ICAP, Columbia University, New York, NY, USA.
John Snow, Inc, Boston, MA, USA.
Int J Qual Health Care. 2020 Apr 27;32(2):85-92. doi: 10.1093/intqhc/mzz137.
The Sierra Leone (SL) Ministry of Health and Sanitation's National Infection Prevention and Control Unit (NIPCU) launched National Infection and Prevention Control (IPC) Policy and Guidelines in 2015, but a 2017 assessment found suboptimal compliance with standards on environmental cleanliness (EC), waste disposal (WD) and personal protective equipment (PPE) use.
ICAP at Columbia University (ICAP), NIPCU and the Centers for Disease Control and Prevention (CDC) designed and implemented a Rapid Improvement Model (RIM) quality improvement (QI) initiative with a compressed timeframe of 6 months to improve EC, WD and PPE at eight purposively selected health facilities (HFs). Targets were collaboratively developed, and a 37-item checklist was designed to monitor performance. HF teams received QI training and weekly coaching and convened monthly to review progress and exchange best practices. At the final learning session, a "harvest package" of the most effective ideas and tools was developed for use at additional HFs.
The RIM resulted in marked improvement in WD and EC performance and modest improvement in PPE. Aggregate compliance for the 37 indicators increased from 67 to 96% over the course of 4 months, with all HFs showing improvement. Average PPE compliance improved from 85 to 89%, WD from 63 to 99% and EC from 51 to 99%.
The RIM QIC approach is feasible and effective in SL's austere health system and led to marked improvement in IPC performance. The best practices are being scaled up and the RIM QIC methodology is being applied to other domains.
塞拉利昂（SL）卫生部和卫生局的国家感染预防和控制股（NIPCU）于 2015 年发布了国家感染预防和控制（IPC）政策和准则，但 2017 年的评估发现，环境卫生（EC）、废物处理（WD）和个人防护设备（PPE）的使用标准合规情况并不理想。
哥伦比亚大学国际艾滋病政策中心（ICAP）、NIPCU 和疾病控制与预防中心（CDC）设计并实施了一项快速改进模型（RIM）质量改进（QI）计划，时间压缩在 6 个月内，以改善 8 个选定的卫生机构（HFs）的 EC、WD 和 PPE。目标是共同制定的，设计了一个 37 项检查清单来监测性能。HF 团队接受了 QI 培训和每周辅导，并每月开会审查进展情况和交流最佳做法。在最后一次学习会议上，开发了一个"收获包"，其中包含了在其他 HFs 中使用的最有效想法和工具。
RIM 导致 WD 和 EC 性能显著改善，PPE 略有改善。37 项指标的综合合规性在 4 个月内从 67%提高到 96%，所有 HF 都有所提高。平均 PPE 合规性从 85%提高到 89%，WD 从 63%提高到 99%，EC 从 51%提高到 99%。
RIM QIC 方法在 SL 严峻的卫生系统中是可行和有效的，导致 IPC 性能显著改善。最佳实践正在扩大规模，RIM QIC 方法正在应用于其他领域。
