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LETTER TO EDITOR  
Year : 2019  |  Volume : 44  |  Issue : 4  |  Page : 399-400
 

Assessment of infection control practices: A cross-sectional study from public health facilities of Madhya Pradesh


Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India

Date of Submission19-Mar-2019
Date of Acceptance16-Sep-2019
Date of Web Publication12-Nov-2019

Correspondence Address:
Dr. Vaibhav Patwardhan
A/10, New Meghna Society, P.O. Railway D'Çabin, Opp. ONGC Avani Bhavan, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcm.IJCM_108_19

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How to cite this article:
Patwardhan V, Kotwani P, Saxena D. Assessment of infection control practices: A cross-sectional study from public health facilities of Madhya Pradesh. Indian J Community Med 2019;44:399-400

How to cite this URL:
Patwardhan V, Kotwani P, Saxena D. Assessment of infection control practices: A cross-sectional study from public health facilities of Madhya Pradesh. Indian J Community Med [serial online] 2019 [cited 2019 Dec 15];44:399-400. Available from: http://www.ijcm.org.in/text.asp?2019/44/4/399/270795




Sir,

Nosocomial infections, also known as, hospital-acquired infections (HAIs) impose a serious hazard to the health of the patients as it leads to increase patients' morbidity and mortality, length of hospital stay as well as the costs associated with a hospital stay. The prevalence of HAIs in low- and middle-income countries, at any point of time, lies between 5.7% and 19.1%.[1]

Health-care facilities (HCFs) are responsible for the management of the waste generated within the facilities. Inefficiencies in following the guidelines lead to increase likelihood of infections and may further lead to sepsis, urinary tract infection, and other complications.[2]

The importance of addressing inadequacy in the facility-based water sanitation and hygiene (WASH) and infection prevention and control (IPC) is becoming more acute given the increasing institutionalization of deliveries. Due to less or untrained health-care staff and poor physical environment, the health facilities severely lack the capacity to deal with the massive rise in demand, thus keeping health gains of beneficiaries at least. Rather, it increases the chances of morbidity and mortality due to HAIs.[3] We assessed existing practices for sanitation and hygiene, infection control, and biomedical waste (BMW) management in ten public health facilities of district Bhopal, Madhya Pradesh. The cross-sectional study was conducted in representative HCFs of all the three levels, namely primary (n = 4), secondary (n = 4), and tertiary (n = 2). Convenient sampling method was adopted for the selection of the study sites based on administrative feasibility.

Mixed methods were adopted to document the observations (OBs). Qualitative OBs were collected by diary methods on the themes of WASH and the quantitative data collection was done by the help of a predesigned, pretested tool based on existing Kayakalp tool of the Government of India (GOI). Practices were documented against THREE components, namely sanitation and hygiene, infection control, and BMW management in HCFs. The assessment methods were supported by direct OB, staff interview, and review of records and documents. The scores were analyzed as fully compliant (2), partially compliant (1), and noncompliant (0). Although the assessment and data collection were done independently, the head of the facility was informed well in advance. The information collected was collated and statistical software was used to analyze the information. Only descriptive statistics was used to draw the inferences.

The study protocol was approved by the Institute's Ethical Clearance Committee and confidentiality of data obtained from each facility was maintained by providing a unique code/number to maintain anonymity.

The overall score for ten facilities was calculated as per the protocols provided in the Kayakalp mission. The overall performance, for all the ten facilities inclusive of three parameters (sanitation and hygiene, BMW management, and infection control), was 70%. The individual percentage score for the THREE components was sanitation and hygiene 64%, BMW management 73%, and infection control 78%. It was observed that the level of facility influenced the performance of HCFs. The IPC practices were found to be relatively poor in primary HCFs as compared to secondary and tertiary level counterparts, as depicted in [Table 1].
Table 1: Parameter wise scores of the facility performance as per level (percentage)

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   Based on the Qualitative Observations, the Following Gaps Were Identified Top


Human resource

Almost all facilities reported a lack of workforce for maintaining optimal WASH. The available staff were overburdened and were asked to do multitasking. A study done in Bengaluru also found similar results and cited multitasking of health workers to be one of the reasons for cross-contamination.[4]

Housekeeping

Knowledge and practice on unidirectional and outward moping techniques of cleaning critical areas were poor. None of the facilities adopted the system of monitoring of adequacy and quality of material used for cleaning.

Lack of equipment/materials for waste handlers

Although, housekeeping staff and waste handlers were provided with heavy-duty gloves, they were reluctant to use it citing discomfortable with utility gloves and preferred use of examination gloves over. Furthermore, the facilities had regular shortage of free supply of alcohol-based hand rub.

Maintenance of records and website

Except one, all the nine facilities failed to display housekeeping checklists or had provision for periodic monitoring of housekeeping activities. No records were found for regular monitoring of infection control practices such as hand hygiene and personal protection.

Knowledge and practices of facility staff regarding infection prevention and control)

In spite of the availability of all 4 color-coded bins, only 2 color-coded bins were used in all four primary HCFs. The awareness regarding IPC was poor. Few departments had practice against prescribed norms like flushing of BMW in the drains.

The present study discusses possible reasons on poor waste management and infection control practices and reflects on its noncompliance. Few facilities in the present study failed to comply with basic routine cleaning, majority of the cleaning staff had poor knowledge regarding correct concentration and dilution while preparing the cleaning solution and technique for washing the mop. As per the guidelines, use of brooms in procedure areas is highly contraindicated,[5] in spite of this, brooms were observed in procedure areas such as labor room and other patient care areas in few facilities. Lack of trained workforce was cited as a common response to nonadherence to optima practices.

There were poor monitoring and reporting of HAIs in all the facilities visited in the present study. There was poor knowledge, practice, and compliance to hand hygiene among the health-care workers observed in the study. The workload on workers also influences hand hygiene compliance.[6]

HCFs are legally bound for BMW and its management. In spite of the availability of color-coded liners/bags inside the bins, practices were not as per the GOI recommendations and HCFs practiced irrational BMW management like indiscriminate dumping, noncompliance to color coding, etc., This might lead to an increase in HAI and nosocomial infections that might aggregate to increased morbidity and cost of treatment on a longer run.

The effective implementation of waste management, infection control, and sanitary practices requires collective efforts of all the caders of the facility to make it achievable. The staff should be motivated for their “good practices” rather than taking radical steps due to their “noncompliance” which only result in degrading the level of motivation within the health worker. Multimodal and multidisciplinary approaches are needed to change the established knowledge, attitude, and behavior of health-care workers toward good hygiene and sanitary practices.[7]

As the present study covered majority cadres only in of public health facilities (District Hospital (DH), Sub-district Hospital (SDH), Community Health Centre (CHC), and Primary Health Centre (PHC)) in a selected district, the study results cannot be extrapolated on all public health facilities of the region.

Acknowledgment

The author would like to thank National Health Mission – Madhya Pradesh.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Health care-associated infections FACT SHEET. Available from: https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. [Last accessed on 2018 Jul 02].  Back to cited text no. 1
    
2.
Bhawan P, Nagar A. Guidelines for Bar Code System for Effective Management of Bio-medical Waste Central Pollution Control Board (Ministry of Environment, Forest and Climate Change) DELHI-110 032 website: April, 2018 Guidelines for Bar Code System for Effective. Available from: http://Www. Cpcb. Nic. In. [Last accessed on 2018 Jun 02].  Back to cited text no. 2
    
3.
Hussein J, Mavalankar DV, Sharma S, D'Ambruoso L. A review of health system infection control measures in developing countries: What can be learned to reduce maternal mortality. Global Health 2011;7:14.  Back to cited text no. 3
    
4.
Challenging Issues in Hospital Housekeeping-Clean India Journal. Available from: https://www.cleanindiajournal.com/challenging-issues-in-hospital-housekeeping/. [Last accessed on 2018 May 02].  Back to cited text no. 4
    
5.
World Health Organization. Prevention of Hospital-Acquired Infections A Practical Guide. 2nd ed. Available from: http://www.who.int/emc. [Last accessed on 2018 Jun 02].  Back to cited text no. 5
    
6.
Pittet D. Improving adherence to hand hygiene practice: A multidisciplinary approach. Emerg Infect Dis 2001;7:234-40.  Back to cited text no. 6
    
7.
van der Vegt DS, Voss A. Are hospitals too clean to trigger good hand hygiene? J Hosp Infect 2009;72:218-20.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1]



 

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