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
AIHA’s Infection Control Program provides technical guidance, clinical training and mentoring, and expert advice to prevent the spread of healthcare-associated infections, often by making simple, low-cost changes to procedures and behaviors, including basic hygiene.
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.”
— Dr. Thomas Lawley, Dean, Emory University Medical School, Atlanta, Georgia
(Tbilisi / Atlanta partnership)
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.
Improvements in patient care and clinical outcomes are predicated on an effective infectious disease surveillance system. To facilitate advances in both these areas, AIHA developed a program for continuous quality improvement in hospital microbiology laboratories through our Infection Control Initiative, which was implemented in countries of the former Soviet Union with USAID support. This program included establishing internal quality control systems for media, reagents, and test performance; introducing current methods of antimicrobial susceptibility testing; and creating an antimicrobial surveillance network, using the World Health Organization’s WHONET information system.
The AIHA program began early in 1997 with a thorough evaluation of microbiology laboratories in three partnership hospitals and at three central reference laboratories in the Russian Federation and Ukraine. Based on needs assessments, each of these six pilot laboratories received equipment and supplies that allowed for quality testing of antimicrobial susceptibility and ongoing monitoring of test results. Since then, a total of 18 AIHA partnership hospitals throughout Armenia, Georgia, Kazakhstan, Kyrgyzstan, Russia, and Ukraine implemented the WHONET system; 13 of them were still actively participating in the program when AIHA’s projects in these countries concluded. To read more on AIHA’s Infection Control Initiative, click here.
- 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
While hospital infection control in the former Soviet Union had a strong hygienic tradition — most hospitals in the region were kept sufficiently clean — healthcare-associated infections are more likely to be spread through person-to-person contact, so additional emphasis needed to be placed on patient care practices.
Building on the successful training center model used for its Emergency and Disaster Medicine and Neonatal Resuscitation programs, AIHA created a comprehensive plan for establishing Infection Control Training Centers (ICTCs) that addressed issues such as developing targeted curricula, educating faculty in evidence-based infection control standards and adult-learning techniques, and compiling appropriate reference and teaching materials. By the time AIHA’s USAID-supported Health Partnerships Programs concluded in the region in 2008, we had established four of these Training Centers, one each in Georgia, Kazakhstan, Russia, and Ukraine.
The cornerstone of each of ICTC is a one-week Basic Infection Control Course that was developed for hospital epidemiologists, assistant epidemiologists, and other physicians and nurses who are responsible for infection control practices in their hospitals. This course was introduced by the national ministries of health of Georgia, Kazakhstan, and Russia into the continuing education curriculum for all hospital epidemiologists.
In addition, the first edition of AIHA’s Basic Infection Control Manual for nations in the region — co-authored by U.S. and Russian infection control experts — was published in 1997 and distributed to all partnership hospitals, major teaching institutions, and national and regional health authorities. In 2003, the manual was updated under the direction of an international editorial committee that included specialists from Eurasia and internationally recognized American experts. It has been widely used by infection control professionals as both a teaching tool and a major resource in their day-to-day practice. Complementing these key elements, are a host of slides, reference materials, and electronic media that enhance the training experience.
Finally, a special “Train the Trainers” program was designed to ensure ICTC faculty remain current on evidence-based infection control practices and continuing education methods. This program allowed for the gradual involvement of faculty from the region in teaching the Basic Infection Control Course, first jointly with their American partners and then on their own.