gap analysis of infection control practices 1213
directly on shelves or carts, and air drying instruments after chemical sterilization. Guidelines for recommended steriliza- tion and disinfection should be made available and followed at all sites and are essential to limit the spread of HAI.27 Hand hygiene practices showed 1 site with inadequate hand
hygieneequipment. Themodulealsoshowed 1site reported hand hygiene was not routinely performed before or after individual patient contact. This was consistent with low hand hygiene adherence even in high-income settings in Greece.28 These findings indicate hand hygiene continues to be major factor in at least some settings and likely represents a large opportunity for improvement with staff education and practices. Behavioral interventions with educational programs, multi- disciplinary quality improvement teams, compliance monitoring and feedback, and a mandated hand hygiene requirement state- ment have been shown to significantly reduce HAI and coloni- zation29 and would likely be beneficial in our study population. Limitations of our study include having SHEA international
ambassadors at each site completing the ICAT modules, thus introducing person-to person variability, although each respondent was trained by webinar. There were also limita- tions in the ICAT itself, which were noted in the section on sterilization and disinfection of equipment and IV fluids, because scores appeared falsely low in some sections owing to losing points for the use of disposable instruments. Despite these limitations, our data show there is opportunity for improvement in IC programs across economies, including HAI surveillance, antimicrobial stewardship, availability of written guidelines and policies, sterilization procedures, and hand hygiene. Concern for antibiotic resistance and for the lack of antibiotics in the pipelines has led to infection prevention initiatives and prudent use of antimicrobials.30
acknowledgments
Financial support. None reported. Potential conflicts of interest. All authors report no conflicts of interest
relevant to this article. Address correspondence to Nalini Singh, MD, MPH, George Washington
University Schools of Medicine and Public Health, Children’s National Medical Center, 111 Michigan Ave, NW, NW, Washington, DC (
nsingh@childrensnational.org).
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