Infection prevention and control and water sanitation and hygiene in health facilities during mpox disease outbreaks: rapid assessment tool, user guide

1. Introduction

The rapid assessment tool (RAT) is meant to assess health facilities within mpox-affected areas that have at least one inpatient bed. Depending on time and resources available, certain facilities may be prioritized during an mpox outbreak. The RAT evaluates 16 infection prevention and control (IPC) and water, sanitation and hygiene (WASH) criteria identified as the minimum essential elements required for safe patient care and prevention of transmission within the health facility during readiness or response activities for outbreaks of mpox. The IPC-WASH RAT collects data as part of an IPC-WASH health facility performance assessment; helps to identify gaps; and guides the development of an improvement action plan and prioritization of activities based on the criteria not met.

The IPC-WASH RAT user guide is intended to provide instructions to those individuals who are conducting IPC assessments of a facility, regardless of the individuals’ previous IPC and/or WASH experience. During mpox outbreaks, they might include but are not limited to IPC managers, IPC implementers, IPC committee members, IPC focal points, IPC response teams and WASH team members.

This guide describes the parameters for each criterion, data collection exercise and follow-up action based on the assessment findings and recommendations. The tool itself provides information to help detect IPC- and WASH-related gaps in health facilities; monitor the implementation of IPC-WASH activities in response to an outbreak; build an improvement plan for the assessed health facilities; and maximize the IPC-WASH response. It is important that those conducting the assessment are trained and knowledgeable about how to score each parameter of the tool so that they can achieve meaningful results and action plans.

A critical activity to support this process is mentorship and supportive supervision for IPC-WASH. This requires the external IPC and/or WASH expert to interact regularly with the focal person in the facility to address IPC-WASH issues and to provide support for implementation of improvement plans while strengthening the capacity of the IPC focal person-WASH engineer to provide expertise to their respective facility.

Support for training of health workers, provision of available tools and increasing general knowledge of IPC standards and transmission precautions will help strengthen the capacity of the IPC focal person in the facility. The provision of supportive supervision and mentorship in health facilities using this tool will enhance their ability to achieve sustainable improvements in IPC and WASH.

The IPC-WASH RAT for health facilities during mpox outbreaks and its user guide should be used in conjunction with related IPC and WASH resources, such as the Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance (16), Sphere Handbook (17), WHO safe management of wastes from health-care activities (18) and case definitions (not an exhaustive list) (19).

This tool is not meant to be used outside of the context of readiness or response for mpox outbreaks. Nor is it meant to be used in dedicated mpox treatment centres. Countries should refer to the Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the national level, whereas health facilities should refer to the Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the health care facility level to guide their planning for outbreak management outside the context of mpox. Other tools, such as the Assessment tool of the minimum requirements for infection prevention and control programmes at the national level should be used during the preparedness phase (e.g. during programmatic delivery of services when there is no ongoing mpox outbreak). Links to these tools are found here:

• Assessment tool of the minimum requirements for infection prevention and control programmes at the national level. World Health Organization: Geneva; 2021. https://www.who.int/publications/m/ item/assessment-tool-of-the-minimum-requirements-for-infection-prevention-and-control- programmes-at-the-national-level

• Infection prevention and control assessment framework at the facility level. World Health Organization: Geneva; 2018. https://iris.who.int/handle/10665/330072.

• Assessment tool on infection prevention and control minimum requirements for primary health care facilities. World Health Organization: Geneva; 2023. https://iris.who.int/handle/10665/367505

• Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the health care facility level. World Health Organization: Geneva; 2022. https://iris.who. int/handle/10665/361522.

• Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the national level. World Health Organization: Geneva; 2021. https://iris.who.int/ handle/10665/345251.

• Infection prevention and control health-care facility response for COVID-19. World Health Organization: Geneva; 2020. https://www.who.int/publications/i/item/WHO-2019-nCoV-HCF_ assessment-IPC-2020.1.