WHO multimodal improvement strategy In other words, the

1. Build it
(system change)

Multimodal implementation strategies are a core component of effective infection WHO multimodal yyWhat infrastructures, equipment, supplies and other
resources (including human) are required to implement the

improvement strategy
intervention?
prevention and control (IPC) programmes according to the WHO Guidelines on Core
yyDoes the physical environment influence health worker
Components of IPC programmes at the National and Acute Health Care Facility Level.
addresses
behaviour? How can ergonomics and human factors
approaches facilitate adoption of the intervention?

these five areas:

yyAre certain types of health workers needed to implement the
The guidelines’ recommendation 5 states that IPC activities using multimodal intervention?
yyPractical example: when implementing hand hygiene
strategies should be implemented to improve practices and reduce HAI and AMR. interventions, ease of access to handrubs at the point of care
and the availability of WASH infrastructures (including water
In practice, this means the use of multiple approaches that in combination will and soap) are important considerations. Are these available,
affordable and easily accessible in the workplace? If not, action
contribute to influencing the behaviour of the target audience (usually health care
2. Teach it is needed.

workers) towards the necessary improvements that will impact on patient outcome (training & education)
and contribute to organizational culture change. Implementation of IPC multimodal yyWho needs to be trained? What type of training should be
strategies needs to be linked with the aims and initiatives of quality improvement used to ensure that the intervention will be implemented in line
with evidence-based policies and how frequently? 3. Check it
programmes and accreditation bodies both at the national and facility levels. yyDoes the facility have trainers, training aids, and the (monitoring & feedback)
necessary equipment?
yyHow can you identify the gaps in IPC practices or other
yyPractical example: when implementing injection safety indicators in your setting to allow you to prioritize your
interventions, timely training of those responsible for intervention?
administering safe injections, including carers and community
Five key elements
yyHow can you be sure that the intervention is being
WHO identifies five elements for workers, are important considerations, as well as adequate
disposal methods. implemented correctly and safely, including at the bedside?
For example, are there methods in place to observe or track
to focus on when IPC multimodal strategies in a practices?
yyHow and when will feedback be given to the target audience
improving IPC health care context: and managers? How can patients also be informed?
yyPractical example: when implementing surgical site
infection interventions, the use of key tools are important
The multimodal strategy
1 the system change 4 reminders and considerations, such as surveillance data collection forms and
the WHO checklist (adapted to local conditions).
consists of several
elements (3 or more;
needed to enable IPC
practices, including
communications to
promote the desired
4. Sell it
(reminders & communication)
usually 5) implemented in infrastructure, actions, at the right time,
yyHow are you promoting an intervention to ensure that there
an integrated way to guide equipment, supplies and including campaigns;
5. Live it
are cues to action at the point of care and messages are
action and provide a clear other resources; reinforced to health workers and patients?

focus for the implementer. 5 a culture of safety yyDo you have capacity/funding to develop promotional
messages and materials?
(culture change)
2 training and education to facilitate an
yyPractical example: when implementing interventions to yyIs there demonstrable support for the intervention at every
to improve health worker organizational climate reduce catheter-associated bloodstream infection, the use of level of the health system? For example, do senior managers
Targeting only ONE area (i.e. provide funding for equipment and other resources? Are they
knowledge; that values the visual cues to action, promotional/reinforcing messages, and
willing to be champions and role models for IPC improvement?
unimodal), is highly likely planning for periodic campaigns are important considerations.
intervention, with a focus yyAre teams involved in co-developing or adapting the
to result in failure. All five
3 monitoring and
on involvement of senior intervention? Are they empowered and do they feel ownership
areas should be considered, feedback to assess and the need for accountability?
managers, champions or yyPractical example: when implementing hand hygiene
and necessary action taken, the problem, drive
role models. interventions, the way that a health facility approaches this as
based on the local context appropriate change part of safety and quality improvement and the value placed on
hand hygiene improvement as part of the clinical workflow are
and situation informed by and document practice important considerations.
periodic assessments. improvement;