title: Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study.
abstract: BACKGROUND
  Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries.
  
  
  OBJECTIVE
  To implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use.
  
  
  METHODS
  A before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods.
  
  
  RESULTS
  We observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)).
  
  
  CONCLUSIONS
  Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries.
authors.affiliation: Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia Department of Paediatrics, Centre for International Child Health, University of Melbourne, MCRI, Melbourne, Victoria, Australia Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Indah K
authors.initials: IK
authors.lastname: Murni
authors.affiliation: Department of Paediatrics, Centre for International Child Health, University of Melbourne, MCRI, Melbourne, Victoria, Australia Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
authors.affiliation: Department of Paediatrics and Nursing, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kinney
authors.affiliation: Laboratory Services, Infection Prevention and Control, Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Daley
authors.affiliation: Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors.forename: Yati
authors.initials: Y
authors.lastname: Soenarto
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000517:prevention & control*; D003906:Developing Countries; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006801:Humans; D007214:Indonesia; D007223:Infant; D017053:Infection Control / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D008297:Male; D015397:Program Evaluation; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic stewardship; Developing countries; Hand hygiene; Hospital acquired infection; Paediatrics