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Gap Analysis of Infection Control Practices in Low- and Middle-Income Countries

Published online by Cambridge University Press:  22 July 2015

Kristy Weinshel ,
Angela Dramowski ,
Ágnes Hajdu ,
Saul Jacob ,
Basudha Khanal ,
Maszárovics Zoltán ,
Katerina Mougkou ,
Chimanjita Phukan ,
Maria Inés Staneloni  and
Nalini Singh
Kristy Weinshel
Affiliation:
Society for Healthcare Epidemiology of America, Arlington, Virginia
Angela Dramowski
Affiliation:
Stellenbosch University, Cape Town, South Africa
Ágnes Hajdu
Affiliation:
National Center for Epidemiology, Budapest, Hungary
Saul Jacob
Affiliation:
George Washington University, Washington, DC
Basudha Khanal
Affiliation:
B. P. Koirala Institute of Health Sciences, Nepal
Maszárovics Zoltán
Affiliation:
Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary
Katerina Mougkou
Affiliation:
National Kapodistrian University, Athens School of Medicine, Athens, Greece
Chimanjita Phukan
Affiliation:
Gauhati Medical College and Hospital, Guwahati, India
Maria Inés Staneloni
Affiliation:
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Nalini Singh*
Affiliation:
Children’s National Medical Center, George Washington University, Washington, DC
*
Address correspondence to Nalini Singh, MD, MPH, George Washington University Schools of Medicine and Public Health, Children’s National Medical Center, 111 Michigan Ave, NW, NW, Washington, DC ([email protected]).
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Abstract

BACKGROUND

Healthcare-associated infection rates are higher in low- and middle-income countries compared with high-income countries, resulting in relatively larger incidence of patient mortality and disability and additional healthcare costs.

OBJECTIVE

To use the Infection Control Assessment Tool to assess gaps in infection control (IC) practices in the participating countries.

METHODS

Six international sites located in Argentina, Greece, Hungary, India, Nepal, and South Africa provided information on the health facility and the surgical modules relating to IC programs, surgical antibiotic use and surgical equipment procedures, surgical area practices, sterilization and disinfection of equipment and intravenous fluid, and hand hygiene. Modules were scored for each country.

RESULTS

The 6 international sites completed 5 modules. Of 121 completed sections, scores of less than 50% of the recommended IC practices were received in 23 (19%) and scores from 50% to 75% were received in 43 (36%). IC programs had various limitations in many sites and surveillance of healthcare-associated infections was not consistently performed. Lack of administration of perioperative antibiotics, inadequate sterilization and disinfection of equipment, and paucity of hand hygiene were found even in a high-income country. There was also a lack of clearly written defined policies and procedures across many facilities.

CONCLUSIONS

Our results indicate that adherence to recommended IC practices is suboptimal. Opportunities for improvement of IC practices exist in several areas, including hospital-wide IC programs and surveillance, antibiotic stewardship, written and posted guidelines and policies across a range of topics, surgical instrument sterilization procedures, and improved hand hygiene.

Infect. Control Hosp. Epidemiol. 2015;36(10):1208–1214

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 10 , October 2015 , pp. 1208 - 1214
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Pittet, D, Allegranzi, B, Storr, J, et al. Infection control as a major World Health Organization priority for developing countries. J Hosp Infect 2008;68:285–292.Google Scholar
2. Rosenthal, VD, Richtmann, R, Singh, S, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005-2010. Infect Control Hosp Epidemiol 2013;34:597–604.Google Scholar
3. Allegranzi, B, Bagheri Nejad, S, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2010;377:228–241.Google Scholar
4. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
5. Report on the burden of endemic health care-associated infection worldwide: clean care is safer care. World Health Organization website. http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf. Published 2011. Accessed April 14, 2014.Google Scholar
6. Reilly, J, Twaddle, S, McIntosh, J, Kean, L. An economic analysis of surgical wound infection. J Hosp Infect 2001;49:245–249.Google Scholar
7. Huskins, WC, Soule, BM, O'Boyle, C, Gulácsi, L, O’Rourke, EJ, Goldmann, DA. Hospital infection prevention and control: a model for improving the quality of hospital care in low- and middle-income countries. Infect Control Hosp Epidemiol 1998;19:125–135.Google Scholar
8. Weinberg, M, Fentes, JM, Ruiz, AI, et al. Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods. Arch Intern Med 2001;161:2357–2365.Google Scholar
9. Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33:322–327.Google Scholar
10. Haynes, AB, Weiser, TG, Berry, WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–499.Google Scholar
11. Dramowski, A. Infection Prevention and Control: A Guide for Healthcare Workers in Low-Resource Settings. Cape Town: Bettercare, 2014.Google Scholar
12. Electronic assessment tool for infection prevention and control. World Health Organization website. http://www.emro.who.int/surveillance-forecasting-response/surveillance-infocus/electronic-assessment-tool.html. Published 2012. Accessed July 31, 2014.Google Scholar
13. Strengthening Pharmaceutical Systems. Infection Control Assessment Tool. 2nd ed. US Agency for International Development. http://projects.msh.org/projects/sps/SPS-Documents/loader.cfm?csModule=security/getfile&pageid=. Published 2009. Accessed June 24, 2015.Google Scholar
14. Huskins, WC, Manchanda, V, Singh, N. Infection control practices during labor and delivery and newborn care in resource limited settings: assessment and recommendations for improvement. Antimicrob Resist Infect Control 2013;2:P269.Google Scholar
15. Huskins, C, Ross-Degnan, D, Goldmann, DA. Improving infection control in developing countries: the Infection Control Assessment Tool. BMC Proc 2011;5:O18.Google Scholar
16. World Bank list of economies, 2014. World Bank website. http://data.worldbank.org/about/country-and-lending-groups. Published 2014. Accessed May 31, 2014.Google Scholar
17. Dimopoulou, A, Papanikolaou, Z, Kopsidas, I, Coffin, S, Kourlaba, G, Zaoutis, T. Surgical site infections and compliance with perioperative antimicrobial prophylaxis in Greek children. Infect Control Hosp Epidemiol 2014;35:1425–1427.Google Scholar
18. Anderson, DJ, Podgorny, K, Berríos-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605–627.Google Scholar
19. Manniën, J, Willie, JC, Snoeren, RL, van den Hof, S. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in the Netherlands. Infect Control Hosp Epidemiol 2006;27:809–816.CrossRefGoogle Scholar
20. Okeke, IN, Laxminarayan, R, Bhutta, ZA, et al. Antimicrobial resistance in developing countries, I: recent trends and current status. Lancet Infect Dis 2005;5:481–493.Google Scholar
21. Van Boeckel, TP, Gandra, S, Ashok, A, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis 2014;14:742–750.Google Scholar
22. Vatopoulos, A. High rates of metallo-beta-lactamase-producing Klebsiella pneumoniae in Greece–a review of the current evidence. Euro Surveill 2008;13 pii:8023.CrossRefGoogle ScholarPubMed
23. Gupta, E, Mohanty, S, Sood, S, Dhawan, B, Das, BK, Kapil, A. Emerging resistance to carbapenems in a tertiary care hospital in north India. Indian J Med Microbiol 2006;124:95–98.Google Scholar
24. Tiwari, H, Das, A, Sapkota, D, Sivrajan, K, Pahwa, V. Methicillin resistant Staphylococcus aureus: prevalence and antibiogram in a tertiary care hospital in western Nepal. J Infect Dev Ctries 2009;3:681–684.Google Scholar
25. Caini, S, Hajdu, A, Kurcz, A, et al. Hospital-acquired infections due to multidrug-resistant organisms in Hungary, 2005-2010. Euro Surveill 2013;18 pii:20352.Google Scholar
26. Draft global action plan on antimicrobial resistance World Health Organization website. http://www.who.int/drugresistance/global_action_plan/en/. Accessed July 31, 2014.Google Scholar
27. Rutala, WA, Weber, DJ. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/pdf/guidelines/disinfection_nov_2008.pdf. Published 2009. Accessed July 17, 2014.Google Scholar
28. Kouni, S, Kourlaba, G, Mougkou, K, et al. Assessment of hand hygiene practices at the two children's hospitals in Greece. Pediatr Infect Dis J 2014;33:e247–e251.Google Scholar
29. Aboelela, SW, Stone, PW, Larson, EL. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. J Hosp Infect 2007;66:101–108.CrossRefGoogle ScholarPubMed
30. Antibiotic resistance threats in the United States. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Published 2013. Accessed July 17, 2014.Google Scholar