Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study

1. Indah K Murni1,2,3, 2. Trevor Duke2,3, 3. Sharon Kinney4, 4. Andrew J Daley5,6, 5. Yati Soenarto1

Author Affiliations

  1. 1Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia
  2. 2Department of Paediatrics, Centre for International Child Health, University of Melbourne, MCRI, Melbourne, Victoria, Australia
  3. 3Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
  4. 4Department of Paediatrics and Nursing, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
  5. 5Laboratory Services, Infection Prevention and Control, Royal Children's Hospital,Melbourne, Victoria, Australia
  6. 6Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia

Correspondence
Dr Indah K Murni, Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta 55824, Indonesia; ita_kartika@yahoo.com

  • Received 9 August 2014 
  • Accepted 21 November 2014
  • Published Online First 10 December 2014

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.

TOP