Implementation of infection prevention and control practices in an upcoming COVID-19 hospital in India: An opportunity not missed

Abstract

Infection prevention and control (IPC) program is obligatory for delivering quality services in any healthcare setup. Lack of administrative support and resource-constraints (under-staffing, inadequate funds) were primary barriers to successful implementation of IPC practices in majority of the hospitals in the developing countries. The Coronavirus Disease 2019 (COVID-19) brought a unique opportunity to improve the IPC program in these hospitals. A PDSA (Plan—Do—Study- Act) model was adopted for this study in a tertiary care hospital which was converted into a dedicated COVID-19 treatment facility in Varanasi, India. The initial focus was to identify the deficiencies in existing IPC practices and perceive the opportunities for improvement. Repeated IPC training (induction and reinforce) was conducted for the healthcare personnel (HCP) and practices were monitored by direct observation and closed-circuit television. Cleaning audits were performed by visual inspection, review of the checklists and qualitative assessment of the viewpoints of the HCP was carried out by the feedbacks received at the end of the training sessions. A total of 2552 HCP and 548 medical students were trained in IPC through multiple offline/onsite sessions over a period of 15 months during the ongoing pandemic. Although the overall compliance to surface disinfection and cleaning increased from 50% to >80% with repeated training, compliance decreased whenever newly recruited HCP were posted. Fear psychosis in the pandemic was the greatest facilitator for adopting the IPC practices. Continuous wearing of personal protective equipment for long duration, dissatisfaction with the duty rosters as well as continuous posting in high-risk areas were the major obstacles to the implementation of IPC norms. Recognising the role of an infection control team, repeated training, monitoring and improvisation of the existing resources are keys for successful implementation of IPC practices in hospitals during the COVID-19 pandemic.

The economic impact of a COVID-19 illness from the perspective of families seeking care in a private hospital in India

“…The Indirect costs for patients and caregivers are displayed in Table 4 . Patients reported they were back to normalcy after a median (IQR) of 25 [ [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ] days (P=0.219). Of the 52 employed, 7 patients did not return to work due to illness, and 28 reported suboptimal efficiency at work.…”

“…Studies that reviewed prescriptions during COVID reported up to 72% of hospitalised patients received antibiotics despite confirmed bacterial isolation in only 3 to 15% [ 28 ]. Another crucial driver of cost was ensuring the safety and protection of health workers via PPE gowns, single-use equipment and infrastructure to set up Covid wards [ 29 , 30 ]. The scarce supply during the pandemic also drove up the unit price of these resources.…”

Assessment of Quality of Infection Prevention and Control in PHCs of Hyderabad in the Context of COVID 19 - A Mixed Method Analysis Study

“…In a study done by Argya das et al (8) a total of 2552 health care professionals and 548 medical students were trained in IPC through multiple offline/onsite sessions over a period of 15 months during the ongoing pandemic (8) The overall compliance to surface disinfection and cleaning increased from 50% to >80% with repeated training, compliance decreased whenever newly recruited HCP were posted. (8) Hand hygiene compliance was poor varying from 10 to 40% complete adherence rate. (8) Fear psychosis in the pandemic was the greatest facilitator for adopting the IPC practices.…”

“…(8) Hand hygiene compliance was poor varying from 10 to 40% complete adherence rate. (8) Fear psychosis in the pandemic was the greatest facilitator for adopting the IPC practices. (8) Continuous wearing of personal protective equipment for long duration, dissatisfaction with the duty rosters as well as continuous posting in high-risk areas were the major obstacles to the implementation of IPC norms (8) The present study found that 94% of the PHCs had the availability of PPEs and 94% had availability of soap and water.…”

“…(8) Fear psychosis in the pandemic was the greatest facilitator for adopting the IPC practices. (8) Continuous wearing of personal protective equipment for long duration, dissatisfaction with the duty rosters as well as continuous posting in high-risk areas were the major obstacles to the implementation of IPC norms (8) The present study found that 94% of the PHCs had the availability of PPEs and 94% had availability of soap and water. In a study done by Suneela Garg et al (9) in PHCs done across India it was found that N95 masks were available at 26 (50.9%) sites.…”