Exploring the context of Governance, Structure and Evaluation of Australian Infection Prevention and Control

Background Infection prevention and control (IPC) is critical to the reduction of healthcare associated infections (HAIs). The COVID-19 pandemic attracted widespread attention and highlighted the importance of IPC programs. This thesis examines Australian IPC programs to assess governance, organisational structure, strategy, and program elements aligned with World Health Organization (WHO) core components, and evaluation. Method Three research studies have been conducted, involving participants with experience and expertise in IPC and HAI across the eight Australian jurisdictions. Study one, compared jurisdictional IPC programs using a survey and document analysis. Study two, evaluated the COVID-19 IPC Response and Escalation Framework, employing an online, cross-sectional survey. Study three, investigated the governance, strategy and organisational structures that should underpin Australian IPC programs. The investigation involved a modified Delphi study involving document analysis, questionnaire survey, open group discussion, and expert panel review. Results Key findings from the jurisdictional comparison (study one) found variability across governance, organisational structure, staffing, competency, resources and focus on HAI compared with IPC. Jurisdictional programs highlighted a lack of governance and any organisational structure framework. Four of eight jurisdictions did not have a formal statewide IPC program. Australian jurisdictions reported partial compliance with WHO core components for IPC. The evaluation of the IPC response and escalation framework in NSW (study two) determined that a risk assessed framework for implementing IPC strategies was an effective IPC management tool (93%) and was easily adopted by clinicians (85%). Stakeholders emphasised the importance of pandemic preparedness aligned with governance and organisational structure for effectiveness. The three highest priority actions for strengthening future pandemic preparedness are increasing IPC resourcing, embedding IPC specific information into state health and emergency response strategic planning, and establishing standardised, transparent IPC governance structures. Investigations of IPC programs (study three) which surveyed 226 IPC representatives from across Australia, identified substantial jurisdictional variability in IPC program governance and reporting structures. Executive engagement was reported as critical for overall effectiveness and culture driven IPC. Varied staffing, resources and differing priorities contribute to independent jurisdictional planning and operations. Governance arrangements were most commonly situated within patient safety (32%), followed by Communicable (Infectious) Diseases (22%) and Public Health (20%). The remaining programs were distributed across a range of other structures, including clinical governance, policy and regulation, aged care, nursing, or operated by sole or independent practitioners. There is no aligned local, state and national governance and organisational structure framework in place, however there is widespread support for IPC programs as integral to the Australian Centres for Disease Control. Conclusion The findings underscore the need for a national governance framework that can be applied consistently across local, state, and national levels. Essential components include: strong IPC leadership and expertise; a consistent and transparent organisational structure; and, executive engagement and adequate resourcing. The proposed framework aligns with WHO core components and supports pandemic preparedness. The AusCDC is positioned as the overarching governance authority, working in collaboration with the ACSQHC to ensure national consistency and accountability in IPC programs.