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Hospital Infection Prevention and Control: A Model for Improving the Quality of Hospital Care in Low- and Middle-Income Countries

  • W. Charles Huskins (a1) (a2), Barbara M. Soule (a3), Carol O'Boyle (a4), László Gulácsi (a5), Edward J. O'Rourke (a1) (a2) and Donald A. Goldmann (a1) (a2)...

Abstract

Continuous quality improvement (CQI) is a powerful methodology for improving clinical outcomes and patient satisfaction while reducing inefficiency and costs. However, most hospitals in low- and middle-income countries have little experience with CQI methods. Hospital infection prevention is an ideal model for nascent efforts to improve the quality of hospital care because of its proven efficacy in reducing the occurrence of infections that compromise patient outcomes and increase costs. This article describes the design and implementation of a demonstration project to reduce the incidence of surgical-site infections (SSIs) for hospitals with little experience with quality-improvement methods. The project has a high likelihood of producing measurable reductions in SSI rates and hospital costs related to inefficient use of perioperative antimicrobial prophylaxis. Moreover, participating staff will gain experience that can be applied to efforts to improve the quality of other aspects of hospital care.

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Corresponding author

International Hospital Infection Prevention and Quality Assessment Program, Division of Infectious Diseases, Children's Hospital, 300 Longwood Ave, Boston, MA 02115

References

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1.World Bank. World Development Report 1993: Investing in Health. New York, NY: Oxford University Press; 1993.
2.Barnum, H, Kutzin, J. Public Hospitals in Developing Countries: Resource Use, Cost, Financing. Baltimore, MD: The Johns Hopkins University Press; 1993.
3.Berwick, DM. Continuous improvement as an ideal in health care. N Engl J Med 1989;320:5356.
4.Decker, MD. The application of continuous quality improvement to healthcare. Infect Control Hosp Epidemiol 1992;13:226229.
5.Klazinga, N. Concerted action programme on quality assurance in hospitals 1990-1993: global results of the evaluation. Int J Qual Health Care 1994;6:219230.
6.Berwick, DM, Godfrey, AB, Roessner, J. Curing Health Care: New Strategies for Quality Improvement. San Francisco, CA: Jossey-Bass Publishers; 1990.
7.Rhinehart, E, Goldmann, DA, O'Rourke, EJ. Adaptation of Centers for Disease Control guidelines for the prevention of nosocomial infection in a pediatric intensive care unit in Jakarta, Indonesia. Am J Med 1991;91(suppl 3B):213S220S.
8.Huskins, WC, O'Rourke, EJ, Rhinehart, E, Goldmann, DA. Infection control in countries with limited resources. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1995:11761200.
9.Mayon-White, RT, Ducel, G, Kereselidze, T, Tikomirov, E. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect 1988;11:4348.
10.Sramova, H, Bartonova, A, Bolek, S, Krecmerova, M, Subertova, V. National prevalence survey of hospital-acquired infections in Czechoslovakia. J Hosp Infect 1988;11:328334.
11.Pall, G, Petras, G. Information data on the incidence of nosocomial infections in Hungary. Orv Hetil 1990;131:14111414.
12.Daniel, SO. An epidemiological study of nosocomial infections at the Lagos University Teaching Hospital. Public Health 1977;91:1318.
13.Srisupan, V, Senaratana, W, Pichiansathien, W, Tongsawas, T. Nosocomial infections in Maharaj Nakhon Chiang Mai Hospital 1987. J Med Assoc Thai 1989;72(suppl 2):711.
14.Sithikesorn, J, Lumpikanon, P, Bunma, P, Patjanasuntorn, B. Nosocomial infections in Srinagarind Hospital. J Med Assoc Thai 1989;72(suppl 2):1214.
15.Paganini, JM, Novaes, HM. Desarrollo y foralecimiento de los sistemas locales de salud. La garantia de calidad. El control de infecciones hospitalarias. HSD/SILOS-12. Washington, DC: Pan American Health Organization/World Health Organization; 1991.
16.Wagner, MB, Petrillo, V, Gay, V, Fagundes, GR. A prevalence survey of nosocomial infection in a Brazilian hospital. J Hosp Infect 1990;15:379381.
17.Lima, NL, Pereira, CR, Souza, IC, Facanha, MC, Lima, AA, Guerrant, RL, et al.Selective surveillance for nosocomial infections in a Brazilian hospital. Infect Control Hosp Epidemiol 1993;14:197202.
18.Hammami, A, Arlet, G, Ben Redjeb, S, Grimont, F, Ben Hassen, A, Rekik, A, et al.Nosocomial outbreak of acute gastroenteritis in a neonatal intensive care unit in Tunisia caused by multiply drug resistant Salmonella wien producing SHV-2 beta-lactamase. Eur J Clin Microbiol Infect Dis 1991;10:641646.
19.Sirinavin, S, Hotrakitya, S, Suprasongsin, C, Wannaying, B, Pakeecheep, S, Vorachit, M. An outbreak of Salmonella urbana infection in neonatal nurseries. J Hosp Infect 1991;18:231238.
20.Banerjee, M, Sahu, K, Bhattacharya, S, Adhya, S, Bhowmick, P, Chakraborty, P. Outbreak of neonatal septicemia with multidrug resistant Klebsiella pneumoniae. Indian J Pediatr 1993;60:2527.
21.Thomas, A, Lalitha, MK, Jesudason, MV, John, S. Transducer related Enterobacter cloacae sepsis in post-operative cardiothoracic patients. J Hosp Infect 1993;25:211214.
22.Adeyemo, AA, Akindele, JA, Omokhodion, SI. Klebsiella septicaemia, osteomyelitis and septic arthritis in neonates in Ibadan, Nigeria. Ann Trop Paediatr 1993;13:285289.
23.Stephen, M, Lalitha, MK. An outbreak of Serratia marcescens infection among obstetric patients. Indian J Med Res 1993;97:202205.
24.Sader, HS, Pignatari, AC, Leme, IL, Burattini, MN, Tancresi, R, Holllis, RJ, et al.Epidemiologic typing of multiply drug-resistant Pseudomonas aeruginosa isolated from an outbreak in an intensive care unit. Diagn Microbiol Infect Dis 1993;17:1318.
25.Murphy, SA, Lowe, B, Maghenda, JK, Apollo, JG. An outbreak of intravenous cannulae associated nosocomial septicaemia due to multidrug-resistant Klebsiella pneumoniae. East Afr Med J 1994;71:271,272.
26.Velandia, M, Fridkin, SK, Cardenas, V, Boshell, J, Ramirez, G, Bland, L, et al.Transmission of HIV in dialysis centre. Lancet 1995;345:14171422.
27.Sanders, CC, Sanders, WE Jr. Beta-lactam resistance in gram-negative bacteria: global trends and clinical impact. Clin Infect Dis 1992;15:824839.
28.Casellas, JM, Blanco, MG, Pinto, ME. The sleeping giant: antimicrobial resistance. Infect Dis Clin North Am 1994;8:2945.
29.Pannuti, CS, Grinbaum, RS. An overview of nosocomial infection control in Brazil. Infect Control Hosp Epidemiol 1995;16:170174.
30.Ponce-de-Leon, S. The needs of developing countries and the resources required. J Hosp Infect 1991;18(suppl A):376381.
31.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG, Munn, VP, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.
32.Wenzel, RP. The economics of nosocomial infections. J Hosp Infect 1995;31:7997.
33.Wey, SB, Cardo, DM, Halker, E, Carratu, F, Saes, AC. Distribution and analysis of 8,268 nosocomial infections at the Hospital Sao Paulo: 19851989. Rev Hosp Sao Paulo 1989;1:169174.
34.Cavalcante, MD, Braga, OB, Teofilo, CH, Oliveira, EN, Alves, A. Cost improvements through the establishment of prudent infection control practices in a Brazilian general hospital, 1986-1989. Infect Control Hosp Epidemiol 1991;12:649653.
35.Starling, CEF, Pinheiro, SMC, Couto, BRGM. Vigilancia Epidemiologica das Infeccoes Hospitalares na Pratica Diaria. Belo Horizonte, MG: Edicoes Cuatiara; 1993.
36.Dellinger, EP, Gross, PA, Barrett, TL, Krause, PJ, Martone, WJ, McGowan, JE, et al.Quality standard for antimicrobial prophylaxis in surgical procedures. Infect Control Hosp Epidemiol 1994;15:182188.
37.Classen, DC, Evans, RS, Pestotnik, SI, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med 1992;326:281286.
38.Langley, GJ, Nolan, KM, Nolan, TW. The Foundation of Improvement. Silver Spring, MD: API Publishing; 1992.
39.Culver, DH, Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG, et al.Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152S157S.
40.Cruse, PJE, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:2740.
41.Olson, MM, Lee, JT Jr.Continuous, 10-year wound infection surveillance: results, advantages, and unanswered questions. Arch Surg 1990;125:794803.
42.Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303307.
43.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20:271274.
44.Society for Hospital Epidemiology of America, Association for Practitioners in Infection Control, Centers for Disease Control, Surgical Infection Society. Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:599605.
45.Altemeier, WA, Burke, JF, Sandusky, WR. Manual on Control of Infection in Surgical Patients. Philadelphia, PA: JB Lippincott Co; 1984.
46.Gulácsi, L, Kis, ST, Goldmann, DA, Huskins, WC. Surgical site infection rates for frequently performed procedures in Hungarian hospitals. Infect Control Hosp Epidemiol 1997;18:P26. Abstract.
47.Sellick, JA. The use of statistical process control charts in hospital epidemiology. Infect Control Hosp Epidemiol 1993;14:649656.
48.Kaminsky, FC, Benneyan, JC, Davis, RB, Burke, RJ. Statistical control charts based on a geometric distribution. Journal of Quality Technology 1992;24:6369.
49.Zaza, S, Jarvis, WR. Investigation of outbreaks. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore: Williams & Wilkins; 1995:105113.
50.Jacquez, GM, Waller, LA, Grimson, R, Wartenberg, D. The analysis of disease clusters, part I: state of the art. Infect Control Hosp Epidemiol 1996;17:319327.
51.Jacquez, GM, Grimson, R, Waller, LA, Wartenberg, D. The analysis of disease clusters, part II: introduction to techniques. Infect Control Hosp Epidemiol 1996;17:385397.
52.Mayhall, CG. Surgical infections including burns. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections, 2nd ed. Baltimore, MD: Williams & Wilkins; 1993:614664.
53.Durbin, W Jr., Lapidas, B, Goldmann, DA. Improved antibiotic usage following introduction of a novel prescription system. JAMA 1981;246:17961800.
54.Kritchevsky, SB, Simmons, BP. Continuous quality improvement: concepts and applications for physician care. JAMA 1991;266:18171823.
55.National Nosocomial Infections Surveillance System. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609621.
56.National Nosocomial Infections Surveillance System. National Nosocomial Infection Surveillance (NNIS) semi-annual report, May 1995. Am J Infect Control 1995;23:377385.

Hospital Infection Prevention and Control: A Model for Improving the Quality of Hospital Care in Low- and Middle-Income Countries

  • W. Charles Huskins (a1) (a2), Barbara M. Soule (a3), Carol O'Boyle (a4), László Gulácsi (a5), Edward J. O'Rourke (a1) (a2) and Donald A. Goldmann (a1) (a2)...

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