Gap Analysis of Infection Control Practices in Low- and Middle-Income Countries
Gap Analysis of Infection Control Practices in Low- and Middle-Income Countries
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DOI：
10.1017/ice.2015.160
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发表时间：
2015-10-01
影响因子：
4.5
通讯作者：
Singh, Nalini
中科院分区：
文献类型：
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作者：
Weinshel, Kristy;Dramowski, Angela;Singh, Nalini
背景与高收入国家相比，低收入和中等收入国家的医疗保健相关感染率较高，导致患者死亡和残疾的发生率相对较高，医疗保健费用增加。objective.使用感染控制评估工具评估参与国感染控制（IC）实践的差距。位于阿根廷、希腊、匈牙利、印度、尼泊尔和南非的六个国际研究中心提供了与IC项目、外科抗生素使用和外科设备程序、外科区域实践、设备和静脉注射液的灭菌和消毒以及手部卫生相关的卫生机构和外科模块的信息。对每个国家的模块进行评分。6个国际研究中心完成了5个模块。在121个已完成的部分中，23个（19%）收到的分数低于推荐的IC实践的50%，43个（36%）收到的分数为50%至75%。IC程序在许多地点有各种局限性，对医疗保健相关感染的监测并不一致。即使在高收入国家，也发现缺乏围手术期抗生素管理、设备灭菌和消毒不足以及手卫生缺乏。许多机构也缺乏明确的书面政策和程序。我们的研究结果表明，坚持推荐的IC做法是次优的。IC实践的改进机会存在于几个领域，包括医院范围内的IC计划和监督，抗生素管理，书面和张贴的指南和政策，在一系列主题，手术器械灭菌程序，并改善手部卫生。
BACKGROUND. Healthcare-associated infection rates are higher in low-and middle-income countries compared with high-income countries, resulting in relatively larger incidence of patient mortality and disability and additional healthcare costs. objective. To use the Infection Control Assessment Tool to assess gaps in infection control (IC) practices in the participating countries.METHODS. Six international sites located in Argentina, Greece, Hungary, India, Nepal, and South Africa provided information on the health facility and the surgical modules relating to IC programs, surgical antibiotic use and surgical equipment procedures, surgical area practices, sterilization and disinfection of equipment and intravenous fluid, and hand hygiene. Modules were scored for each country.RESULTS. The 6 international sites completed 5 modules. Of 121 completed sections, scores of less than 50% of the recommended IC practices were received in 23 (19%) and scores from 50% to 75% were received in 43 (36%). IC programs had various limitations in many sites and surveillance of healthcare-associated infections was not consistently performed. Lack of administration of perioperative antibiotics, inadequate sterilization and disinfection of equipment, and paucity of hand hygiene were found even in a high-income country. There was also a lack of clearly written defined policies and procedures across many facilities.CONCLUSIONS. Our results indicate that adherence to recommended IC practices is suboptimal. Opportunities for improvement of IC practices exist in several areas, including hospital-wide IC programs and surveillance, antibiotic stewardship, written and posted guidelines and policies across a range of topics, surgical instrument sterilization procedures, and improved hand hygiene.