Promoting patient safety in India: situational analysis and the way forward

Unsafe healthcare is a well-recognized issue internationally and is attracting attention in India as well. Drawing upon the various efforts that have been made to address this issue in India and abroad, we explore how we can accelerate developments and build a culture of patient safety in the Indian health sector. Using five international case studies, we describe experiences of promoting patient safety in various ways to inform future developments in India. We offer a roadmap for 2020, which contains suggestions on how India could build a culture of patient safety.

Development of an evaluation framework for African-European hospital patient safety partnerships

BACKGROUND

Patient safety is recognised as a significant healthcare problem worldwide, and healthcare-associated infections are an important aspect. African Partnerships for Patient Safety is a WHO programme that pairs hospitals in Africa with hospitals in Europe with the objective to work together to improve patient safety.

OBJECTIVE

To describe the development of an evaluation framework for hospital-to-hospital partnerships participating in the programme.

METHODS

The framework was structured around the programme's three core objectives: facilitate strong interhospital partnerships, improve in-hospital patient safety and spread best practices nationally. Africa-based clinicians, their European partners and experts in patient safety were closely involved in developing the evaluation framework in an iterative process.

RESULTS

The process defined six domains of partnership strength, each with measurable subdomains. We developed a questionnaire to measure these subdomains. Participants selected six indicators of hospital patient safety improvement from a short-list of 22 based on their relevance, sensitivity to intervention and measurement feasibility. Participants proposed 20 measures of spread, which were refined into a two-part conceptual framework, and a data capture tool created.

CONCLUSION

Taking a highly participatory approach that closely involved its end users, we developed an evaluation framework and tools to measure partnership strength, patient safety improvements and the spread of best practice.

Strengthening the evidence-policy interface for patient safety: enhancing global health through hospital partnerships

Strengthening the evidence-policy interface is a well-recognized health system challenge in both the developed and developing world. Brokerage inherent in hospital-to-hospital partnerships can boost relationships between “evidence” and “policy” communities and move developing countries towards evidence based patient safety policy. In particular, we use the experience of a global hospital partnership programme focused on patient safety in the African Region to explore how hospital partnerships can be instrumental in advancing responsive decision-making, and the translation of patient safety evidence into health policy and planning. A co-developed approach to evidence-policy strengthening with seven components is described, with reflections from early implementation. This rapidly expanding field of enquiry is ripe for shared learning across continents, in keeping with the principles and spirit of health systems development in a globalized world.

Hand hygiene--when and how should it be done?

Practising hand hygiene at the right times to prevent healthcare-associated infections is one of the most important patient care practices health professionals can undertake. However, changing behaviour to ensure staff practise appropriate hand hygiene requires a multifaceted approach. This article highlights two important aspects of the message staff need--the when and the how of hand hygiene.

Improving adherence to hand hygiene practice

Hand hygiene compliance rates continue to vary between healthcare settings and individual professionals. This article looks at how a multimodal approach to infection prevention and control, using expertise from other disciplines, can increase compliance with hand hygiene practices.

Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study

BACKGROUND

Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO's strategy for improvement of hand hygiene in five countries.

METHODS

We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3-6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygiene principles. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010.

FINDINGS

We noted 21,884 hand-hygiene opportunities during 1423 sessions before the intervention and 23,746 opportunities during 1784 sessions after. Overall compliance increased from 51.0% before the intervention (95% CI 45.1-56.9) to 67.2% after (61.8-72.2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4.67, 95% CI 3.16-6.89; p<0.0001) than in high-income countries (2.19, 2.03-2.37; p<0.0001). Implementation had a major effect on compliance of health-care workers across all sites after adjustment for main confounders (OR 2.15, 1.99-2.32). Health-care-workers' knowledge improved at all sites with an increase in the average score from 18.7 (95% CI 17.8-19.7) to 24.7 (23.7-25.6) after educational sessions. 2 years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up.

INTERPRETATION

Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide.

FUNDING

WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists.

Cutting levels of antimicrobial resistance

The incidence of antimicrobial resistance is increasing and represents a serious threat not only to patients who have infections that do not respond to antimicrobial drugs but also to global healthcare systems. European Antibiotics Awareness Day aims to ensure health professionals and the public understand the importance of ensuring antibiotics are used correctly to minimise the spread of resistance. This article discusses the nursing role in preventing antimicrobial resistance.

Developed-developing country partnerships: benefits to developed countries?

Developing countries can generate effective solutions for today's global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed--this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries.

Importance of hand hygiene during invasive procedures

Invasive devices, such as urinary catheters and peripheral and central venous catheters, can form part of essential patient care and may provide life-saving support and treatment. However, the invasive nature of these devices and the vulnerability of patients can increase the risk of acquiring a healthcare-associated infection (HCAI). This article highlights the importance of best practice in relation to insertion and management of invasive devices, incorporating hand hygiene, to reduce the risk of HCAI. Although the information can be applied to invasive devices in general, the focus is on urinary catheters.

Hand hygiene improvement in the community: a systems approach

Hand hygiene compliance, which is influenced in part by human behaviour, is central to infection prevention in all care settings. This article focuses specifically on the importance of a multimodal strategy for continued hand hygiene improvement, and its relevance to community nursing. Additionally, the article addresses the challenges and opportunities of infection prevention and control in a community context, and highlights current national and international guidelines that offer a framework and set of principles for implementation and sustainability with a specific focus on the multimodal strategy associated with the WHO Guidelines on Hand Hygiene in Health Care (2009). The authors conclude with some considerations for community nurses when addressing translation of these principles into their everyday working context.

Disney, engagement, action: the Infection Prevention Society’s strategy from development to launch

This paper details the development of the Infection Prevention Society strategic plan 2011–2016 from its inception in 2009 to its launch in September 2011 at the Infection Prevention Society’s annual conference. It aims to provide a transparent account of how the vision, mission and strategic aims of the strategy were shaped and crafted through a number of iterations that involved members at key stages.

Involving the patient to ask about hospital hand hygiene: a National Patient Safety Agency feasibility study

Healthcare-associated infections (HAIs) affect at least 300,000 patients annually in the UK and represent a significant, yet largely preventable, burden to healthcare systems. Hand hygiene by healthcare workers (HCWs) is the leading prevention measure, but compliance with good practice is generally low. The UK National Patient Safety Agency surveyed the public, inpatients, and HCWs, particularly frontline clinical staff and infection control nurses, in five acute care hospitals to determine whether they agreed that a greater level of involvement and engagement with patients would contribute to increased compliance with hand hygiene and reduce HAIs. Fifty-seven percent (302/530) of the public were unlikely to question doctors on the cleanliness of their hands as they assumed that they had already cleaned them. Forty-three percent (90/210) of inpatients considered that HCWs should know to clean their hands and trusted them to do so, and 20% (42/210) would not want HCWs to think that they were questioning their professional ability to do their job correctly. Most HCWs surveyed (178/254, 71%) said that HAI could be reduced to a greater or lesser degree if patients asked HCWs if they had cleaned their hands before touching them. Inviting patients to remind HCWs about hand hygiene through the provision of individual alcohol-based hand-rub containers and actively supporting an 'It's OK to ask' attitude were perceived as the most useful interventions by both patients and HCWs. However, further work is required to refute the myth among HCWs that patient involvement undermines the doctor- or HCW-patient relationship.

Moving forward with confidence: 2009 IPS insight survey of the membership

In this paper we present the findings of the first Infection Prevention Society membership survey conducted at the end of 2009. The survey sought to identify the views of current members in relation to the future direction and services provided by the Society and the reasons for some existing members leaving the Society. Around one-third of the membership responded to the survey. The findings reveal general satisfaction with the direction of the Society and point out areas of activity that can be developed and these have informed the current work of the Board in setting the strategic aims of the Society for the next 5 years.