Implementing Infection Prevention and Control Programs When Resources Are Limited

Infection Prevention and Safety in Low and Middle Income Countries (C Bardossy, Section Editor)
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  1. Topical Collection on Infection Prevention and Safety in Low and Middle Income Countries

Opinion Statement

There have been established at least four pillars of patient safety viz., healthcare-associated infection prevention and control (IPC), surgical safety, medication safety, and patient communication. It has always been challenging to design, implement, and monitor the functioning of such pillars especially when resources are limited. The trained human resource is most precious of all followed by infrastructure, consumables, and continuous training. The establishment of “IDEAL framework” recommended elsewhere is the approach to achieve “optimal minimal” patient safety goal; however, simple steps with the limited resources can help improve the patient outcomes and safe work environment in healthcare setting. The program may not be comprehensive initially, and step-wise expansion of program can be planned based on available resources and buying-in from various stakeholders in the healthcare units. Involvement of leadership in the implementation of the IPC program can be the key driver of the program. The program can be initiated in one of the key high-risk areas (e.g., intensive care units or operating room complex) and then can be expanded to other units. Meticulous capturing of healthcare-associated infection (HAI) indicators and their regular feedback brings credibility to the program and help other people to take ownership of the program. This review highlights the basic components of designing, implementation, and monitoring of IPC program when resources are limited.

Keywords

Patient safety Hand hygiene Antimicrobial stewardship Sterilization Healthcare worker safety Communication 

Notes

Compliance with Ethical Standards

Conflict of Interest

Vikas Manchanda declares that he has no conflict of interest. Urvashi Suman declares that she has no conflict of interest. Nalini Singh declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Global Guidelines for the Prevention of Surgical Site Infection. World Health Organization. Geneva: World Health Organization; 2016. http://apps.who.int/iris/bitstream/10665/250680/1/9789241549882-eng.pdf?ua=1. Accessed 5 Oct 2017. This document provides the recommendations for the prevention of SSI to be applied or considered in the pre-, intra- and postoperative periods and give practical ways to implement the recommendations and guidelines.
  2. 2.
    Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–41.  https://doi.org/10.1016/S0140-6736(10)61458-4.CrossRefPubMedGoogle Scholar
  3. 3.
    •• Report on the burden of endemic health care-associated infection worldwide. A systematic review of the literature. Geneva: World Health Organization; 2011. Available at: http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf. Accessed 5 Oct 2017. This document was published under WHO Patient Safety programme and as an effort to integrate other WHO programmes to reduce HCAI. The document details about burden of HAIs in developed as well as LMIC and highlights the impact of HAIs worldwide.
  4. 4.
    •• Hospital infection prevention control guidelines. New Delhi, India: National Center for Disease Control. 2016. http://www.nicd.nic.in/writereaddata/mainlinkfile/File571.pdf. Accessed 5 Oct 2017. This document can be used as template for infection prevention and control manual by different set of health care units in LMIC and can provides practical base document to initiate IPC program in hospitals.
  5. 5.
    Raka L. Prevention and control of hospital-related infections in low and middle income countries. The Open Infect Dis J. 2010;4(2):125–31.  https://doi.org/10.2174/1874279301004020125.CrossRefGoogle Scholar
  6. 6.
    • Singh N, Manchanda V. Control of multidrug-resistant Gram-negative bacteria in low- and middle-income countries-high impact interventions without much resources. Clin Microbiol and Infect. 2017;23(4):216–8. This article is a comprehensive review for the policy makers and program managers to understand key challenges and core components for IPC program in LMIC.  https://doi.org/10.1016/j.cmi.2017.02.034.CrossRefGoogle Scholar
  7. 7.
    Rosenthal V. Central line–associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis. 2009;49(12):1899–907.  https://doi.org/10.1086/648439.CrossRefPubMedGoogle Scholar
  8. 8.
    Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.  https://doi.org/10.1056/NEJMoa061115.CrossRefPubMedGoogle Scholar
  9. 9.
    •• Core components for infection prevention and control programmes- Assessment tools for IPC programmes. Geneva: World Health Organisation; 2011. WHO/HSE/GAR/BDP/2011.3. http://www.wpro.who.int/hrh/about/nursing_midwifery/core_components_for_ipc.pdf. Accessed 5 Oct 2017. The documents provide comprehensive details about the various components of typical IPC program through the various tools kits. These tool kits have great potential to help identifying the gaps in resources, infrastructure, and process implementation of IPC program in healthcare setting.
  10. 10.
    •• Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings Recommendations of the HICPAC. March 2017. https://www.cdc.gov/hicpac/pdf/core-practices.pdf. Accessed 5 Oct 2017. This document provides comprehensive practice elements of IPC program in a healthcare setting.
  11. 11.
    Rutala WA, Weber DJ. Disinfection and sterilization in health care facilities: what clinicians need to know. Clin Infect Dis. 2004;39(5):702–9.  https://doi.org/10.1086/423182.CrossRefPubMedGoogle Scholar
  12. 12.
    Weinshel K, Dramowski A, Hajdu A, Jacob S, Khanal B, Zoltan M, et al. Gap analysis of infection control practices in low- and middle-income countries. Infect Control Hosp Epidemiol. 2015;36(10):1208–14.  https://doi.org/10.1017/ice.2015.160.CrossRefPubMedGoogle Scholar
  13. 13.
    •• Antibiotic Stewardship Statement for Antibiotic Guidelines – Recommendations of the HICPAC. September 2017. https://www.cdc.gov/hicpac/pdf/antibiotic-stewardship-statement.pdf. Accessed 5 Oct 2017. This document provides principles of laboratory testing and antimicrobial treatment to be addressed in implementing antimicrobial stewardship program in healthcare settings.
  14. 14.
    Resar R, Griffin FA, Haraden C, Nolan TW. Using care bundles to improve health care quality. IHI innovation series white paper. Cambridge: Institute for Healthcare Improvement; 2012. http://www.ihi.org/resources/Pages/IHIWhitePapers/UsingCareBundles.aspx. Accessed 5 Oct 2017Google Scholar
  15. 15.
    •• Sandra I, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91. This article provides various recommendations to reduce surgical site infections and can help development of surgical site infection reduction bundle. CrossRefGoogle Scholar
  16. 16.
    Borg MA. Lowbury Lecture 2013. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change. J Hosp Infect. 2014;86(3):161–8.  https://doi.org/10.1016/j.jhin.2013.12.006.CrossRefPubMedGoogle Scholar
  17. 17.
    Rawson TM, Moore LSP, Tivey AM, Tsao A, Gilchrist M, Charani E, et al. Behaviour change interventions to influence antimicrobial prescribing: a cross-sectional analysis of reports from UK state-of-the-art scientific conferences. Antimicrob Resist Infect Control. 2017;6(1):11.  https://doi.org/10.1186/s13756-017-0170-7.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Smits H, Supachutikul A, Mate KS. Hospital accreditation: lessons from low and middle-income countries. Glob Health. 2014;10(1):65.  https://doi.org/10.1186/s12992-014-0065-9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of MicrobiologyMaulana Azad Medical CollegeNew DelhiIndia
  2. 2.Department of PediatricsGeorge Washington UniversityWashingtonUSA

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