Strengthening infection prevention and control and systematic surveillance of healthcare associated infections in India

Diwan

et al. 2018

IJERPH

Background: Health care-associated infections (HAIs) result in treatment delays as well as failures and financial losses not only to patients but also to the treating hospital and overall health-care delivery system. Due to hospital-acquired infections, there are problems of increase in morbidity and mortality, additional diagnostic and therapeutic interventions and ultimately antimicrobial resistance. Proper understanding among health-care workers about the ill effects of HAIs is very important to address this issue. The present study is a qualitative exploration aimed at understanding various aspects of hospital environmental hygiene and Infection prevention control program, by exploring the staff perception regarding the challenges, facilitators and barriers as well as feasible measures towards improvement in a rural tertiary teaching hospital in central India. Method: A qualitative study was conducted using 10 focus group discussions (FGDs) among five different professional groups, which included hospital administrators, doctors, nurses, environmental cleaning staff, and undergraduate medical students. The FGD guide included the following topics: (1) opinion about the status of cleanliness, (2) concepts and actual practices prevailing of hospital environmental hygiene, (3) Barriers, constraints, and problems in maintaining hospital environmental hygiene, (4) Suggestions for improvements. The data were analyzed manually using the content (thematic) analysis method. Results: Two themes were identified: Theme 1: “Prevailing practices and problems related to hospital surface/object contamination and hospital infection control”. Theme 2: “Measures suggested for improving hospital cleanliness within the existing constraints”. The participants emphasized the influence of resource constraints and needed inputs. They brought up the consequent prevailing practices and problems related, on one hand, to various stakeholders (service consumers, hospital personnel including the management), on the other, to specific infection prevention and control processes. They also suggested various measures for improvement. Conclusions: The study has revealed prevailing practices, problems, and suggested measures related to hospital environmental hygiene, particularly hospital cleanliness and HAI prevention and control processes. These insights and assertions are important for developing future behavioral and structural interventions in resource-limited settings. This study recommends a nationwide reliable HAI surveillance system and a robust infection prevention and control program in each health-care institution.

Section: Introductionmentioning

confidence: 99%

“How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections”? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India

Diwan

et al. 2018

IJERPH

Eur J Clin Microbiol Infect Dis

“…The absence of surveillance systems for SSIs is the perceived second key hindering factor in implementation of SSI guidelines in the ORs of a low-income country. Surveillance of infection control is present in high-income countries, but not in most low-income countries [11]. However, without a functional surveillance system, it is not feasible for the ministry of health to monitor, evaluate, and document the real burden of infection at the national level.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, an institutional and national surveillance system is at the heart of infection control. It not only identifies the problem but also defines the priorities for allocating funds to develop human resources, to prevent infection, and report lessons learnt regarding prevention of SSIs in the literature [11,12]. Moreover, no policy exists to prevent SSIs in the ORs of low-income country at the national and institutional levels.…”

Section: Discussionmentioning

confidence: 99%

Factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries: a mixed-method study

Khan

Verstegen

Bhatti

et al. 2018

The study aims to find the factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries. The design of the study is a mixed-method sequential explanatory study. The setting is Shifa International Hospital and Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Participants are health care workers. A questionnaire and structured key informant interviews probed the perspectives and perceptions of different stakeholders regarding the factors which hinder the implementation of surgical site infection control guidelines. Two-hundred fifty-two health care workers took part in the survey. The response rate was 90%. The majority of the participants was based in private teaching hospitals (63.9%) and 36.1% in the public sector teaching hospitals. The factors of surveillance, knowledge, education, and culture had low scores. Qualitative data analysis revealed the hindering factors in the implementation of surgical site infection control guidelines in the operating rooms of low-income country. The important one are lack of a surveillance system, education, and culture of infection control. This study identified hindering factors regarding implementation of surgical site infection control guidelines in the operating rooms at the institutional and individual level involved in patient care. The identification of these hindering factors may help politicians, policy makers, and institutions to identify the strategies for overcoming these hindering factors. Education is the key factor for success. By offering training to health care workers, we significantly contribute to decrease the incidence of SSIs in the low-income country.

Curr Treat Options Infect Dis

“…Since then, many countries have attempted to establish IPC programs with varying degrees of success [58,59]. Countries like India with high burden of antimicrobial resistance have committed to come up with a national action plan [60][61][62]. Other initiatives, such as the Global Antibiotic Resistance Partnership (GARP) and the Global Health Security Agenda (GHSA), also aim to assess and improve national capacity for combatting AMR.…”

Section: Recent Global Efforts To Facilitate Infection Prevention Andmentioning

confidence: 99%

Opportunities to Overcome Implementation Challenges of Infection Prevention and Control in Low-Middle Income Countries

Sengupta

Barman

2019

Purpose of review Healthcare-associated infections (HAIs) and rising antimicrobial resistance (AMR) have posed a major challenge in patient care across the globe, more so in lower-middle-income countries (LMICs). Studies have shown that implementation of an effective infection prevention and control (IPC) program reduces incidence of HAI to a large extent. However, implementation of such a program in low-resource setting has many challenges. Research have shown that gaps exist due to absence of political will, trained manpower, and alternate healthcare priorities. Recent findings With progress in science of healthcare epidemiology and digital communication, opportunities to establish an effective IPC program at minimal cost is possible. In this review, we explore ways the existing challenges can be mitigated in LMICs. In recent times, the UN general assembly along with World Health Organization (2015) and member countries took a resolution to come up with an action plan to tackle the rising threat of AMR by strengthening IPC programs at national level.Summary We reviewed the progress made by the developing countries in their efforts to implement the program.