What is Infection Prevention and Control (IPC) and what does it have to do with disease control?

Matt Mason^{1, 4}, Peta-Anne Zimmerman^{2, 4}, Vanessa Sparke^{3, 4}

As we navigate through the current COVID-19 pandemic, many health disciplines and professions are reflecting on our successes and failures in infectious disease prevention and control in Australia, and the role we have played in the larger region. This focus has reached the Federal Labor government with their commitment to establish a centre for disease control, or perhaps, an Australian Centres for Disease Control and Prevention (ACDC). With such an agency we would finally join similar well-established organisations such as the CDC in the United States, the Africa Centres of Disease Control, and European equivalent.

The scope of the ACDC should have strategic objectives that address health threats on a broad scale similar to that of the African organisation. The World Health Organization (WHO) recognises human health security requires a One Health approach that considers the health of humans, animals, plants, and the environment in general as interlinked. As such an ACDC should have a remit, and be resourced, to the full spectrum of the Sustainable Development Goals (SDGs) to enable Australia to tackle health threats from a One Health approach. As such, an ACDC would reflect the multidisciplinary nature of disease prevention or control, for both communicable and non-communicable disease.

This multi-disciplinary approach would include, but not be limited to, the professions of:

• social science,
• risk communication and community engagement,
• epidemiology,
• laboratory sciences,
• animal and agriculture health,
• clinical/case management,
• occupational health and safety,
• water sanitation and hygiene (WASH),
• mass gatherings,
• and infection prevention and control (IPC).

While primarily seen as a discipline specific to the prevention and control of infectious disease in healthcare facilities, IPC has a broad scope that touches on many aspects of the SDGs.

Professionally IPC is an established discipline with both a clinical and public health focus. The field has direct influence and involvement in health system strengthening, patient and healthcare worker safety, quality improvement, clinical care, prevention of antimicrobial resistance and implementation of antimicrobial stewardship, outbreak preparedness and response, WASH, and the International Health Regulations. Any new Australian centre for disease prevention and control would thus need to include IPC.

Until the current COVID-19 pandemic, IPC had generally been underutilised in settings other than healthcare facilities, and the pandemic demonstrated the urgent need for IPC expertise in managing community care and quarantine of suspected and confirmed cases. Many challenges and failures witnessed in hotel quarantine, for example, were unlikely to have been mitigated until experienced experts in IPC were placed in coordinating positions. Prior to this we saw individuals with no apparent expertise, qualifications, or experience in IPC working in these positions, potentially resulting in transmission of COVID-19 to staff and the public. Given a recent review of tertiary public health programmes across Australia and New Zealand (currently in press) identified that 41% of the 217 Australian degrees and 49% of the 45 in New Zealand did not offer any IPC content as core or elective subjects, we should not be surprised.

The pre-conception that any or all healthcare workers are experts in IPC because it is part of their practice, and can therefore manage a comprehensive IPC programme, is a fallacy. The WHO identify 16 core competencies for someone to be an IPC professional. Equally the Australasian College for Infection Prevention and Control offers a credentialling framework that determines and acknowledges demonstrated prescribed competence in the role of IPC specialist. Within this framework, credentialling “designates specialist or advanced expertise; informs consumers; establishes practice standards; enhances the quality of care provided; and assists employers in managing risk”. This risk management is important as it has been demonstrated that IPC programmes where credentialled professionals are employed have far better patient safety outcomes, including prevention and control of antimicrobial resistance, than those that do not. Infection prevention and control expertise is not only knowing the principles and practices, but how to apply them in different contexts, beyond the walls of healthcare facilities, within the confines of available resources.

An ACDC would also offer an opportunity for Australia to catch up to other similarly sized health systems, by creating national standardised definitions and a centre for the collection, analysis, and reporting of healthcare associated infections and antimicrobial resistant pathogens.

While calls for an ACDC predate the COVID-19 pandemic, the lack of an independent national body has highlighted the at times disjointed nature of Australia’s current system. This reliance on a web of state, territory and federal committees and networks has arguably served Australia well but the lack of strong, centralised leadership has exposed how the influence of politics has subverted a united approach. With the establishment of an ACDC also being subject to political jousting, it is clear that the independence of such an organisation is paramount to allow for frank, fearless, and transparent operation, particularly in relation to IPC guidance.

As a well-resourced nation, an ACDC should be seen as a regional – if not global – resource, just as its US, African, and European counterparts are. Partnering with regional organisations such as The Pacific Community and the WHO regional offices (Western Pacific Regional Office and South East Asia Regional Office) provides an opportunity to share resources and collaboratively learn and grow. This recognises regional expertise, not limited to high-income settings, that can enhance national disease prevention programmes.

Authors:

Matt Mason^{1, 4}, Dr Peta-Anne Zimmerman^{2, 4}, Dr Vanessa Sparke^{3 4}

Affiliations:

1. School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast
2. School of Nursing and Midwifery, Griffith University
3. College of Healthcare Sciences, James Cook University
4. Collaborative for the Advancement of Infection Prevention and Control (http://www.caipc.global/)