Multifaceted interventions for healthcare-associated infections and rational use of antibiotics in a low-to-middle-income country: Can they be sustained?

Abstract

Background Transmission of infection between patients by health workers, and the irrational use of antibiotics are preventable causes for healthcare-associated infections (HAI) and multi-resistant organisms. A previous study implementing a hand hygiene campaign and antibiotic stewardship program significantly reduced these infections. Sustaining such interventions can be challenging. Aims To evaluate whether there was a sustained effect of a multifaceted infection control and antibiotic stewardship program on HAI and antibiotic use 5 years after it began. Methods A prospective evaluation study was conducted over 26 months (from February 2016 to April 2018) in a teaching hospital in Indonesia, 5 years after the implementation of an antibiotic stewardship and infection control program, which was successful when initially evaluated. All children admitted to the pediatric ICU and pediatric wards were observed daily. Assessment of HAI was made based on the criteria from the Centers for Disease Control and Prevention. Assessment of rational antibiotic use was based on the WHO Pocket Book of Hospital Care for Children. Multivariable logistic regression analysis was used to quantify the relationship between the HAI and the multifaceted intervention.

Risk factors for healthcare-associated infection among children in a low-and middle-income country

“…A prospective cohort study was conducted in the PICU and general pediatric wards at Dr Sardjito Hospital in Yogyakarta, Indonesia during 1st June 2016 to 31st December 2019 [ 11 ]. The Dr. Sardjito Hospital is a referral hospital for Yogyakarta and the Southern part of the Central Java provinces in Indonesia, and provides services to a population of approximately 3.5 million people.…”

“…The definitions of HAI were based on the US Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) and the National Nosocomial Infections Surveillance (NNIS) system. Every child in the study was observed each day to see whether he/she fulfilled the CDC criteria for a HAI [ 11 , 12 ]. Investigations of the causes of fever and other signs of infection were at the discretion of the treating clinical staff.…”

Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study

“…However, the current understanding of the drivers of hand hygiene behaviours specific to labour and delivery is limited [ 12 , 13 ]. Hand hygiene improvement strategies targeting HCW often result in small or moderate effects [ 12 , 22 ] and are often only short-term [ 13 , 23 ]. Current approaches to improving hand hygiene practices among HCW largely focus on a limited set of known behavioural determinants (knowledge, skills, and physical opportunity), provide limited information on the specific determinants interventions target, or address hand hygiene as part of a generalized set of hygiene behaviours [ 18 , 24 ].…”

Hand Hygiene During Facility-Based Childbirth in Cambodia: A Theory-Driven, Mixed-Methods Observational Study

“…A total of 45 mothers were observed; 22 from the PHC and 23 from the RH. Mothers from the PHC and RH had similar characteristics with a mean age of 28 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) and had an average of 2 (0-6) previous live births. The average travel time to the HCF was 19 minutes .…”

“…However, the current understanding of the drivers of hand hygiene behaviours speci c to labour and delivery is limited (12,13). Hand hygiene improvement strategies targeting HCW often result in small or moderate effects (12,22) and are often only short-term (13,23). Current approaches to improving hand hygiene practices among HCW largely focus on a limited set of known behavioural determinants (knowledge, skills, and physical opportunity), provide limited information on the speci c determinants interventions target, or address hand hygiene as part of a generalized set of hygiene behaviours (18,24).…”