Strengthening infection prevention and control in humanitarian settings: lessons and opportunities from Médecins Sans...

Effective infection prevention and control (IPC) is fundamental to patient safety in low-resource settings, yet its implementation remains a challenge. Standardised tools are essential for assessing IPC programmes and guiding improvements. This study evaluates the implementation level of IPC across global Médecins Sans Frontières (MSF) supported facilities using the Stepwise Infection Prevention and Control Approach (SIPCA) assessment tool.

A retrospective analysis of 374 SIPCA assessments from 173 MSF-supported facilities was conducted between August 2021 and December 2023. Overall and component-specific IPC scores were analysed and a mixed-effects logistic regression model was used to identify factors associated with higher IPC performance. Changes in scores over time were stratified by initial IPC level.

The overall median IPC score was 60.4%, corresponding to an 'upper-intermediate' level of implementation. The presence of a formal IPC programme (OR 6.47, p<0.001) and a bed occupancy rate below 90% (OR 2.94, p=0.001) were the strongest predictors of achieving a score above the median IPC threshold. Repeated assessments were associated with significant improvement, particularly for facilities starting at a 'basic' level (median score increase of +21.6%). However, a ceiling effect was observed, with minimal improvement in facilities already at an 'upper-intermediate' level. Key programme weaknesses were identified in healthcare-associated infections (HAIs) surveillance, particularly regarding surgical site infections (40.6%).

The SIPCA tool is effective for monitoring IPC status and guiding IPC interventions in humanitarian contexts. To enhance patient safety, efforts must focus on establishing IPC programmes and addressing systemic pressures, such as high bed occupancy rates. Targeted strategies are necessary to strengthen HAI surveillance and help high-performing facilities overcome performance plateaus, ultimately achieving advanced levels of IPC excellence.