Program Schedule

Gap Analysis of infection control practices in low and middle income countries (LMIC): Role of antimicrobial stewardship

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC


Health-care associated infections (HAI) rates are higher in LMIC (6-18%)   resulting in increased patient mortality, disability, and healthcare costs. We explored opportunity for improvement using a standardized tool - Infection Control Assessment Tool (ICAT).  Prevention of Surgical site infections is a priority globally. In order to address this global health problem, we set out to further investigate specific areas where infection control practices could be improved in LMIC.


SHEA's international ambassadors were trained in specific modules by webinar using ICAT developed as a collaborative by USAID.  Five out of the ten international sites completed the surgical modules-(1) Surgical antibiotics use and surgical equipment procedures, (2) Surgical practice area, (3) Sterilization and disinfection- equipment and IV fluids.  Modules were scored and rated per guidelines: rating of (1) 75% -A: recommended practices are followed consistently, (2) 50-75% B-recommended practices usually followed and (3) <50%-C: training and follow-up needed on recommended practices. Data from the five sites were combined and analyzed based on World Bank country economy classification.


Of the five sites, one was classified as a high income economy, three were upper-middle income economies, and one was a low-middle income economy. Scores (%) for the two surgical modules are presented in Table 1, categorized by income economy classification. Sterilization and disinfection scores were also low at 50% -C grade. Overall hand hygiene (HH) rates were low, an average of 33%.


Our results indicate that adherence to recommended infection control practices are suboptimal. Opportunities for improvement of infection control practices in several areas exist.  Major areas of focus for improvement should be antimicrobial prophylaxis and preoperative preparation of the patient. Basic IC practices like HH, sterilization and disinfection should be addressed.  Surgical site infections were not routinely monitored in these hospitals and SSI surveillance is not being consistently performed at the all the participating sites. International collaborative efforts should be established to improve IC practices.

Kristy Weinshel, MBA, Society for Healthcare Epidemiology of America, Arlington, VA, Angela Dramowski, MD, Community Health, Academic Unit for Infection Prevention and Control, Stellenbosch University, Cape Town, South Africa, Katerina Mougkou, MD, Clinical Epidemiology and Outcomes Research Center (CLEO), University of Athens, 1st Department of Pediatrics, Athens, Greece, Chimanjita Phukan, MD, DEPT. of Microbiology, GAUHATI MEDICAL COLLEGE & HOSPITAL, GUWAHATI, India, Agnes Hajdu, MD, Hospital Epidemiology and Hygiene, National Center for Epidemiology, Budapest, Hungary, Maria Staneloni, MD, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Saul Jacob, George Washington University, Washington, DC and Nalini Singh, MD, MPH, FIDSA, FSHEA, The George Washington University, Washington, DC


K. Weinshel, None

A. Dramowski, None

K. Mougkou, None

C. Phukan, None

A. Hajdu, None

M. Staneloni, None

S. Jacob, None

N. Singh, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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