This article is more than 5 years old. Information may no longer be current.
Compliance with infection control guidelines poor; worse in low-income countries
Click Here to Manage Email Alerts
Compliance with recommended infection control guidelines in low- and middle-income countries is substandard, with opportunity for improvement in hospitalwide surveillance, antibiotic management and written policies, according to recent data.
In the study, researchers evaluated the Infection Control Assessment Tool (ICAT), a method of assessing infection control created by WHO and the U.S. Agency for International Development to identify goals for improving practice and reducing health care-associated infections (HAIs). Six sites completed ICAT modules through the Society for Healthcare Epidemiology of America’s ambassador program: Nepal (low income), India (low-middle income), Argentina, Hungary and South Africa (upper-middle income), and Greece (high income).
The sites completed six ICAT modules that addressed topics such as health facility information; infection control programs; surgical antibiotic use; surgical equipment protocols; surgical environment practices; sterilization and cleaning of IV fluids and surgical equipment; and hand-washing and hygiene. Each module had a questionnaire and point values. The researchers assigned a percentage of total points for each section and evaluated data from all sites as a median of total points accrued across all locations.
Of 121 completed sections for five submitted modules, 19% achieved scores of less than 50% of the recommended infection control practices. Scores from 50% to 75% of recommended practices were seen in 36% of sections. Surveillance of nosocomial infection scored lowest within the infection control module, with a total median score of 42% (95% CI, 6%-80%) compliance to guidelines and scores of less than 50% at three sites. Infection control program responsibility and authority had a median score of 69% (95% CI, 15%-82%) with two sites assigned scores of less than 50%. The infection control education programs section scored a median of 73% (95% CI, 55%-91%).
Within the surgical antibiotic use and equipment procedure module, the lowest scores were in the perioperative antimicrobial section, with a median score of 47% (95% CI, 16%-90%) compliance. Four sites scored less than 50% in this section. The section on proper reprocessing of surgical instruments yielded a median compliance rate of 78% (95% CI, 25%-89%), with one site scoring less than 50%. The section on surgical area cleaning had a median adherence rate of 82% (95% CI, 17%-83%), and two locations scored less than 50%.
At many sites, the infection control programs had significant limitations and practiced inconsistent HAI surveillance. While many of these limitations were seen in low- and middle-income categories, Greece demonstrated inadequacy in terms of perioperative antibiotic administration, sterilization and disinfection of equipment, and proper hand hygiene.
“Our data show there is opportunity for improvement in IC programs across economies, including HAI surveillance, antimicrobial stewardship, availability of written guidelines and policies, sterilization procedures and hand hygiene,” the researchers wrote. “Concern for antibiotic resistance and for the lack of antibiotics in the pipelines has led to infection prevention initiatives and prudent use of antimicrobials.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts