1210 infection control & hospital epidemiology october 2015, vol. 36, no. 10


the 6 sites from low- to high-income countries were assessed as median (range) of total points received across all sites for each section and module. The observational checklist on handwashing was scored separately.


results


The module on general hospital facility information revealed that facilities participating were both private and public hospitals with number of beds ranging from 645 to 2,245. Site 1 was a public hospital with 939-bed capacity located in Hungary, an upper-middle income economy. It had adopted ministry of health guidelines and had government regulations determining IC practices as well as accreditation standards related to IC. Site 2 was a public hospital with 1,384-bed capacity located in South Africa, an upper-middle income economy. It had also adopted ministry of health guidelines and had government regulations determining IC practices as well as accreditation standards related to IC. Site 3 was a private hospital with 645-bed capacity located in Argentina, an upper- middle income economy. It had adopted ministry of health guidelines and had government regulations determining IC practices. This site did not have accreditation standards related to IC. Site 4 was a public hospital with 2,245-bed capacity located in India, a low-middle income economy. It had adopted ministry of health guidelines but did not have any government regulations determining IC practices or accred- itation standards related to IC. Site 5 was an academic hospital with 700-bed capacity located in Nepal, a low income econ- omy. It had adopted ministry of health guidelines but did not have government regulations determining IC practices or accreditation standards related to IC. Lastly, site 6 was an academic hospital with 750-bed capacity located in Greece, a high income economy. It had neither ministry of health guideline awareness nor government regulations determining IC practices nor accreditation standards related to IC. Overall, survey results showed that IC programs were regulated by a government organization at 3 sites and only 2 sites had accreditation standards for IC. The results of each section are listed by country with median


(range) of percentage of recommended IC practices followed (Table 2). Within the IC module, nosocomial infection surveillance and outbreak investigation received the lowest scores with 3 sites scoring less than 50%. The total median score for this section was 42% (6%–80%) adherence to recommended practices. IC program responsibility and authority, which addresses the role of IC personnel in the hospitals, had a median score of 69% (15%–82%) with 2 sites scoring less than 50%. The IC committee section addressed the role and organization of IC control committees in the hospital and scored a median of 73% (55%–91%). Key IC personnel training and level of effort scored a median 57% (25%–100%) with 2 sites scoring less than 50%. Lastly, the IC education programs section addressed orientation and continuing education programs in ICand scored amedian73%(0%–100%)


adherence with 2 sites scoring less than 50%. The healthcare facility in Greece—the high-income country site in this study—scored less than 50% for 4 of the 5 sections in this module, including outbreak investigation and nosocomial infection surveillance (6%), IC education programs (0%), key IC personnel (38%), and IC program responsibility and authority (15%). The surgical antibiotic use and equipment procedures


module consisted of sections on perioperative antimicrobial prophylaxis, surgical drains, and reprocessing of surgical instruments (Table 2). The lowest scores in this section were for perioperative antimicrobial prophylaxis, which addressed accessibility of written policies or guidelines, monitoring of adherence to guidelines, accessibility of antibiotics, and their appropriate administration. This section scored a median of 47% (16%–90%) adherence with 4 sites scoring less than 50%. Appropriate placement of surgical drains had a median score of 100% (50%–100%) adherence. Appropriate reprocessing of surgical instruments scored a median of 78% (25%–89%) with 1 site scoring less than 50%. The healthcare facility in Greece also scored less than 50% for 2 of these 3 sections—that is, perioperative antimicrobial prophylaxis (16%) and reprocessing of surgical instruments (25%). The surgical area practices module included sections on preoperative preparation, preoperative scrub, barrier precau- tions, cleaning, ventilation, area traffic, and attire (Table 2). Preoperative preparation of the patient addressed written policy or procedures, bathing, hair removal, and antiseptic use, and scored a median of 50% (36%–79%) with 1 site scoring less than 50%. Preoperative scrub by surgical personnel had a median score of 71% (50%–77%). Barrier precautions used by surgical personnel scored a median of 82% (73%–100%). The section on cleaning of the surgical area questioned availability of written policies or guidelines, procedures for contaminated surgeries, and cleaning practices, with a median score of 82% (17%–83%) and 2 sites scoring less than 50%. Surgical area ventilation addressed ventilation systems, windows, air pres- sure, and air conditioning, with a median of 59% (33%–83%) and 2 sites scoring less than 50%. Surgical area traffic had a median score of 61% (25%–100%)with 1 site scoring less than 50%, and the surgical area attire median was 75% (25%–100%) also with 1 site scoring less than 50%. The Greek hospital scored less than 50% for 4 of the 7 sections, which included pre- operative preparation of the patient (36%), cleaning of surgical area (17%), surgical area ventilation (33%), and surgical area attire (25%). The sterilization and disinfection of equipment and IV


fluids module included availability of policies and procedures, which scored a median of 70% adherence (0%–80%) with 2 sites scoring less than 50% for no written policies or procedures. Preparation of sterile irrigation and IV fluids, addressing where IV fluids are obtained or sterilized, scored 67% (50%–83%). Decontamination and cleaning of instruments and equipment, which questioned related policies and recommended practices for cleaning, scored 71%


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