1. WHO- Cambodia Philip Pugh & Karen Shaw WHO Consultants Mission - Infection Prevention & Control Policy Development Cambodia Unmasking Cambodia – Developing Infection Prevention & Control

2. WHO- Cambodia The Kingdom of Cambodia Formerly known as Kampuchea is a country in South East Asia. Borders Thailand, Laos, Vietnam, and the Gulf of Thailand. Dominated by the Mekong River. About 2/3 the size of England with a population of 14 million ethnic Khmer – Buddhist, Muslim War – invaded many times - 1975 the Khmer Rouge led by Pol Pot took power. They attempted to rebuild the countries agriculture based on a model of the 11 th century and destroyed anything that was considered western and destroyed medicines temples libraries etc. Over a million Cambodians died from executions, torture imprisonment as well as overwork starvation and disease.

3. WHO- Cambodia The Kingdom of Cambodia -

4. WHO- Cambodia World Health Organisation - Cambodia

5. WHO- Cambodia Assessment of Infection Prevention & Control in Cambodia Briefing from key people including; –WHO consultants to cover the history of IC in Cambodia –NGO colleagues working on Infection Control –Hospital visits in Phnom Penh including; ;Kossamak Hospital ;Calmet Hospital –Province Hospital visits including; ;Chheung Prey Health Centre ;Chheung Prey Referral Hospital CPA 1 ;Kampong Cham Province CPA 3

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7. Assessment of Infection Control in Cambodia Meeting with key National Programme Directors –Dr Mao Tan Eng - CENAT Director (TB) –Dr Mean Chhi Vun - NCHADS Director (HIV) –Professor Koun Kanal – Chair National Working Group for Healthcare Waste Management Meeting with the Dr Sok Touch, Director, Chair, Working Group on Infection Control, Universal Precautions and Surveillance Meeting with His Excellency Professor Eng Huot –Secretary of State for Health –Meeting again Friday 24 July 2009

8. WHO- Cambodia Assessment findings Some photo’s and findings from our visits

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18. Draft Infection Prevention & Control Policy 12 Key Action Areas –These action areas cover what is needed to deliver an Infection Control Programme Overall Goal for each Action –The high level goal for each action area that summarises the key issue Objectives for each Action –A set of objectives to deliver the Goal for each Action

19. WHO- Cambodia 1. Management and Organisation Goal : To have a national and local infrastructure in place for infection control; MOH, senior management commitment, local infrastructure and systems are vital, as engaging HAI is everyone’s responsibility Key issue : O wnership of IC is very important at all levels of the healthcare system Discussion point : Structure for IC in Cambodia – Dr Nora Chea

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21. 2. Human Resources Goal : To have staff at all levels of the healthcare system from the Ministry of Health to the provincial hospital with responsibility for infection control who can drive forward the infection control agenda. Healthcare workers in Cambodia will have a good understanding of how to practice infection prevention and control to deliver Clean, Safe, Care. Key Issue: Training for all healthcare workers Question: What are the logistics of conducting national training for Infection Control in Cambodia? How can this be achieved?

22. WHO- Cambodia A local clinic offering HIV and other testing.

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24. 3. Infection Control Guidelines Goal: The Ministry of Health must ensure the development, dissemination and implementation of evidence-based guidelines for infection control in Cambodia Key Issue: Resources are often scarce Discussion Point: How to ensure compliance and safe care when resources are not available

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28. 4. Environment Goal : A clean, safe, environment for implementing the infection control guidelines Key Issues : –Clean water –Adequate hand washing facilities –high standards of hygiene and clinical practice –Adequate Isolation facilities –Planned preventive maintenance for facilities – ongoing maintenance programme for; sinks, washing machines, toilets, showers etc –Food safety Question : How can this goal be achieved ? Think of long term goals and steps to take to achieve this goal

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32. 5. Surveillance Goal: Surveillance of HAI is essential to understanding the burden, understanding the underlying causes, tracking IC practice and highlighting outbreaks Key Issues : Establish priorities for surveillance in Cambodia; eg Surgical site surveillance Urinary Tract Infections Bloodstream infections Antimicrobial resistance Questions : What are the priorities for surveillance in Cambodia?

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35. Signage was generally good but occasionally standards were low...!!

36. WHO- Cambodia 6. Waste Management Goal : safe disposal of waste including sharps as per IC and Waste Management Guidelines Key Issues : point of source segregation, safe handling of waste and incineration Inappropriate use of waste as a source of income Laboratory waste management Discussion point: Do you have any suggestions for the National Waste Management working group?

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39. 7. Equipment Goa l: Reducing the risk of infection from clinical and non-clinical equipment by ensuring it’s safe use (including single use equipment) Key Issues : –Clinical Equipment ; sterile (Cleaning, disinfection and sterilisation) ; non-sterile patient equipment ; invasive ; non-invasive –Non-clinical (eg. Mops, buckets, beds etc) Question : How can Equipment be made safe for patient care when resources are scarce?

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44. 8. Microbiology Goal : Microbiology services need to be assessed and strengthened Key Issues: –Long delays for results –Ability to detect antimicrobial resistance –Biosafety in the laboratory Discussion point : priorities for assessing and strengthening microbiology services in Cambodia

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47. 9. Prudent Use of Antimicrobials Goal: To promote the appropriate use of antibiotics to minimise antimicrobial resistance of micro-organisms Key Issue: –Educate healthcare workers in the prudent or appropriate use of antimicrobials –Reduce the burden of antimicrobial resistance –Work towards surveillance of antimicrobial resistant organisms, in line with surveillance objective Question: How realistic is this goal and how can we work towards achieving it?

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49. 10. Quality Improvement Goal : Ongoing monitoring and evaluation of the Infection Control Programme Key Issues: –ongoing audit of Infection Control at all levels of the healthcare system –Developing assessment tools and applying these –Changes to practice and implementation of areas identified for improvement Discussion point: what is the current level of understanding of quality improvement and what level should the policy target?

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51. 11. Collaboration Goal: Communicate and collaborate with other Key Working Groups, Departments and Organisations Key Departments – see Draft Infection Control Policy Discussion point : What are the other key Groups and Organisations to collaborate with on the Policy Development?

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54. 12. Research and Development Goal : Country specific research and development will lead to a better understanding of HAI in Cambodia which will be used to benefit patient care Key Issues : resources and capacity to conduct good healthcare epidemiology Discussion : How can this be achieved?

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56. Way forward Small Group work Discuss the Draft Policy for Infection Control Action Areas Goals Key Issues Questions and Discussion Points – to develop the IC Policy for Cambodia it needs input from the people doing the work here with assistance from partner organisations.

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