Understanding the Landscape of Hospital-Acquired Infections and Antimicrobial Resistance
Hospital-acquired infections (HAIs) and antimicrobial resistance (AMR) pose significant global health challenges, with a disproportionate burden in low- and middle-income countries (LMICs) like Bangladesh. Despite global efforts to reduce HAIs over time, the pooled prevalence remains alarmingly high in resource-constrained settings at 15.5%, compared to 7.6% in high-income countries.
The drivers of this endemic burden in LMICs are multifaceted, stemming from shortfalls in fundamental infection prevention and control (IPC) measures, irrational antibiotic use, and limited access to reliable diagnostic tools. These factors have cultivated a progressively antibiotic-resistant microbial landscape, with drug-resistant infections continuing to rise.
HAIs, especially those caused by multidrug-resistant organisms, adversely impact patient care, leading to prolonged hospital stays, long-term disability, substantial morbidity and mortality, and significant economic loss. These escalating challenges underscore the critical importance of strengthening IPC practices and implementing effective antimicrobial stewardship programs (ASPs) to ensure the safety and quality of healthcare delivery.
Assessing the Current State of IPC in Bangladeshi Healthcare Facilities
To combat the key challenges of HAIs in tertiary healthcare facilities of Bangladesh, a comprehensive assessment of existing IPC practices and infrastructure is essential. The research team, in collaboration with the Directorate General of Health Services (DGHS) and hospital leadership, aims to conduct a baseline assessment using a mixed-methods approach.
Evaluating IPC Capacity through the WHO IPCAF
The team will first assess the IPC capacity of each healthcare facility using the World Health Organization’s Infection Prevention and Control Assessment Framework (IPCAF). This diagnostic tool evaluates the implementation of the WHO’s core components of IPC programs, categorizing hospitals on a continuum from “inadequate” to “advanced” based on their total score.
The IPCAF covers eight core components:
1. IPC program
2. IPC guidelines
3. IPC education and training
4. Healthcare-associated infection surveillance
5. Multimodal strategies
6. Monitoring/audits of IPC practices and feedback
7. Workload, staffing, and bed occupancy
8. Built environment, materials, and equipment for IPC
By assessing each facility’s performance across these domains, the research team can identify strengths and gaps in existing IPC activities, informing the design of targeted interventions.
Observing IPC Practices in Action
In addition to the IPCAF assessment, the team will conduct direct observations to evaluate hand hygiene compliance and personal protective equipment (PPE) utilization among healthcare providers, patients, and visitors. These observations will follow the WHO’s “5 Moments for Hand Hygiene” and standard checklists for appropriate PPE use.
Furthermore, the research team will assess the hospital infrastructure, including the availability and functionality of handwashing stations, waste management systems, and overall cleanliness of wards and nursing stations. This comprehensive evaluation of IPC practices and infrastructure will provide a clear picture of the current state of infection control in these healthcare facilities.
Gauging Knowledge, Attitudes, and Practices of Healthcare Workers
To gain a deeper understanding of IPC-related knowledge, attitudes, and practices (KAP) among healthcare providers, the team will administer a structured questionnaire. This survey will cover components such as IPC knowledge, attitudes towards IPC, and self-reported IPC practices. The results will help identify gaps in understanding and implementation, which can then be addressed through targeted training and interventions.
Importantly, the KAP survey will also include cleaning and maintenance staff, who play a vital role in environmental cleaning and waste disposal, yet are often overlooked in IPC training programs. By involving all cadres of healthcare workers, the research team can develop a holistic approach to strengthen IPC practices across the entire healthcare ecosystem.
Strengthening IPC and Antimicrobial Stewardship Committees
Recognizing the critical importance of institutional ownership and sustainability, the research team will work closely with DGHS and hospital leadership to establish or strengthen the IPC and ASP committees in each participating facility. These multidisciplinary committees will play a pivotal role in identifying context-specific solutions, designing tailored interventions, and championing IPC and antimicrobial stewardship efforts within their respective healthcare institutions.
Designing and Implementing Tailored Interventions
Based on the comprehensive baseline assessments, the research team, in collaboration with the IPC and ASP committees, will design and implement a series of targeted interventions and quality improvement projects. These responses will be carefully tailored to address the unique gaps and barriers identified in each healthcare facility, ensuring optimal relevance and sustainability.
The interventions may include, but are not limited to:
– Strengthening IPC policies and guidelines
– Enhancing IPC training and educational programs for all cadres of healthcare workers
– Improving infrastructure and resources for hand hygiene, PPE, and environmental cleaning
– Establishing robust HAI surveillance systems
– Implementing effective ASPs to promote rational antibiotic use
By actively involving hospital leadership and IPC/ASP committees in the design and implementation of these interventions, the research team aims to foster a sense of ownership and commitment, ultimately leading to more sustainable improvements in infection control and antimicrobial stewardship practices.
Evaluating the Impact and Scaling Successful Strategies
After 12 months of implementing the tailored interventions, the research team will conduct an end-line assessment using the same IPCAF, observation, and KAP tools employed during the baseline. This will allow for a comparative analysis to measure the changes in IPC and antibiotic stewardship practices within each healthcare facility.
The findings from this comprehensive assessment will not only guide the refinement of existing interventions but also provide valuable policy-relevant data to support the scale-up of successful strategies across the healthcare system in Bangladesh. The lessons learned and the framework developed through this implementation research can serve as a model for other resource-limited settings seeking to strengthen IPC and antimicrobial stewardship practices, ultimately reducing the burden of HAIs and AMR.
Conclusion
Comprehensive assessments of healthcare facilities in LMICs are crucial for identifying gaps and designing contextually appropriate solutions to strengthen IPC measures and ASP activities. The research team’s approach, centered on a mixed-methods assessment, tailored interventions, and collaborative implementation, aims to provide a replicable framework for improving infection prevention and control practices in resource-constrained healthcare settings.
By empowering healthcare facilities to take ownership of their IPC and antimicrobial stewardship efforts, this study can guide the development and implementation of feasible, sustainable, and impactful interventions to address the pressing challenges of HAIs and AMR. The insights gained from this research can inform national policies and serve as a blueprint for other LMICs seeking to enhance the safety and quality of healthcare delivery.
