Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study
Background Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies hav...
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| Veröffentlicht in: | Archives of disease in childhood 2015-05, Vol.100 (5), p.454-459 |
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| creator | Murni, Indah K Duke, Trevor Kinney, Sharon Daley, Andrew J Soenarto, Yati |
| description | Background Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. Aims To implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use. Methods A before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods. Results We observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)). Conclusions Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries. |
| doi_str_mv | 10.1136/archdischild-2014-307297 |
| format | Article |
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Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. Aims To implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use. Methods A before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods. Results We observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)). Conclusions Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries.</description><identifier>ISSN: 0003-9888</identifier><identifier>EISSN: 1468-2044</identifier><identifier>DOI: 10.1136/archdischild-2014-307297</identifier><identifier>PMID: 25503715</identifier><identifier>CODEN: ADCHAK</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject>Adolescent ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Attrition (Research Studies) ; Care and treatment ; Child ; Child, Preschool ; Compliance ; Control ; Cross infection ; Cross Infection - prevention & control ; Developed Nations ; Developing Countries ; Disease control ; Disease transmission ; Dosage and administration ; Female ; Guideline Adherence ; Guidelines ; Health Personnel ; Hospitals ; Humans ; Hygiene ; Indonesia ; Infant ; Infection Control - methods ; Intensive Care Units, Pediatric ; Intervention ; LDCs ; Male ; Medical care ; Medical care (Private) ; Medical referrals ; Mortality ; Nosocomial infections ; Observation ; Original ; Outcome Measures ; Patients ; Pediatrics ; Performance evaluation ; Personal hygiene ; Physicians ; Prevention ; Program Evaluation ; Prospective Studies ; Quality management ; Referral ; Research Assistants ; Research Design ; Risk factors ; Sample Size ; Seminars ; Teaching Methods ; Workers</subject><ispartof>Archives of disease in childhood, 2015-05, Vol.100 (5), p.454-459</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b633t-dfb4bc52a6fc4d840086f1ac341cb733c9da3a3df678b8a1b49c6f20615378d53</citedby><cites>FETCH-LOGICAL-b633t-dfb4bc52a6fc4d840086f1ac341cb733c9da3a3df678b8a1b49c6f20615378d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://adc.bmj.com/content/100/5/454.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://adc.bmj.com/content/100/5/454.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,780,784,885,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25503715$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Murni, Indah K</creatorcontrib><creatorcontrib>Duke, Trevor</creatorcontrib><creatorcontrib>Kinney, Sharon</creatorcontrib><creatorcontrib>Daley, Andrew J</creatorcontrib><creatorcontrib>Soenarto, Yati</creatorcontrib><title>Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study</title><title>Archives of disease in childhood</title><addtitle>Arch Dis Child</addtitle><description>Background Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. Aims To implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use. Methods A before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods. Results We observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)). Conclusions Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries.</description><subject>Adolescent</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Attrition (Research Studies)</subject><subject>Care and treatment</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Compliance</subject><subject>Control</subject><subject>Cross infection</subject><subject>Cross Infection - prevention & control</subject><subject>Developed Nations</subject><subject>Developing Countries</subject><subject>Disease control</subject><subject>Disease transmission</subject><subject>Dosage and administration</subject><subject>Female</subject><subject>Guideline Adherence</subject><subject>Guidelines</subject><subject>Health Personnel</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hygiene</subject><subject>Indonesia</subject><subject>Infant</subject><subject>Infection Control - methods</subject><subject>Intensive Care Units, Pediatric</subject><subject>Intervention</subject><subject>LDCs</subject><subject>Male</subject><subject>Medical care</subject><subject>Medical care (Private)</subject><subject>Medical referrals</subject><subject>Mortality</subject><subject>Nosocomial infections</subject><subject>Observation</subject><subject>Original</subject><subject>Outcome Measures</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Performance evaluation</subject><subject>Personal hygiene</subject><subject>Physicians</subject><subject>Prevention</subject><subject>Program Evaluation</subject><subject>Prospective Studies</subject><subject>Quality management</subject><subject>Referral</subject><subject>Research Assistants</subject><subject>Research Design</subject><subject>Risk factors</subject><subject>Sample Size</subject><subject>Seminars</subject><subject>Teaching Methods</subject><subject>Workers</subject><issn>0003-9888</issn><issn>1468-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkk9v1DAQxSMEotvCV0CWuHBJsWPHcTggVSv-SZUqIThbjj3ZeOXEW9tZsWe-OE5TqsIFTpY9v3kav3lFgQi-JITytyrowdioB-tMWWHCSoqbqm2eFBvCuMhPjD0tNhhjWrZCiLPiPMY9xqQSgj4vzqq6xrQh9ab4-RXMrO20Q4OPB5uUK5W-nW0Ag-zUg07WTxGpKV_HQ_DHBU0DoKCWinJojoB8n4lkO-uT1TE3IoUMHMH5w8JrP08pnN5lCEF_J3qECWJEMc3m9KJ41isX4eX9eVF8__jh2_ZzeX3z6cv26rrsOKWpNH3HOl1XiveaGcEwFrwnSlNGdNdQqlujqKKm543ohCIdazXvK8xJTRthanpRvF91D3M3gtGQh1JOHoIdVThJr6z8szLZQe78UTJGqOAsC7y5Fwj-doaY5JiXAM6pCfwcJRFYZFdp1f4b5Q3LW2qZyOjrv9C9n0O2dhHMC2uxYE2mypXaKQfSTtpPCX4k7Z2DHchs1PZGXjHC6prTu1nFyuvgYwzQP_yTYLmESD4OkVxCJNcQ5dZXj316aPydmgzQFejG_f_L_gJpdNoD</recordid><startdate>20150501</startdate><enddate>20150501</enddate><creator>Murni, Indah K</creator><creator>Duke, Trevor</creator><creator>Kinney, Sharon</creator><creator>Daley, Andrew J</creator><creator>Soenarto, Yati</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88B</scope><scope>88E</scope><scope>88I</scope><scope>8A4</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>CJNVE</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0P</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEDU</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20150501</creationdate><title>Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study</title><author>Murni, Indah K ; Duke, Trevor ; Kinney, Sharon ; Daley, Andrew J ; Soenarto, Yati</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b633t-dfb4bc52a6fc4d840086f1ac341cb733c9da3a3df678b8a1b49c6f20615378d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Attrition (Research Studies)</topic><topic>Care and treatment</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Compliance</topic><topic>Control</topic><topic>Cross infection</topic><topic>Cross Infection - prevention & control</topic><topic>Developed Nations</topic><topic>Developing Countries</topic><topic>Disease control</topic><topic>Disease transmission</topic><topic>Dosage and administration</topic><topic>Female</topic><topic>Guideline Adherence</topic><topic>Guidelines</topic><topic>Health Personnel</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hygiene</topic><topic>Indonesia</topic><topic>Infant</topic><topic>Infection Control - methods</topic><topic>Intensive Care Units, Pediatric</topic><topic>Intervention</topic><topic>LDCs</topic><topic>Male</topic><topic>Medical care</topic><topic>Medical care (Private)</topic><topic>Medical referrals</topic><topic>Mortality</topic><topic>Nosocomial infections</topic><topic>Observation</topic><topic>Original</topic><topic>Outcome Measures</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Performance evaluation</topic><topic>Personal hygiene</topic><topic>Physicians</topic><topic>Prevention</topic><topic>Program Evaluation</topic><topic>Prospective Studies</topic><topic>Quality management</topic><topic>Referral</topic><topic>Research Assistants</topic><topic>Research Design</topic><topic>Risk factors</topic><topic>Sample Size</topic><topic>Seminars</topic><topic>Teaching Methods</topic><topic>Workers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Murni, Indah K</creatorcontrib><creatorcontrib>Duke, Trevor</creatorcontrib><creatorcontrib>Kinney, Sharon</creatorcontrib><creatorcontrib>Daley, Andrew J</creatorcontrib><creatorcontrib>Soenarto, Yati</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Education Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>Education Periodicals</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Education Collection</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Education Database</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Education</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of disease in childhood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Murni, Indah K</au><au>Duke, Trevor</au><au>Kinney, Sharon</au><au>Daley, Andrew J</au><au>Soenarto, Yati</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study</atitle><jtitle>Archives of disease in childhood</jtitle><addtitle>Arch Dis Child</addtitle><date>2015-05-01</date><risdate>2015</risdate><volume>100</volume><issue>5</issue><spage>454</spage><epage>459</epage><pages>454-459</pages><issn>0003-9888</issn><eissn>1468-2044</eissn><coden>ADCHAK</coden><abstract>Background Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. Aims To implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use. Methods A before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods. Results We observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)). Conclusions Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>25503715</pmid><doi>10.1136/archdischild-2014-307297</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Anti-Bacterial Agents - therapeutic use Antibiotics Attrition (Research Studies) Care and treatment Child Child, Preschool Compliance Control Cross infection Cross Infection - prevention & control Developed Nations Developing Countries Disease control Disease transmission Dosage and administration Female Guideline Adherence Guidelines Health Personnel Hospitals Humans Hygiene Indonesia Infant Infection Control - methods Intensive Care Units, Pediatric Intervention LDCs Male Medical care Medical care (Private) Medical referrals Mortality Nosocomial infections Observation Original Outcome Measures Patients Pediatrics Performance evaluation Personal hygiene Physicians Prevention Program Evaluation Prospective Studies Quality management Referral Research Assistants Research Design Risk factors Sample Size Seminars Teaching Methods Workers |
| title | Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study |
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