The Infection Prevention Unit was not officially established until 2008, but as with so many sections of Mae Tao Clinic, the activities of the Infection Prevention programme started long before there was an official title for them.
All health care related trainings conducted by MTC over the years have contained a universal precautions module, with staff learning basic infection prevention techniques such as hand washing and using protective barriers such as gloves, but there was not always a monitoring and evaluation system within the departments to ensure these actions were being performed. In 2000, the blood transfusion, HIV prevention programs, and medical waste disposal programs were upgraded and Mae Sot Hospital staff came to the clinic to demonstrate appropriate techniques for labelling and separation of medical waste.
The Reproductive Health Monitoring and Evaluation Project initiated in 2002 was a two year project, implemented to improve quality of Reproductive Health services. The post-abortion care training within this project included an “infection control” section within the monitoring and evaluation training component. The staff began using a monitoring and evaluation checklist that included such things as: hand washing, using gloves correctly, and using barriers such as masks or gloves. This was an opportunity to ensure that infection prevention procedures were being followed. Training included sterilisation techniques, via either boiling or the use of reagents. Room safety and sterilisation was also addressed. As this training program finished in the RH department, it was clear that all the departments of the Clinic would benefit from incorporating a similar infection control aspect into their monitoring and evaluation program. In order to make this possible, more training was needed. An upgrade training was provided for all current medics to ensure that they received the new information, and all health care training curriculums were permanently changed, and to implement this, a 3 to 4 day infection prevention component was added to the monitoring and evaluation module.
Challenges and Services
Working independently of each other, with some departments finding greater success than others; in 2006 it was decided to move towards more standardised protocol. An infection prevention working group was brought together with its first task being to evaluate the current procedures of each department. From this initial evaluation it became apparent that external factors were playing a major role in medics not properly adhering to the procedures. Therefore, the second task of the working group was to focus on improving supplies and logistics; how could a person be expected to wash their hands if sinks weren’t always working properly or there wasn’t any soap? Facilities were improved, and changes were made to the management of supplies, including ordering and storage, resulting in improved availability of soap and other sterilisation products. These improvements to supply management and logistics certainly led to enhancements in medics’ infection prevention behaviours, but they were not the only influencing factors to consider.
Another external factor influencing adherence to infection prevention procedures was a lack of knowledge; even though all medics were receiving training on the topic during their initial health care training, it was decided that this was not enough: upgrade trainings were needed. In 2008 the Infection Prevention Unit (IPU) was established, with ongoing upgrade trainings incorporated as one of the responsibilities of the staff in this Unit. An added responsibility of the IPU is the sterilisation of medical equipment and the preparation of bandaging materials, such as gauze, for the clinic departments.
New challenges are presented in relation to the broadening range of services provided by the Clinic, and by the wider range of illnesses treated. This combination increases threats and necessitates continually improving techniques. Each department appoints a person who looks after infection prevention; however, further steps need to be taken to ensure new staff members are trained, and that supplies are always available.
The expansion of the Clinic and the broadening range of services provided represents a challenge for the training and supply activities of the unit. There is a focal point for IPU in each department, but further steps need to be taken to ensure that new staff are trained and that supplies are available.
The IPU is also in need of a new autoclave, due to the large amounts of procedures done in the Clinic. The desire of the IPU team is to reduce the risk of infection, for both staff and patients.