Quality of Hospital Infection Control Programs in Low- and Middle-income Countries: A National Survey

Abstract

Background: One of the strategies to reduce healthcare-associated infections (HAIs) and promote the quality of disease prevention and control actions is the creation of a hospital infection control program. This program is a set of deliberately and systematically developed actions aimed toward reducing the incidence and severity of infections to the maximum extent possible. In Brazil, studies on the subject still need to be improved; they focus on structural and process assessments, especially the survey of continuing education indicators as a quality requirement for the prevention of HAIs. The organizational context does not contribute to the success of the program, and difficulties remain in implementing recommendations and in implementing patient safety policies. Objective: To analyze hospital infection control programs in relation to quality components. Methods: This cross-sectional epidemiological study was conducted in health services located in the 5 official regions of Brazil: Midwest, Northeast, North, Southeast, and South. To select the study sites, nonprobabilistic sampling using the snowball technique was used. The potential study population consisted of 114 hospital infection control services. Health professionals responded to the structured instrument sent electronically via e-mail, and other health services near their locality, until reaching a national proportion. We used the “Hospital Infection Control Program Evaluation Questionnaire”; it consists of 36 multiple-choice questions. This tool was validated by 96 expert judges using the Cronbach’s alpha test (0.82) and the content validity index (0.88). A data analysis was performed using the multivariate principal component analysis technique (PCA). Results: Overall, 13 PCA components (Fig. 1) were used to build a score for measuring the performance of the hospital infection control program (ie, IQPC score). The Southern region had the best performance of the hospital infection control program (mi = 1.50; P = .02) (Fig. 2), private administration (mi = 0.45; P = .05), of hospitals that contained 300 beds or (mi = 1.38; P < .01), hospitals that used the NHSN criterion for HAI surveillance (mi = 2.12; P < .01), and those who searched prospective activity as a surveillance method (mi = 0.51; P < .01). Conclusions: The quality of nosocomial infection control programs still needs to be improved among health services, highlighting the need to invest in small, publicly managed hospitals that use retrospective active surveillance methods.Funding: NoneDisclosures: None