Strategies to address healthcare associated infections in India

Abstract

Healthcare Associated Infections (HAI), commonly known as nosocomial infections, is a global public health problem. Most frequently occurring HAI are surgical site infection, urinary tract infection, bloodstream infection and hospital acquired pneumonia. It is caused by bacterial, viral and fungal microorganisms. In addition to this, the Multi-Drug Resistant (MDR) or antibiotic resistant strains contribute to the increase in the HAI related mortality and morbidity. Every year, hundreds of millions of patients are affected worldwide by HAI, and it leads to significant increase in mortality and financial cost for the healthcare system. According to World Health Organization (WHO), no country has yet solved the issue of HAI completely. The burden of this HAI problem is higher in the lower and middle-income countries when compared to high income countries. According to a 2011-2012 point-prevalence survey, the prevalence of HAI (at least one infection) in hospitalized patients was 6.0% in Europe. According to WHO report from 1995-2010, the prevalence rate of HAI was 8.8% and 12.5% in Iran and Turkey, respectively. According to WHO estimates, the annual financial losses in Europe due to HAI’s was approximately €7 billion and, in the USA, approximately US$6.5 billion in 2004. For, India an overall HAI rate is not available, but according to a study done in seven cities of India from 2004-2007 ventilator-associated pneumonia (VAP) was 29.6% of all HAI’s (10.46 per 1000 device-days) and CAUTI was 9.0% of all HAI’s (1.41 per 1000 device-days). The key risk factors that are related to HAI are “inadequate environmental hygienic conditions, poor infrastructure, insufficient equipment, understaffing, overcrowding, little knowledge and application of basic infection-control measures, prolonged and inappropriate use of invasive devices and antibiotics, lack of local and national policies, low hygiene compliance, and reuse of equipment (including needles and gloves).” Being admitted in the intensive care unit (ICU) itself serves as a major risk factor for contracting HAI. The intervention strategies that are used to address this HAI problem are key infection control guidelines and their implementation, education of Healthcare Workers (HCW), use of financial incentives, surveillance, reducing hospital overcrowding and tackling nursing shortage. These strategies were assessed for their strengths and weaknesses based on the following eligibility criteria such as intervention effectiveness, intervention feasibility, financial resources available, intervention sustainability and political feasibility. Based on the priority setting, compliance with the guidelines and education of HCW were found to be most effective in the prevention of HAI. These chosen strategies, will be implemented through an infection control program in all health facilities. To see the effectiveness of the chosen strategies, a two-staged evaluation will be conducted, observation of HCW and before/after comparison of HAI rates. The observation of HCW will be done to see the HCW compliance with guidelines and then the HAI rates of the health facility will be compared before and after the implementation of the infection control program to see whether the implemented strategies where effective in reducing the HAI.