Healthcare-associated infection: challenges in low- and middle-income setting

BACKGROUNDHealthcare-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.OBJECTIVETo use the Infection Control Assessment Tool to assess gaps in infection control (IC) practices in the participating countries.METHODSSix 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.RESULTSThe 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.CONCLUSIONSOur 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

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Surveillance systems for healthcare-associated infection in high and upper-middle income countries: A scoping review

Journal of Infection and Chemotherapy ◽

10.1016/j.jiac.2020.01.001 ◽

2020 ◽

Vol 26 (5) ◽

pp. 429-437 ◽

Cited By ~ 1

Author(s):

Saho Takaya ◽

Kayoko Hayakawa ◽

Nobuaki Matsunaga ◽

Yuki Moriyama ◽

Yuichi Katanami ◽

...

Keyword(s):

Scoping Review ◽

Surveillance Systems ◽

Healthcare Associated Infection ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Associated

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Surveillance of Healthcare-Associated Infections in Low- and Middle-Income Countries: From the Need to a Reality

Current Treatment Options in Infectious Diseases ◽

10.1007/s40506-018-0148-x ◽

2018 ◽

Vol 10 (1) ◽

pp. 1-6

Author(s):

Valeska Stempliuk

Keyword(s):

Healthcare Associated Infections ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Associated ◽

Low And Middle Income

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Clinical and Molecular Epidemiology of Healthcare-Associated Infections Due to Extended-Spectrumβ-Lactamase (ESBL)–Producing Strains ofEscherichia coliandKlebsiella pneumoniaeThat Harbor Multiple ESBL Genes

Infection Control and Hospital Epidemiology ◽

10.1086/591864 ◽

2008 ◽

Vol 29 (11) ◽

pp. 1026-1034 ◽

Cited By ~ 22

Author(s):

Anucha Apisarnthanarak ◽

Pattarachai Kiratisin ◽

Linda M. Mundy

Keyword(s):

Confidence Interval ◽

Antimicrobial Therapy ◽

Odds Ratio ◽

Healthcare Associated Infections ◽

Healthcare Associated Infection ◽

Middle Income ◽

E Coli ◽

Esbl Gene ◽

Empirical Antimicrobial Therapy ◽

Healthcare Associated

Objectives.To characterize healthcare-associated infections due to extended-spectrumβ-lactamase (ESBL)-producing strains ofEscherichia coliandKlebsiella pneumoniaethat harbor multiple ESBL genes, as opposed to a single ESBL gene.Methods.All patients with a confirmed healthcare-associated infection due to an ESBL-producing strain ofE. coliorK. pneumoniaewere enrolled in the study. Molecular typing of isolates was performed, and the comparative risks and outcomes of patients were analyzed.Results.Among 71 patients with healthcare-associated infection due to an ESBL-producing strain ofE. coliorK. pneumoniae, the gene for CTX-M, with or without other ESBL genes, was identified in all 51 (100%) of the patients infected with anE. colistrain and in 18 (90%) of the 20 patients infected with aK. pneumoniaestrain. Of these 71 patients, 17 (24%) met the definition of healthcare-associated infection due to an ESBL-producing strain that harbored multiple genes; in multivariate analysis, previous exposure to 3 or more classes of antibiotics (adjusted odds ratio, 4.5 [95% confidence interval, 1.7-75.2]) was the sole risk factor for healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes. Isolates recovered from patients with healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes were more resistant to various antibiotic classes, and, compared with patients with healthcare-associated infection due to an ESBL-producing strain that harbored a single ESBL gene, they were more likely to have ineffective initial empirical antimicrobial therapy (52% vs 94%; odds ratio, 5.1 [95% confidence interval, 1.04-14.5]).Conclusions.CTX-M ESBL is highly prevalent in Thailand. Patients with healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes were more likely to have had ineffective initial empirical antimicrobial therapy, and, given that antibiotic selection pressure was the only associated risk, we suggest focused antimicrobial stewardship programs to limit the emergence and spread of healthcare-associated infection due to ESBL-producing strains in this middle-income country.

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Development of National Infection Control and Prevention Guidelines in Georgia, 2017–2019

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.729 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s189-s189

Author(s):

Lali Madzgarashvili ◽

Jamine Weiss ◽

Marina Baidauri ◽

Marika Geleishvili ◽

Meghan Lyman ◽

...

Keyword(s):

Infection Control ◽

Clinical Laboratory ◽

Health And Safety ◽

Steering Committee ◽

Infection Prevention And Control ◽

Healthcare Associated Infection ◽

Middle Income ◽

International Guidelines ◽

Middle Income Countries ◽

Low And Middle Income

Background: In 2015, the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs (MoLHSA) of Georgia identified infection prevention and control (IPC) as a top priority. Infection control legislation was adopted and compliance was made mandatory for licensure. Participation in the universal healthcare system requires facilities to have an IPC program and infrastructure. To support facilities to improve IPC, MoLHSA and the National Center for Disease Control and Public Health (NCDC) requested assistance from the US CDC to revise the 2009 National IPC guidelines, which were translated versions of international guidelines and not adapted to the Georgian context. Methods: An IPC guideline technical working group (TWG), comprising clinical epidemiologists, IPC nurses, head nurses, and infectious diseases doctors from the NCDC, academic and healthcare organizations and the CDC was formed to lead the development of the national IPC guidelines. Additionally, an IPC steering committee was established to review and verify the guidelines’ compliance with applicable decrees and regulations. The TWG began work in April 2017 and was divided into 4 subgroups, each responsible for developing specific guideline topics. A general IPC guideline template for low- and middle-income countries was used to develop 7 of the guidelines. Additional reference materials and international guidelines were used to develop all the guidelines. Drafts were shared with the subgroups and the steering committee during 2 workshops to discuss unresolved technical issues and to validate the guidelines. Results: The revised guidelines consist of 18 topics. In addition to standard precautions (eg, hand hygiene, personal protective equipment, injection safety, etc) and transmission-based precautions, the guideline topics include laundry, environmental cleaning and disinfection, decontamination and sterilization, occupational health and safety, biosafety in clinical laboratory, blood bank and transfusion services, intensive care unit, emergency room, and mortuary. They do not include healthcare-associated infection surveillance or organism-specific guidance. To supplement the guidelines, a separate implementation manual was developed. The guidelines were approved by MoLHSA in October 2019. The TWG continues to be engaged in IPC activities, assisting with guideline rollout, training, and monitoring, and drafting the National IPC strategy and action plans. Conclusions: The Georgian Ministry of Health developed national IPC guidelines using local experts. This model can be replicated in other low- and middle-income countries that lack country-specific IPC guidelines. It can also be adapted to develop facility-level guidelines and standard operating procedures.Funding: NoneDisclosures: None

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Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana

Health Policy and Planning ◽

10.1093/heapol/czaa102 ◽

2020 ◽

Vol 35 (Supplement_1) ◽

pp. i38-i50

Author(s):

Gifty Sunkwa-Mills ◽

Lal Rawal ◽

Christabel Enweronu-Laryea ◽

Matilda Aberese-Ako ◽

Kodjo Senah ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Healthcare Providers ◽

Neonatal Intensive Care Units ◽

Healthcare Associated Infections ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Associated ◽

Low And Middle Income

Abstract Healthcare-associated infections (HAIs) remain a serious threat to patient safety worldwide, particularly in low- and middle-income countries. Reducing the burden of HAIs through the observation and enforcement of infection prevention and control (IPC) practices remains a priority. Despite growing emphasis on HAI prevention in low- and middle-income countries, limited evidence is available to improve IPC practices to reduce HAIs. This study examined the perspectives of healthcare providers (HPs) and mothers in the neonatal intensive care unit on HAIs and determined the major barriers and facilitators to promoting standard IPC practices. This study draws on data from an ethnographic study using 38 in-depth interviews, four focus group discussions and participant observation conducted among HPs and mothers in neonatal intensive care units of a secondary- and tertiary-level hospital in Ghana. The qualitative data were analysed using a grounded theory approach, and NVivo 12 to facilitate coding. HPs and mothers demonstrated a modest level of understanding about HAIs. Personal, interpersonal, community, organizational and policy-level factors interacted in complex ways to influence IPC practices. HPs sometimes considered HAI concerns to be secondary in the face of a heavy clinical workload, a lack of structured systems and the quest to protect professional authority. The positive attitudes of some HPs, and peer interactions promoted standard IPC practices. Mothers expressed interest in participation in IPC activities. It however requires systematic efforts by HPs to partner with mothers in IPC. Training and capacity building of HPs, provision of adequate resources and improving communication between HPs and mothers were recommended to improve standard IPC practices. We conclude that there is a need for institutionalizing IPC policies and strengthening strategies that acknowledge and value mothers’ roles as caregivers and partners in IPC. To ensure this, HPs should be better equipped to prioritize communication and collaboration with mothers to reduce the burden of HAIs.

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Prevention of Healthcare-Associated Infections in Low- and Middle-Income Countries: The ‘Bundle Approach’

Indian Journal of Medical Microbiology ◽

10.4103/ijmm.ijmm_18_152 ◽

2018 ◽

Vol 36 (2) ◽

pp. 155-162 ◽

Cited By ~ 4

Author(s):

Purva Mathur

Keyword(s):

Healthcare Associated Infections ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Associated ◽

Low And Middle Income

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Perceptions of Healthcare-Associated Infection and Antibiotic Resistance among Physicians Treating Syrian Patients with War-Related Injuries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122709 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2709 ◽

Cited By ~ 2

Author(s):

Andreas Älgå ◽

Karin Karlow Herzog ◽

Murad Alrawashdeh ◽

Sidney Wong ◽

Hamidreza Khankeh ◽

...

Keyword(s):

Antibiotic Resistance ◽

Qualitative Content Analysis ◽

Emergency Setting ◽

Healthcare Associated Infection ◽

Treatment Protocols ◽

Middle Income ◽

Course Of Action ◽

Resource Limited ◽

Healthcare Associated ◽

Injured Patients

Healthcare-associated infections (HAIs) constitute a major contributor to morbidity and mortality worldwide, with a greater burden on low- and middle-income countries. War-related injuries generally lead to large tissue defects, with a high risk of infection. The aim of this study was to explore how physicians in a middle-income country in an emergency setting perceive HAI and antibiotic resistance (ABR). Ten physicians at a Jordanian hospital supported by Médecins Sans Frontières were interviewed face-to-face. The recorded interviews were transcribed verbatim and analyzed by qualitative content analysis with an inductive and deductive approach. The participants acknowledged risk factors of HAI and ABR development, such as patient behavior, high numbers of injured patients, limited space, and non-compliance with hygiene protocols, but did not express a sense of urgency or any course of action. Overuse and misuse of antibiotics were reported as main contributors to ABR development, but participants expressed no direct interrelationship between ABR and HAI. We conclude that due to high patient load and limited resources, physicians do not see HAI as a problem they can prioritize. The knowledge gained by this study could provide insights for the allocation of resources and development of hygiene and wound treatment protocols in resource-limited settings.

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