Hrev_master [Healthcare in Low-resource Settings 2013; 1:e23] [page 79] Prevention of nosocomial infections in low resource countries Saurabh R. Shrivastava, Prateek S. Shrivastava, Jegadeesh Ramasamy Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, India Dear Editor, Nosocomial infections are infections acquired during hospital care which are not present neither incubating at the time of admission. Infections occurring more than 48 h after admission are usually considered noso- comial. In other words it is the cross-infection of one patient by another or by doctors, nurses and other hospital staff while in hospital.1 Nosocomial infections have been observed worldwide affecting both developing nations with inadequate resources and developed nations.2 Hospital-acquired infections add to functional disability, economic burden and emotional stress for the patient and his/her relatives that can reduce the quality of life.3,4 The most frequent nosocomial infections are infections of the surgical wounds, urinary tract infections and lower respiratory tract infections, with their highest incidence being observed in intensive care units and acute sur- gical/orthopedic wards. Infection acquired in healthcare settings is one of the major cause of morbidity/mortality among hospitalized patients and is a direct indicator of quality of healthcare service delivered especially in low resource countries.1,2 Many factors such as emergence of antimicrobial resistance, sus- ceptibility of the patients (viz. age, immuno- compromised state, underlying disease, inva- sive diagnostic and therapeutic interventions- parenteral nutrition, biopsies/endoscopic examinations/catheterization, etc.), a pro- longed hospital stay, patient care practices, and hospital environment, have predominantly contributed to the rise in the occurrence of nosocomial infections.1,2,5 In order to prevent the occurrence of noso- comial infections, onus lies with all stakehold- ers’ i.e. all individuals providing health care services in the hospital, must work as a team to reduce the risk of infection to the patients and the staff. Each hospital should design and implement a work plan to assess and promote good health care; advocate appropriate isola- tion/sterilization practices; and training and re-training of the hospital staff in a phase-wise manner.2 The above mentioned goals can be achieved by constituting a hospital infection control committee with representatives from different departments for multidisciplinary inputs and information sharing. This commit- tee should devise mechanism for proper uti- lization of scarce resources and also ascertain the roles and responsibilities of different healthcare personnel (viz. hospital manage- ment/physician/microbiologist/pharmacist/nur sing staff/food handlers/central sterilization department/housekeeping department/laundry department, etc.) in the process of infection control in the hospital. Hospital management must provide sufficient resources to support this program.1,2 On a global scale to prevent emergence of nosocomial infections, World Health Organization has launched an Infection Prevention and Control in Healthcare initia- tive to help low resource countries in reducing dissemination of infections associated with healthcare delivery, by assisting them in the assessment, planning, implementation and evaluation of national infection control poli- cies. The ultimate goal is promotion of health care services which is safe for patients, health care workers, others in the healthcare setting, and to accomplish these goals in a cost-effec- tive manner.6 Surveillance of nosocomial infections has also been advocated as an important element to plan appropriate steps in different countries.7 To conclude, an increased awareness among the healthcare personnel, supplemented with proper implementation of a well-designed plan by active involvement of dedicated healthcare workers will substantially contribute in reduc- ing the incidence of nosocomial infections in low resource countries. References 1. Park K. Epidemiology of communicable diseases. In: Park K, ed. Text book of pre- ventive and social medicine. Jabalpur: Banarsidas Bhanot Publ.; 2011. pp 332- 335. 2. Girard R, Perraud M, Pruss A, et al. Epidemiology of nosocomial infections. In: Ducel G, Fabry J, Nicolle L, eds. Prevention of hospital-acquired infections: a practical guide. Geneva: WHO ed.; 2002. pp 4-8. Available from: http://www.who.int/ csr/resources/publications/drugresist/en/w hocdscsreph200212.pdf 3. Herwaldt LA, Cullen JJ, Scholz D, et al. A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect Cont Hosp Ep 2006;27:1291-8. 4. Rosenthal VD, Guzman S, Migone O, Safdar N. The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: a prospective, matched analysis. Am J Infect Control 2005;33:157-61. 5. Colombo AL, Matta DD, Almeida LPD, Rosas R. Fluconazole susceptibility of Brazilian candida isolates assessed by a disc diffusion method. Braz J Infect Dis 2002;6:118-23. 6. WHO. Infection prevention and control in health care. Available from: http://www. who.int/csr/bioriskreduction/infection_co ntrol/en/index.html 7. Lizan-Garcia M, Peyro R, Cortina M, et al. Nosocomial infection surveillance in a surgical intensive care unit in Spain, 1996-2000: a time-trend analysis. Infect Cont Hosp Ep 2006;27:54-9. Healthcare in Low-resource Settings 2013; volume 1:e23 Correspondence: Saurabh RamBihariLal Shrivastava, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Thiruporur-Guduvancherry main road, 603108 Kancheepuram, India. Tel./Fax: +91.988.422.7224. E-mail: drshrishri2008@gmail.com Key words: nosocomial infections, prevention, antimicrobial resistance, healthcare. Contributions: SS: conception and design, draft- ing of the article, review of literature, guarantor; PS: drafting of the article, review of literature, revising it critically for important intellectual content; JR: general supervision of the research, overall guidance in writing the manuscript. Conflicts of interests: the authors declare no potential conflict of interests. Received for publication: 7 May 2013. Accepted for publication: 22 May 2013. This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0). ©Copyright S.R. Shrivastava et al., 2013 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2013; 1:e23 doi:10.4081/hls.2013.e23 No n- co mm er cia l u se on ly