title: Gap analysis of infection control practices in low- and middle-income countries.
abstract: BACKGROUND
  Healthcare-associated infection rates are higher in low- and middle-income countries compared with high-income countries, resulting in relatively larger incidence of patient mortality and disability and additional healthcare costs.
  
  
  OBJECTIVE
  To use the Infection Control Assessment Tool to assess gaps in infection control (IC) practices in the participating countries.
  
  
  METHODS
  Six international sites located in Argentina, Greece, Hungary, India, Nepal, and South Africa provided information on the health facility and the surgical modules relating to IC programs, surgical antibiotic use and surgical equipment procedures, surgical area practices, sterilization and disinfection of equipment and intravenous fluid, and hand hygiene. Modules were scored for each country.
  
  
  RESULTS
  The 6 international sites completed 5 modules. Of 121 completed sections, scores of less than 50% of the recommended IC practices were received in 23 (19%) and scores from 50% to 75% were received in 43 (36%). IC programs had various limitations in many sites and surveillance of healthcare-associated infections was not consistently performed. Lack of administration of perioperative antibiotics, inadequate sterilization and disinfection of equipment, and paucity of hand hygiene were found even in a high-income country. There was also a lack of clearly written defined policies and procedures across many facilities.
  
  
  CONCLUSIONS
  Our results indicate that adherence to recommended IC practices is suboptimal. Opportunities for improvement of IC practices exist in several areas, including hospital-wide IC programs and surveillance, antibiotic stewardship, written and posted guidelines and policies across a range of topics, surgical instrument sterilization procedures, and improved hand hygiene.
authors.affiliation: 1Society for Healthcare Epidemiology of America,Arlington,Virginia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Weinshel
authors.affiliation: 2Stellenbosch University,Cape Town,South Africa.
authors.forename: Angela
authors.initials: A
authors.lastname: Dramowski
authors.affiliation: 3National Center for Epidemiology,Budapest,Hungary.
authors.forename: Ágnes
authors.initials: Á
authors.lastname: Hajdu
authors.affiliation: 4George Washington University,Washington,DC.
authors.forename: Saul
authors.initials: S
authors.lastname: Jacob
authors.affiliation: 5B. P. Koirala Institute of Health Sciences,Nepal.
authors.forename: Basudha
authors.initials: B
authors.lastname: Khanal
authors.affiliation: 6Markhot Ferenc Teaching Hospital and Outpatient Clinic,Eger,Hungary.
authors.forename: Maszárovics
authors.initials: M
authors.lastname: Zoltán
authors.affiliation: 7National Kapodistrian University,Athens School of Medicine,Athens,Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Mougkou
authors.affiliation: 8Gauhati Medical College and Hospital,Guwahati,India.
authors.forename: Chimanjita
authors.initials: C
authors.lastname: Phukan
authors.affiliation: 9Hospital Italiano de Buenos Aires,Buenos Aires,Argentina.
authors.forename: Maria
authors.initials: M
authors.lastname: Inés Staneloni
authors.affiliation: 10Children's National Medical Center,George Washington University,Washington,DC.
authors.forename: Nalini
authors.initials: N
authors.lastname: Singh
mesh_terms: D001118:Argentina; D003428:Cross Infection / Q000517:prevention & control*; D003906:Developing Countries; D006115:Greece; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006814:Hungary; D007194:India; D017053:Infection Control / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D009390:Nepal; D017410:Practice Guidelines as Topic; D013019:South Africa