National Guidelines for Nosocomial Infections in Healthcare Facilities in India: Strategies for Effective Infection Prevention and Control
Dr. Mahboob Ali Khan (MHM) Advisor ??
I'm Healthcare Management C-suite Consultant | Skills: #Quality #Accreditation | #Operations & #Businessdevelopment |#Policymaking | #Strategy #planning #business #financialmanagement#analytics #virtualassistance
Ensuring the well-being and safety of patients, families, healthcare workers, and the community requires adherence to Infection Prevention and Control (IPC) and quality standards in healthcare. A well-structured IPC program is fundamental in every healthcare facility (HCF) to support healthcare workers (HCWs) in delivering high-quality healthcare. In 2016, the World Health Organization (WHO) released evidence-based guidelines, integrated into an implementation manual, outlining the essential components of IPC. The initial step in putting these guidelines into practice is the establishment of an IPC program at the HCF level.
Objectives of IPC Program:
Roles and Responsibilities:
The Hospital Infection Control Committee (HICC) is vital to the HCF's IPC program, overseeing its establishment and maintenance, including functions such as monitoring, surveillance, reporting, research, and education. The HICC needs to encompass broad representation from all relevant disciplines or departments within the facility. The proposed structure and responsibilities of the HICC are outlined below.
Infection Prevention and Control Manual
At the facility level, the IPC manual must be meticulously crafted by the IPC team, aligning with the IPC policy defined by the HICC. Incorporating inputs from relevant departments, the manual undergoes thorough review and approval by the HICC. National guidelines serve as the fundamental framework for the IPC manual, allowing adaptation to local conditions, facility types, provided services, infrastructure, and human resource availability. Widespread distribution within the HCF ensures accessibility in all relevant areas. Training programs for staff at all levels should strictly adhere to procedures and practices outlined in the IPC manual, subject to regular reviews and updates, preferably on an annual basis.?
The comprehensive IPC manual encompasses facility-specific protocols, policies, guidelines, SOPs, and recommendations, addressing IPC practices, environmental control, HAI surveillance, outbreak management, guidelines for special areas or situations based on facility services, infection prevention among HCWs, and ongoing monitoring and evaluation.
Antimicrobial Use and Management
Antimicrobial use is a critical aspect of the IPC program, necessitating the establishment of an Antimicrobial Stewardship Programme (AMSP) in HCFs. Achieving appropriate antimicrobial use involves formulating standard treatment guidelines, providing ongoing education to clinicians, restricting selected antibiotics, and submitting specimens for bacteriological examination before initiating treatment.?
The microbiology laboratory plays a pivotal role in containing Antimicrobial Resistance (AMR) through antibiotic susceptibility testing, supporting the AMSP committee, monitoring resistance trends, and providing timely notification of unusual AMR patterns. Addressing poor specimen collection and transportation practices, the laboratory must enforce strict rejection criteria and communicate results promptly to clinicians. Biomarkers, such as C-reactive protein and procalcitonin, contribute to infection management, aiding in risk stratification and guiding therapeutic decisions, but their use requires careful interpretation within the clinical context.
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Educational Programmes and Strategies
Risk Assessment and Risk Management:
Formulating the annual action plan for IPC should adopt a risk-based approach, assessing procedures and processes associated with infection risk to patients and staff in the HCF. The risk assessment and management (RA-RM) system should be structured into individual functional, structural, and operational components. Hypothetical event frequencies should be semi-quantified, ranging from unlikely to imminent, while the magnitude of impact should be assessed on a scale from mild to catastrophic. Utilizing arbitrary 3-point or 5-point scales, the annual IPC implementation plan should consider the cumulative effect of frequency and impact. Immediate action is required for imminent and catastrophic events, strategic long-term planning for rare and mild occurrences, root cause analysis for frequent but mild situations, and strategic long-term planning for infrequent but severe events.
Planning, Monitoring, Audit and Feedback
A yearly plan of action, based on risk assessment, should be formulated by the end of the current year and approved by the HICC. Emphasis should be on setting targets aligned with program aims and objectives, outlining strategies for implementation. The primary goal of audit/monitoring practices and feedback is to induce behavioral change or process modifications, enhancing care quality and practices to reduce HAI risk and AMR spread. Regular monitoring/auditing of IPC practices and feedback (individual/team/unit) effectively promotes adherence.
Examples of indicators include:
Implementation Strategies
This approach integrates three or more components, known as the bundle approach, utilizing tools like checklists and bundles created by multidisciplinary teams based on local conditions. This involves proper infrastructure, training, and communication fostering a cultural shift within the establishment to strengthen the safety climate.
This comprehensive strategy has demonstrated significant improvements in IPC practices and a reduction in HAI risk.
Conclusion:
In conclusion, a robust IPC program, guided by WHO's multimodal strategy, is crucial for ensuring patient, healthcare worker, and community well-being. The structured program, led by the HICC integrates components like a comprehensive IPC manual and the AMSP. This approach aim to foster a culture of safety and quality in healthcare settings.