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Recent years have seen the emergence of dangerous strains of viruses previously held in check — or virtually eliminated — through medicines such as antibiotics. The relative ease of international travel makes an outbreak in one part of the world a real public health concern for people around the globe.
One potential breeding ground for infectious disease is in hospitals and other health facilities, where both patients and healthcare providers can all too easily transfer microbes to others. Discovering how these healthcare-associated infections are perpetuated by existing clinical procedures and obtaining support for implementing evidence-based infection control measures are the first steps to reducing such infections.
In low- and middle-income countries around the globe, healthcare-associated infections represent a critical patient safety problem. These infections often prolong hospital stays and can lead to long-term disability or even death. They also increase resistance to antibiotics and other life-saving medications and drive up the cost of care for patients, institutions, and the health system as a whole.
Inadequate infrastructure and equipment, poor hygiene and waste disposal, and overcrowding all contribute to increased rates of healthcare-associated infections. Staffing shortages, lack of training in basic infection control procedures, and lack of polices and guidelines further compound the problem. As a result, WHO estimates that healthcare-associated infections affect hundreds of millions of people the world over, though exact numbers are unknown due to challenges related to gathering reliable data — particularly in resource-constrained settings worldwide that lack national surveillance systems.
Even in low-income countries, where as many as one out of every three surgical patients acquires an infection, there are a number of simple, low-cost interventions that can improve outcomes — proper education and training of staff; development and implementation of rational and evidence-based protocols and guidelines; and ensuring optimal hand hygiene practices, for example.
Unfortunately, there is a huge gap between the existing knowledge of best practices and the implementation of these infection control practices in clinical settings. Again, this gap is even more pronounced in low- and middle-income countries where the consequences squander scares resources and undermine investments in health systems.
AIHA’s Infection Control Program
By working to stop the emergence of new infections, as well as the reemergence of old ones, AIHA and out partners have been striving to improve healthcare practices and patient outcomes since our first hospital-to-hospital partnerships were established in 1992.
AIHA’s Infection Control partnership program works with national and local ministries of health, as well as individual healthcare facilities, to develop local and nationwide infection control practices. AIHA partners also help individual healthcare workers and patients learn practical techniques to lessen the spread of infections.
Some of the approaches used by partners to curb healthcare-associated infections include:
- Teaching universal precautions, such as adequate hand-washing, use of disposable supplies, and safe waste removal;
- Developing infection surveillance systems, including enhancements to hospital microbiology laboratories;
- Curbing the over-prescription of antibiotics to avoid the development of drug-resistant organisms
- Training clinicians to test for antimicrobial resistance and to use WHONET, the World Health Organization’s globally linked antimicrobial surveillance network;
- Teaching primary healthcare providers about occupational health issues; and
- Establishing Infection Control Training Centers (ICTCs) where hospital epidemiologists and clinicians are trained as trainers.
AIHA partnership successes — such as a 35 percent reduction in surgical site infections at Odessa Oblast Hospital in Ukraine — have proven that patient health can significantly improve with the help of evidence-based infection control procedures.
“All of us involved in healthcare know we cannot solve the problems of infectious diseases and infection control . . . unless we recognize those problems as being simultaneously local and global.”
Selected Program Results
- US experts from Elmhurst Hospital Center worked with their partners at Debre Berhan Referral Hospital in Ethiopia to create the local institution’s first infection control manual. Elmhurst infection control specialists provided comprehensive training and mentorship for Debre Berhan staff, helped them establish a system of infection control rounds throughout the hospital, and instituted employee interviews to determine knowledge of hospital-associated infections.
- In Russia, the model Infection Control Training Center at the Northwestern State Medical University (I. I. Mechnikov) trained more than 2,000 local epidemiologists and infection control specialists in surveillance, proper use of antibiotics, microbiology, and standards of practice between 1997 and 2002.
- The rate of healthcare-associated infections among neonates at the Kosice Faculty Hospital in Slovakia dropped dramatically following the implementation of a new protocol for antibiotic use developed by AIHA’s Kosice / Providence partners.
- Some 18 AIHA partnership sites throughout Eurasia participate in WHONET, the World Health Organization’s project to assist hospitals, reference laboratories, and ministries of health around the world implement interventions that facilitate the appropriate use of antimicrobial agents and stem the rise of multi-drug resistant infections.
- In several countries where AIHA partnerships selected infection control as a priority activity, their efforts coincided with — and in many cases catalyzed — regulatory changes at both regional and national levels. In 1993, for example, the Russian Ministry of Health issued the first mandate for the formal establishment of a hospital-based infection control program that included the creation of physician-nurse hospital epidemiology teams to oversee related policies and practices at their institutions. Following the Russian example, other countries throughout the region also attempted to institutionalize hospital infection control.
AIHA Infection Control Training Centers in Euraisa