The Real Scenario in Infection Prevention and Control in Low- and Middle-Income Countries: the Challenge of “Starting From Scratch”

Abstract

Infection control and prevention (the routine use of infection prevention and control policies, procedures, and interventions in healthcare institutions) is fundamental to improving patient care outcome while ensuring the health and safety of healthcare workers, patients, and visitors. Healthcare facilities with an effective infection prevention and control (IPC) program have demonstrated a decrease in healthcare-associated infections, a common complication of interaction with healthcare, through adherence to IPC guidelines resulting in safer clinical care environments and impacting patient morbidity and mortality. A safer clinical care environment and adherence to certain basic principles are fundamental for IPC programs, all leading to an impact on patient morbidity and mortality. However, recent experience in developed countries suggests possible lowering of hospital-acquired infection rates is achieved only when infection control is accepted as core to the healthcare institutions. The prevalence of hospital-acquired infection (HCAI) is well known in developed countries (Rosenthal et al. 2011). These infections incur additional costs, extend hospitalization, increase treatment costs, increase antimicrobial resistance, increase disabilities, and increase patient morbidity and mortality. It is generally accepted due to a lack of robust surveillance systems that HCAIs are higher in low- and middle-income countries and especially in LMIC intensive care units. Healthcare-associated infection rates are generally higher in low- and middle-income countries compared with high-income countries resulting in a relatively larger incidence of patient mortality, disability, and additional healthcare cost. An earlier observation, the SENIC Study (1985) published by Haley RW et al. showed that 6% of nosocomial infection can be prevented by minimal infection prevention and control efforts and 32% could be prevented by a very well-organized infection prevention and control program. More recent published guidelines have demonstrated that it is possible to control the spread of multidrug-resistant Gram-negative and Gram-positive bacteria priority organisms in low- and middle-income countries using IPC interventions despite resource limitations (WHO 2017). This narrative will attempt to define the important concept of “PROGRESS”—a roadmap to define the essential aspect of starting an infection prevention and control program “from scratch” with emphasis on resource-limited settings. The acronym PROGRESS from scratch in a resource-limited setting in low- and middle-income countries attempts to define mechanisms and multimodal strategies for starting IPC programs to reduce the overall patient morbidity and mortality associated with HCAIs in these settings.