Infection Control

Bridging the Gulf in Infection Control

The challenge for infection control in Saudi Arabia and the Gulf is to further advance the science of healthcare, and specifically the practice of infection control and hospital epidemiology. To achieve this, partnerships must be created. Experts and leaders must engage in a collective effort to address common concerns and meet shared challenges if the practise of infection control and hospital epidemiology in the region is to progress.

Key Points

- Comprehensive strategies have been implemented in Saudi Arabia and the Persian Gulf region for the detection and prevention of infectious disease.

- A training initiative is underway to increase the number of infection control professionals in the region.

Gwen Cunningham and Ziad A Memish explore some of the advances in infection control that are bringing Saudi Arabia and other Persian Gulf countries into line with the highest international standards.

Infection control and hospital epidemiology is a steadily emerging discipline in healthcare institutions in the Middle East. Since the first infection control ‘sister’ was appointed in the UK in the late 1950s and in the US in the early 1960s, there has been a steady evolution in the practise of infection control globally. Infection control was first introduced to combat and control a pandemic of Staphylococcus aureus wound infections. However, the principles and practices of infection control are now being used for the surveillance and control of hospital-acquired infections.

As the decades passed, the scope of infection control expanded beyond hospital walls to other healthcare facilities, where it was used to assess a broader spectrum of infection risks and outcomes. Meanwhile, infection control practice expanded to include epidemiological principles. These developments have enhanced the role and efficacy of infection control practice and improved the quality of healthcare.One of the most fascinating aspects of China’s recent history has been the evolution of its healthcare system. While the economy has boomed over the past 20 years, China’s healthcare system has nearly imploded, partly because of strategies adopted from some US proponents of radical healthcare privatisation. Further stress is placed on the system by the increased demand caused by the extended mortality of an ageing population in a rapidly urbanising society.

Latest Initiatives

Infection control and hospital epidemiology has now taken on a global dimension, with the growing global concern over healthcare-associated infections and the emergence of antibiotic resistance. Meanwhile, high consumer expectations in terms of healthcare quality and the need for hospitals to meet accreditation standards are now features of the healthcare landscape in a growing number of countries. Nevertheless, in some regions of the world, infection control remains a developing discipline, as it is in the Middle East, where many initiatives are underway to promote it.

Most hospitals in the region have now established infection control programmes or appointed infection control personnel.

Saudi Arabia has had organised preventive health services since the 1960s.1 Although, it is not clear when the discipline of infection control was first incorporated into the Saudi system,2 significant steps have been taken to join the global community in a common endeavour to safeguard patients through the control of healthcare-associated infections. Infection control and hospital epidemiology have now emerged as a growing discipline in Saudi Arabia. Most hospitals have tablished an infection control programme, while international, national and regional strategies have been created for detecting and preventing emerging infectious diseases.

King Abdulaziz Medical City – Riyadh in Saudi Arabia, now named the Gulf Cooperative Council Centre for Infection

Control, has taken the initiative in joining the global community to address infection control concerns through the planning and hosting of regional and international conferences and education programmes. The infection control challenge is daunting, and success will depend on the collaborative efforts of individuals, professional societies and associations, governmental and non-governmental agencies, health ministries, business and industry.

Development and Training

Like all countries, the nations of the Gulf Cooperative Council States (GCC States) face major problems in the shape of healthcare-associated infections and emerging antibiotic resistance. To address these, the Health Ministers’ Council for the Gulf Cooperation Council States has resolved to unify efforts to improve healthcare in the Persian Gulf region to the highest level. The council aims to achieve this through the establishment and maintenance of standards and policies for healthcare delivery, the prevention and eradication of communicable disease, and the promotion of combined research to provide technical advice on healthrelated issues. A collaborative approach will be taken to the development of programmes to meet these challenges.

A shortage of trained infection control personnel in Saudi Arabia and other Middle Eastern countries
threatens the sustainability of infection control programmes. Long-term training programmes for turning Saudi physicians and nurses into infection control professionals are therefore a priority.

The main aim of the Gulf Cooperative Council Centre for Infection Control is to achieve excellence and a high level of safety in healthcare in the Gulf and beyond, through collaboration and the establishment of training and certification programmes for the region. The centre’s stated goals include:

  • The provision of practical training and certification for infection control personnel
  • The development of regional infection control standards
  • The creation of a forum to assist in the building of partnerships and sharing of expertise

A major function of the centre is to bind together the collective infection control effort – nationally, regionally and internationally – in areas such as antibiotic use, disaster and pandemic planning (as the threat of avian flu looms over us), regional health planning, and the development of professional and practice standards for infection control professionals.

Collective Approach

The problems encountered in combating healthcare-associated infections are often common to most countries. These include:

  • Inadequate numbers of trained personnel
  • Inadequate financial resources
  • The reluctance of healthcare workers to modify their behaviour - their non-compliance with hand cleaning practices and overuse or misuse of antimicrobial agents, for example

However, some problems are more acute in developing regions. These include:

  • Lack of supplies
  • Poor or contaminated water supplies
  • Inadequate laboratory support
  • Outdated and poorly maintained equipment
  • Social and cultural barriers
  • Government indifference or interference

All these variables mean that infection control programmes and practices differ widely among countries. However, in recent years, collaboration between countries and institutions has increased significantly, especially in education and training, research and publishing.

In one example of such a collaboration,the Society for Healthcare Epidemiology of America (SHEA), the Association for Professionals in Infection Control and Epidemiology, Inc (APIC) and the Community and Hospital Infection Control Association – Canada (CHICA – Canada) joined the Gulf Cooperative Council Centre for Infection Control in an international conference and training programme for infection control. The information exchanged and the relationships developed through such activities will help those involved meet the infection prevention and control challenges of the future. In another collaboration, with the World Health Organization (WHO), the Gulf Cooperative Council Centre for Infection Control has highlighted and promoted among its member states the WHO’s World Alliance for Patient Safety programme initiative on hand hygiene.

Certification Drive

Many challenges remain, and as the complexity of healthcare services and the demands placed on them increase, it sometimes seems that little progress is being made in improving care and reducing risks. At least there is little doubt that advances have been made in the practise of infection control in Saudi Arabia. In the past, the provision of certified infection control personnel in some of the larger Saudi hospitals was erratic. Today, Saudi Arabia ranks third after the USA and Canada in terms of the provision of infection control professionals – all certified through the Certification Board of Infection Control and Epidemiology, Inc (CBIC), USA. This growth in numbers was initiated and facilitated by the Riyadh Infection Control Forum, founded in 1997 and based at the King Fahad National Guard Hospital.

More and more hospitals prefer to recruit certified infection control personnel to avoid inconsistent practices in infection control programmes. While these still exist in Saudi Arabia, most infection control programmes follow the Western model. The remaining inconsistencies need to be rectified to streamline practice and training and address the unique cultural, religious, economic and social practices in the country and the region.

Looking Ahead

Since becoming a part of healthcare services over 40 years ago, infection control has evolved into an influential profession, which, through research on effective infection prevention methods, has transformed clinical practice globally.

In the Middle East, as infection control continues to evolve, new ways are being explored to improve infection control practice and expand its scope to enable it to respond to the challenges it faces.

The challenge for infection control in Saudi Arabia and the Gulf is to further advance the science of healthcare, and specifically the practice of infection control and hospital epidemiology. To achieve this, partnerships must be created. Experts and leaders must engage in a collective effort to address common concerns and meet shared challenges if the practise of infection control and hospital epidemiology in the region is to progress.