Nicholas Feasey – Care Bundles, Behaviour and the Prevention of Healthcare-Associated Infection in Malawi

Abstract

Healthcare-associated infections (HAI) are a substantial global challenge, responsible for a huge and preventable burden of disease, including in Africa. A recent systematic review of HAI in Africa found a median infection prevalence of 15%, with marked variation between settings and high levels of antibiotic resistance among the bacteria responsible. Preventing these infections depends on reliable delivery of apparently simple practices: cleaning hands, maintaining aseptic technique and keeping the healthcare environment clean. Yet translating guidelines into everyday care remains difficult where staff, supplies and infrastructure are stretched.

This talk will draw on a programme of infection prevention and control research in Malawi, moving from a national assessment of hospital systems to detailed observational and qualitative research in two referral hospitals and ultimately to the co-production and implementation of pragmatic interventions to reduce the burden of HAI in Malawi. These formative studies revealed substantial gaps between policy and practice, including inaccessible guidelines, inconsistent training, shortages of essential supplies and limited monitoring and feedback. They also highlighted the importance of family members in the Malawian setting who provide much of patients’ everyday care.

I will present early findings from IPC-Implement, a co-created intervention combining practical training, empowerment of local champions, multidisciplinary improvement teams, mentoring, audit and feedback, and targeted infrastructure improvements. Ward-led improvement work demonstrated substantial gains in observed hand hygiene and aseptic technique. Qualitative findings described growing ownership among staff and patient-guardians, and a shift towards mutual support and shared responsibility for improving practice. Dedicated IPC staff, working through the Ministry of Health endorsed “Work Improvement Team” quality improvement structure helped build trust and support local problem-solving. However, continued dependence on project support for IPC consumables and unreliable access to supplies raise questions about sustaining these changes.

The talk will explore the behavioural questions arising from this work: how do individual actions interact with professional hierarchies, collective routines and material constraints? What makes a bundle of recommended practices become routine care? How can we distinguish the contributions of resources, knowledge, motivation and social influence?

Speaker bio