Customizing infection prevention and control modules for combating healthcare-acquired infections in low-resource hospitals or resource-constrained healthcare settings: a local and global approach.

Abstract

Background: In resource-constrained healthcare settings such as in India, effective infection prevention and control (IPC) practices are essential for reducing healthcare-associated infections (HAIs) and enhancing patient outcomes. This study aimed to evaluate a customized IPC model implemented in Indian hospitals to address these challenges and improve patient safety. The model was designed to be replicable by other hospitals with similar objectives.

Methods: The multicenter pre-post quality improvement study was conducted across 11 Indian private tertiary hospitals from January 2022 to June 2023, with a 6 months preintervention phase (January-June 2022) and a 12 months intervention phase (July 2022-June 2023). Following the World Health Organization (WHO) guidelines, the study employed a stepwise methodology, including induction, HAI data collection, baseline assessments using WHO's Infection Prevention and Control (IPC) Assessment Framework (IPCAF) tool to evaluate IPC level, team formation, training, surveillance, and audit protocols. The intervention phase focused on comprehensive IPC training, virtual courses, and IPC surveillance. The project utilized the IPC model to enhance the methodology of implementing IPC, enabling transition over an 18-month duration.

Results: Significant improvements were observed in IPC assessment scores, hand hygiene compliance, and adherence to IPC care bundles during the intervention phase. IPC assessment scores remarkably improved from a median of 78-97% (p = 0.004), with hospitals remaining in the advanced IPC level both pre and post intervention. Compliance toward hand hygiene improved from a median of 65% in the preintervention phase to 88% in the postintervention phase (p = 0.004). Significant improvement in compliance with IPC care bundles were observed for CAUTI (p = 0.016), CLABSI (p = 0.004), SSI (p = 0.010), and VAP (p = 0.037).Overall, HAI incidence rates remained consistently low during the study period with no statistically significant difference (p > 0.05) between preintervention and postintervention rates; however, variability across individual hospitals highlights differences in settings and indicates further strengthening and standardization of IPC practices.

Conclusions: This quality improvement initiative highlights that a structured, WHO-aligned IPC approach can be practically adopted across Indian hospitals and can strengthen key IPC practices such as hand hygiene and care bundle compliance. With HAI rates already low at baseline and remaining stable over the study period, the findings primarily highlight the feasibility and scalability of such IPC programs across diverse healthcare settings.