Improving outcomes and reducing costs by modular training in infection control in a resource-limited setting

Singh, Sanjeev; Kumar, Raman Krishna; Sundaram, K. R.; Kanjilal, Barun; Nair, Prakash

doi:10.1093/intqhc/mzs059

Cited by 32 publications

(44 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 2009, we recorded rates of 3–5% in maternity units [15] while others have reported infection rates of 6% [30] and 18% [31] in non-intensive care surgical settings. These figures suggest that the levels of infection we recorded are plausible.…”

Section: Discussionmentioning

confidence: 88%

The Effect of Surveillance and Appreciative Inquiry on Puerperal Infections: A Longitudinal Cohort Study in India

et al. 2014

View full text Add to dashboard Cite

ObjectiveTo evaluate the effects of an intervention comprising surveillance and an organisational change called Appreciative Inquiry on puerperal infections in hospitals in Gujarat state, India.MethodsThis longitudinal cohort study with a control group was conducted over 16 months between 2010 and 2012. Women who delivered in six hospitals were followed-up. After a five month pre-intervention period, the intervention was introduced in three hospitals. Monthly incidence of puerperal infection was recorded throughout the study in all six hospitals. A chi-square test and logistic regression were used to examine for associations, trends and interactions between the intervention and control groups.FindingsOf the 8,124 women followed up, puerperal infections were reported in 319 women (3.9%) over the course of the study. Puerperal sepsis/genital tract infections and urinary tract infections were the two most common puerperal infections. At the end of the study, infection incidence in the control group halved from 7.4% to 3.5%. Levels in the intervention group reduced proportionately even more, from 4.3% to 1.7%. A chi-square test for trend confirmed the reduction of infection in the intervention and control groups (p<0.0001) but the trends were not statistically different from one another. There was an overall reduction of infection by month (OR = 0.94 95% CI 0.91–0.97). Risk factors like delivery type, complications or delivery attendant showed no association with infection.ConclusionInterruption of resource flows in the health system occurred during the intervention phase, which may have affected the findings. The incidence of infection fell in both control and intervention groups during the course of the study. It is not clear if appreciative inquiry contributed to the reductions observed. A number of practical and methodological limitations were faced.Trial RegistrationControlled-Trials.com ISRCTN03513186

show abstract

Section: Discussionmentioning

confidence: 88%

The Effect of Surveillance and Appreciative Inquiry on Puerperal Infections: A Longitudinal Cohort Study in India

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The probabilities of reduced HAI through improved hand hygiene compliance will be retrieved from phase 1 and phase 2 of the study. Similarly cost data will be obtained from Indian studies reporting cost per HAI patient and per day of ICU stay [26,27].…”

Section: Model Inputsmentioning

confidence: 99%

Health Technology Assessment of Ultraviolate light based imaging technology to reduce burden of hospital acquired infections: A Study Protocol

Shah

Kotwani

Saha

2020

Preprint

View full text Add to dashboard Cite

Background: HAIs impart a huge clinical and economic burden in India. Healthcare worker’s compliance to hand hygiene protocol can play an important role in preventing the transmission of cross-infection and thus reducing the HAIs. Over last few years, there has been a wide use of ultraviolate (UV) based fluorescent markers for assessing quality of hand hygiene. This Health Technology Assessment (HTA) study will be conducted with the aim to identify low cost, easy and feasible strategy having potential to get integrated in the current health system to deal with issue of HAI in ICU settings.Methods: The study will be conducted in three phases. The impact of innovation on hand hygiene compliance will be assessed quantitatively by undertaking meta-analysis of secondary literature on UV based imaging tool in improving hand hygiene compliance in ICUs. Following this, the feasibility of using this innovation in developing country like India will be assessed. Decision Analytic modelling will be conducted for cost-effectiveness analysis using health systems perspective. Cost per ICU stay (day) and QALY gained will be calculated and ICER will be reported to comment on the cost-effectiveness of the innovation.Discussion: The HTA study will provide a comprehensive overview of the effectiveness of UV light based imaging device in reduction of HAIs. The results of this HTA study will generate evidence for the decision makers for its incorporation in public healthcare system of India.Systematic review registration: The protocol has been registered in Prospero (Prospero Id: CRD42018108960)

show abstract

“…The other two educational studies by Singh et al and Girard et al delivered face-to-face training programmes across hospital staff on geriatric units but neither study found a significant reduction in CAUTI or UTI [32,33]. Singh et al used a faceto-face training intervention in geriatric units at six locations, which covered general infection control, including hand hygiene, sterilization and disinfection, isolation precautions, etc., using didactic sessions, video shows, quizzes, role plays, and tests; despite not finding reductions in CAUTI they did find significant reductions in all other infection rates [32].…”

Section: Education And/or Training Interventionsmentioning

confidence: 99%

Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review

Jones

Meyrick

Bath

et al. 2019

Journal of Hospital Infection

View full text Add to dashboard Cite

Background: Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors. Aim: To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults. Methods: Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading. Findings: Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) ¼ 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (c 2 ¼ 254). A third study reported fewer UTIs per patient week (risk ratio ¼ 0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias. Conclusion: The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation.

show abstract

Improving outcomes and reducing costs by modular training in infection control in a resource-limited setting

Abstract: Standardization of infection control training and practices is the most cost-effective way to reduce HCAIs and related adverse outcomes.

Cited by 32 publications

References 18 publications

The Effect of Surveillance and Appreciative Inquiry on Puerperal Infections: A Longitudinal Cohort Study in India

The Effect of Surveillance and Appreciative Inquiry on Puerperal Infections: A Longitudinal Cohort Study in India

Health Technology Assessment of Ultraviolate light based imaging technology to reduce burden of hospital acquired infections: A Study Protocol

Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review

Contact Info

Product

Resources

About