Multifaceted interventions for healthcare-associated infections and rational use of antibiotics in a low-to-middle-income country: Can they be sustained?

• DOI: 10.1371/journal.pone.0234233
• Publication Date: 2020-06-16T17:34:49Z
• Authors: Indah K. Murni; Trevor Duke; Sharon Kinney; Andrew J. Daley; Ida S. Laksanawati; Nurnaningsih; Desy Rusmawatinin...; M. Taufik Wirawan; Yati Soenarto
• Keywords: Antimicrobial Stewardship; Antibiotic Stewardship

Transmission of infection between patients by health workers, and the irrational use antibiotics are preventable causes for healthcare-associated infections (HAI) multi-resistant organisms. A previous study implementing a hand hygiene campaign antibiotic stewardship program significantly reduced these infections. Sustaining such interventions can be challenging.To evaluate whether there was sustained effect multifaceted control on HAI 5 years after it began.A prospective evaluation conducted over 26 months (from February 2016 to April 2018) in teaching hospital Indonesia, implementation an program, which successful when initially evaluated. All children admitted pediatric ICU wards were observed daily. Assessment made based criteria from Centers Disease Control Prevention. rational WHO Pocket Book Hospital Care Children. Multivariable logistic regression analysis used quantify relationship intervention.We increase HAIs, 8.6% (123/1419 patients) initial post-intervention period 2011-2013 16.9% (314/1855) (relative risk (RR) (95% CI) 1.95 (1.60 2.37)). After adjusting potential confounders, we found that with adjusted OR 1.94 CI 1.53 2.45). Inappropriate also increased, 20.6% (182 882 who prescribed antibiotics) 48.6% (545/1855) (RR 2.35 (2.04 2.71)). Hand compliance declined 62.9% (1125/1789) moments requiring 51% (1526/2993) 3.33 (2.99 3.70)).Healthcare-associated remain significant even intervention program. There is need continuous input, ongoing surveillance long-term monitoring sustain effectiveness address problems as they emerge.