Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study

Abstract

BackgroundPrevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries.AimsTo implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use.MethodsA before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods.ResultsWe observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)).ConclusionsMultifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries.

Healthcare-Associated Infections in Pediatric and Neonatal Intensive Care Units: Impact of Underlying Risk Factors and Antimicrobial Resistance on 30-Day Case-Fatality in Italy and Brazil

“…4,6,[15][16][17][18] The great majority of children in our cohort had an underlying disease (93.3%), a proportion quite similar to previous data in pediatric ICUs. 19 Consistent with previous studies, BSIs represented the leading cause of pediatric HAIs, followed by LRTIs and urinary tract infections. 6,[16][17][18]20 These findings underline how children differ from adults in HAI distribution, emphasizing the need to target interventions focused on BSI prevention in neonates and children.…”

Role of antimicrobial stewardship programmes in children: a systematic review

“…Five studies reported on the reduction of antibiotic consumption [11][12][13][14][15] , seven reported on the reduction of broad spectrum/restricted antibiotic use 11,12,[15][16][17][18][19] , one reported on HAI reduction , 13 and one reported on reduction of bacterial resistance. 18 Two studies evaluated ASPs costs.…”

Irrational use of antibiotics and clinical outcomes in children with pneumonia

“…These differences may have been due to studying only children below 5 years of age or including adults. 4,7,8,9 Most of our subjects were < 1 year of age (25; 54.3%) or 1 -< 5 years old (18; 39.1%), with a 1:1 ratio of males to females. Pneumonia was found to be the main cause of morbidity and mortality in children below 5 years by Latumahina et al and the Indonesian Ministry of Health.…”