.
Core infection prevention and control practices for safe healthcare delivery
in all settings – recommendations of the Healthcare Infection Control
Practices Advisory Committee. 2017 (https://www.cdc.gov/hicpac/
recommendations/core-practices.html, accessed 29 October 2019).
ISBN 978-92-4-151694-5

MinReq-Manual 2019 PDF

Uploaded by

Copyright:

Available Formats

MinReq-Manual 2019 PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

MinReq-Manual 2019 PDF

Uploaded by

Copyright:

Available Formats

MINIMUM REQUIREMENTS

for infection prevention

© World Health Organization 2019

Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.

Graphic design by Maraltro, Italy.

Abbreviations and acronyms IV

Glossary of key terms and definitions V

Part 2. Executive summary of the minimum requirements 13

Part 3: In-depth review of the minimum requirements 23

The Department of Integrated Health Services of the World

OVERALL COORDINATION, WRITING

EXPERT CONTENT DEVELOPMENT GROUP

The content was further developed with the substantial

Fahmi Ahmed (WHO Country Office for Ethiopia); Anjana

ABBREVIATIONS AND ACRONYMS

ABHR alcohol-based handrub

AMR antimicrobial resistance

CDC Centers for Disease Control and Prevention (USA)

CPE carbapenemase-producing Enterobacteriaceae

EQAS external quality assurance system

HAI health care-associated infection

HCW health care worker

IPC infection prevention and control

IPCAF infection prevention and control assessment framework

IPCAT infection prevention and control assessment tool

PPE personal protective equipment

SOP standard operating protocols

UNICEF United Nations Children’s Fund

USA United States of America

WASH water, sanitation and hygiene

WASH FIT water, sanitation and hygiene facility improvement tool

WHO World Health Organization

GLOSSARY Cohorting: Grouping of patients who are colonized or

always used in addition to standard precautions. They are

Water quality: The quality of water is affected by microbial,

Visual representation of the WHO core components of

Visual representation of minimum versus full

Key people to be involved in an activity.

Process undertaken to develop the document.

How the document is structured.

Achieving the effective implementation of the IPC

Content relevant for the national level.

Content relevant for the health care facility level.

Preventing harm to patients, health workers and visitors due to infection in

IPC is a cross-cutting issue in health care. Strong, effective IPC programmes

1.1 PURPOSE OF THE DOCUMENT

The purpose of this document is to present and promote the minimum

The minimum requirements are defined as:

IPC standards that should be in place at the national and

1.2 TARGET AUDIENCE

The main target audience of this document are IPC and

The document could also be helpful to other stakeholders, such as those

health, antimicrobial stewardship programmes, clinical microbiology and

1.3 DOCUMENT DEVELOPMENT AND STRUCTURE

A group of international experts and professionals working at national and

The document includes four parts.

BOX 1 STRUCTURE OF THE MINIMUM REQUIREMENTS (PART 3)

Text of the minimum Identification of Indicators to be Explanations Comprehensive

1.4 ROLE OF THE MINIMUM REQUIREMENTS