Matt Mason

In ongoing collaboration with colleagues in the Solomon Islands, it was identified that the scope of practice for registered nurses is poorly defined, with a Nursing Act that has not been updated since 2013.

A team was established, consisting of academics from The Solomon Islands National University (SINU), University of the Sunshine Coast, Australia (UniSC) and Whitireia College, New Zealand.

Background: Solomon Islands (SI) is a nation of 700,000 people with a small health Workforce and no infectious disease physician. Bloodstream infections (BSIs) are a significant cause of mortality. Historically management of BSI in SI had been challenging, including delays in notification, lack of clinician understanding, non-standardised approach to patient management and lack of appropriate antibiotics.

Purpose: A multidisciplinary group with local and international clinicians was established with the purpose of improving clinical management of patients with BSIs within a larger program to support training, and capacity building to address the threat of antimicrobial resistance (COMBAT-AMR).

Methods/description of process, or experience: The Solomon Blood stream Infection group includes physicians, surgeons, infection prevention and control (IPC) nurses, microbiology scientists and pharmacists at the National Referral Hospital with online support from internatioanl counterpart (PRIDA and Alfred Hospital). Weekly hybrid meetings provide real time review and patient managemtn advice for positive blood cultures and multi-resistant organisms (MROs). There is a strong mentoring and information sharing focus. The meetings provide a forum to discuss issues relating to IPC, antimicrobial stewardship and microbiology.

Results: Weekly meetings have been held since March 2022 with discussions on diagnosis and management of conditions such as infective endocarditis and surgical site infections. Participants have reported better dissemination of information and improved collaboration between teams. This resulted in the early identification and containment of two MRO outbreaks, audits, policies and training have been developed and implemented from gaps identified during meetings. Local champions have reported gaining knowledge and confidence in BSI management.

Conclusion: This project highlights the importance of multidisciplinary involvement and local engagement in the successful management of complex infections in low resource settings. It is expected that the same approach could be effectively applied to the management of non-communicable diseases. The provision of regular online expert support is an effective and sustainable method to provide mentoring and support development of local champions.

Background: Solomon Islands is a nation of 700,000 people with a small health workforce and no infectious disease physician. Bloodstream infections (BSIs) are a significant cause of mortality. Historically management of BSI in Solomon Islands had been challenging, including delays in notification, lack of clinician understanding, non-standardised approach to patient management and lack of appropriate antibiotics.

Purpose: A multidisciplinary group with local and international clinicians was established with the purpose of improving clinical management of patients with BSIs within a larger program to support training, and capacity building to address the threat of antimicrobial resistance (COMBAT-AMR).

Methods/description of process/experience: The Solomon Blood Stream Infection group includes physicians, surgeons, infection prevention and control (IPC) nurses, microbiology scientists and pharmacists at the National Referral Hospital with online support from international counterparts (PRIDA and Alfred Hospital). Weekly hybrid meetings provide real time review and patient management advice for positive blood cultures and multi-resistant organisms (MROs). There is a strong mentoring and information sharing focus. The meetings provide a forum to discuss issues relating to IPC, antimicrobial stewardship and microbiology.

Results: Weekly meetings have been held since March 2022 with discussions on diagnosis and management of conditions such as infective endocarditis and surgical site infections. Participants have reported better dissemination of information and improved collaboration between teams. This resulted in the early identification and containment of two MRO outbreaks. Audits, policies, and training have been developed and implemented from gaps identified during meetings.

Conclusion: This project highlights the importance of multidisciplinary involvement and local engagement in the successful management of complex infections in low resource settings. It is expected that the same approach could be effectively applied to the management of non-communicable diseases. The provision of regular online expert support is an effective and sustainable method to provide mentoring and support development of local champions.

Background: Infection prevention and control (IPC) in low and middle income countries (LMIC) is often constrained by limited resources and competing health priorities, necessitating external agency support. Yet, no reported frameworks exist to guide the development of such collaborations.

Aim: This study aimed to identify the core elements of a collaborative support framework to strengthen IPC in LMICs.

Methods: A systematic scoping review of literature (2005-2020, in English) was conducted based on PRISMA 2020 guidelines. MEDLINE, CINAHL, Embase, and Scopus databases were utilised, with a search strategy that included varied combinations of MeSH terms, Emtree and IPC-related keywords.

Results: Six core elements of a comprehensive IPC collaborative support framework were identified: 1) Collaborative Projects, 2) Policies and Procedures, 3) Training and Professional Development, 4) Surveillance Systems, 5) Assessment and Feedback, and 6) Partnerships, the latter being a crucial enabling factor. The analysis showed that training and collaborative projects benefit from pre-workshop preparations and multidisciplinary groups, fostering collaboration and skills enhancement. Working groups of multidisciplinary stakeholders proved pivotal in IPC collaborations, providing forums for information exchange and assisting in resource development. Their input fortifies partnerships, underscoring the interconnectedness of the elements.

Conclusion: The identified core elements should guide the construction of a collaborative support model for IPC in LMIC. The next step is developing a framework of equitably empowered partnerships for sustained IPC improvement in LMIC settings.