1. Webinar IPC Roadmap Development and IPC Roadmap Implementation
TB CARE II
23 September 2019

2. Designing and Implementing IPC Roadmaps
Introduction
Designing and Implementing IPC Roadmaps

3. Introduction and Purpose
To discuss the use of IPC roadmaps for institutionalizing data collection and use
To discuss IPC roadmaps in the context of reporting on NAP progress
To understand the specific, operationalized measurements of IPC interventions and hear experiences from country teams on how they measure IPC interventions at national and sub-national levels.

4. Developing an Implementation Roadmap
IPC Roadmap
Developing an Implementation Roadmap

5. IPC Roadmap: Core Components
Core components for developing and implementing an IPC roadmap include the following:
New or Existing: is the indicator already in use?
Data Source: what data systems are used to collect data for this indicator?
Responsible Parties: who (at each level) is responsible for data collection, aggregation, analysis and presentation?
Frequency: How frequently is this indicator reported?
Timeline: for new indicators, when will the indicator be in use and reported?

6. Core Components: New or Existing?
Is the indicator currently in use in the country?
To what extent?
Is the indicator included in guidance document?
Are data available for this indicator?
If the indicator is new in the country, is it being collected elsewhere?

7. Core Components: Data Source
What data systems are in place for collecting this indicator?
At what level is the indicator collected (i.e. facility, laboratory)?
At what level is the indicator aggregated and summarized?
What is the general data flow (i.e. collected at the facility, summarized and validated at district level, summarized and validated at provincial level, summarized and validated at national level)

8. Core Components: Responsible Parties
Who is responsible for data collection, aggregation, validation and presentation?
At all levels (i.e., facility, district, provincial, national)
Is there a champion for the given indicator or intervention who understands the indicator and data collection methods?

9. Core Components: Frequency
How frequently are data aggregated and presented?
For example: collected at the facility level and then aggregated monthly, with summary results presented in a quarterly report

10. Core Components: Timeline
For implementing new indicators in a given country context, what steps must be taken to establish data systems, responsible parties and other factors, and what is the projected start date for data collection and subsequent reporting?

11. IPC Roadmap: Levels of Implementation
Most indicators are facility level indicators (with aggregation to various higher levels for reporting purposes)
National level indicators could include the following
Incidence of TB infection among health care workers
National TB infection control guideline scorecard

12. Operationalizing the Roadmap
IPC Roadmap
Operationalizing the Roadmap

13. IPC Roadmap: Reporting Progress on NAP Milestones
Assess current indicators in the country
Which IPC indicators are currently in place?
For new indicators, follow the “essential elements” to define a plan for implementing
Define a baseline for new indicators
Use a set of IPC indicators to report progress toward NAP milestones in a standardized, comparable manner (or as comparable as possible)

14. Country Example
South Africa

15. Existing IPC Practices
South Africa
Existing IPC Practices

16. Existing practices for TB infection control
Existing tools, checklists, SOPs, and scope of use
Screening Tool - TB symptomatic screen for all patients and HCW
Risk Assessment Tool – for clinics and hospitals, conducted annually
IPC Evaluation checklist – conducted monthly, used to monitor implementation of IPC plans
Ideal Clinic Dashboard – used to assess compliance to IPC at facility level, used monthly
Other tools in use
Household risk assessment tool – being piloted, used every 6 months
Risk assessment tools for Correctional facilities (prisons) and police cells

17. Roadmap/Pathway to Adapting and Adopting Best IPC Practices
New or Existing
Frequency
Timeline
Selected indicators
Does the indicator already exist? Are you collecting data on this/these indicators?
If yes, what is the data collection approach? How you collect data on/for this indicator(s)
How frequently is this indicator be reported?
If this is a new indicator, what is the timeline for rolling out this indicator?
Comments
Managerial
Controls
National TB infection control guideline scorecard
Yes - Ideal clinic and National Core Standards (Hospital QA)
By completing a self and peer-assessment spreadsheet.
 Quarterly
These are for clinics and CHCs but not for Hopsital
Proportion of health care facilities (small, medium, larger) with an updated (past 10 years) IPC Plan/SOP that includes TB IPC measures
Online checklist
Quarterly 
New for hospitals - full implementation April 2019 
Proportion of health care facilities in the district/state with an active infection control committee responsible for implementing the written infection control plan that includes airborne infection control
Proportion of health care workers trained in infection prevention and control.
Proportion of tertiary health care facilities in the district/state that have been subjected to facility risk assessment for airborne infection control

18. Roadmap/Pathway to Adapting and Adopting Best IPC Practices
New or Existing
Frequency
Timeline
Selected indicators
Does the indicator already exist? Are you collecting data on this/these indicators?
If yes, what is the data collection approach? How you collect data on/for this indicator(s)
How frequently is this indicator be reported?
If this is a new indicator, what is the timeline for rolling out this indicator?
Comments
Administrative Controls
Proportion of facilities w/ > 90% of hospitalized patients screened for active TB
Yes. The tick register / hospital register
At each entry point as part of the regular triage.
Monthly
Environmental Controls
Proportion of facilities w/ airborne infection control risk assessment
Yes- Ideal clinic and National Core Standards (Hospital QA)
Online checklist
Respiratory Hygiene
Proportion of facilities with surgical masks available for patients identified with a cough
To check stock out of surgical masks and n95
New system. Report stock outs
Apr-19
Explore inclusion in the Stock management information system
HCW Surveillance
Proportion of HCWs screened for active TB disease
Self reporting. Depending on the policy approval
New system
Proportion of HCWs screened for TB infection
Proportion of facilities w/ adequate score on HCW screening program evaluation
OUTCOME/IMPACT: Risk of TB (disease) among health care workers relative to the general population, adjusted for age and sex
In Patient Waiting Time

19. South Africa
Example: FAST

20. FAST & U-LAM administrative process indicators
FAST & U-LAM administrative process indicators . To evaluate the proportion of patients in care who are screened for TB and put on treatment . To evaluate time from sample submission to diagnosis to treatment . Cascade Data reported monthly
FAST Data Elements
Number of patients screened for TB
Number presumptive
Number tested by GeneXpert
Number tested positive by Gene Xpert
Number diagnosed with DS TB
Number diagnosed with RR TB
Number started on DS TB treatment
Number DS TB initial lost to follow-up
Number DS TB died before treatment started
Number RR TB started on treatment
Number RR TB lost to follow up before treatment started
Number RR TB died before treatment started
Number tested by other Clinical Diagnostic Tests
Number tested positive by other Clinical Diagnostic
Time from sample submission to diagnosis
Time from diagnosis to treatment
U-LAM Data Elements
Number of HIV positive patients with low CD4 count ( less than or equal to 100 cells/ul
Number of HIV positive patients who are seriously ill and regardless of low CD4 count
Number of clients LAM tested
Number tested LAM positive
Number initiated on TB treatment
Initial death
Loss to follow
Number done Xpert/MTB Rif
Number diagnosed RR positive
Number of RR positive on MDRTB treatment

21. Example: Health Care Worker Surveillance
South Africa
Example: Health Care Worker Surveillance

22. Screening of LTBI among HCWs
Study conducted to determine the prevalence of LTBI and progression to active TB using QuantiFERON-Plus (QFT-Plus) in three hospitals
1) Pelonomi Regional hospital, Free State
2) Zithulele District hospital, Eastern Cape and
3) Pretoria West District Hospital, Gauteng
Phase one (recruitment and enrolment of 272 participants) at Pretoria West District Hospital has been completed.
Preliminary findings show that 121 (44.5%) were LTBI positive and 129 (54.8%) negative.

23. Healthcare worker surveillance
There is a draft national policy on Occupational TB and HIV services for healthcare workers
IPC guidance documents do not include surveillance for healthcare workers
Provinces have guidelines that include TB medical surveillance and indicators, this is not standardized across provinces
Number of health care workers diagnosed with TB (DS/ MDR/ XDR-TB)
Systems used to collect the data vary – OHASSYS, DHIS, ETR
Data not flowing to national level but can be obtained from the provinces
Data not reported to the WHO currently

24. Legal and Policy Framework
Constitution of the Republic of South Africa (Act No. 108 of 1996)
The National Health Act (No. 61 of 2003)
Occupational Health and Safety Act (No. 85 of 1993), and Regulations for Hazardous Biological Substances, 2001
Roles of employer and employees
Record keeping of risk assessment, monitoring activities, medical
surveillance (the last being subject to confidentiality) for a period of
40 years
Compensation for Occupational Diseases and Injuries Act (No. 130 of 1993)
TB schedule 5 Biological Hazard
Compensable disease

25. Healthcare worker surveillance future plans
Approval of policy
Development of guidelines
Training of Occupational Health Practitioners
Develop M and E framework
Roll out the OHASYS (Occupational health Information system)
Only for health care workers
Confidential
Quarterly and Annual reports will be provided by the Occupational Health Unit for all medical conditions

26. IPC Roadmap
Conclusions

27. Questions

28. USAID TB CARE II In partnership with:
The TB CARE II project is funded by the United States Agency for International Development (USAID) under Cooperative Agreement number AID-OAA-A and is managed by the prime recipient, URC.
In partnership with: