Infection control (IC) is a key strategy to slow the spread of antimicrobial resistance. The Rational Pharmaceutical Management (RPM) Plus program had developed an approach consisting of the use of a self-evaluation assessment tool (the Infection Control Assessment Tool [ICAT]) combined with rapid cycle quality improvement (RCQI) methods to identify problems and develop and implement low-cost interventions. The ICAT modules cover various aspects of hospital infection control or potential sources of infection including hand hygiene, waste management, and labor and delivery. Each individual module contains questions and check lists for self assessment, a scoring system, and notes for reference outlining the current internationally recognized practices. During a pilot in five Guatemalan hospitals for several months in 2007, each hospital demonstrated improvements in limited areas through targeted interventions, although all recognized the need for scale-up to other areas of the hospital and to ensure sustained results. As a result, the Ministry of Health (MoH) in Guatemala (Ministerio de Salud Publica y Asistencia Social) Vice Ministry of Hospitals decided to adopt the standardized approach to improve IC practices in its 43 hospital network.

Approach to Improving IC Practices

A team of three facilitators from the Vice Ministry were trained to orient the 43 hospitals in the standard approach of application of the Guatemalan ICAT combined with the RCQI methods. Regional training sessions are currently underway to orient the IC teams from each of the 43 hospitals to the approach. The training sessions allow the participants to practice applying the techniques they learn in a hospital setting. The teams are encouraged to involve as many different disciplines as possible for maximum effect.

Follow-up and monitoring, an important part of the intervention, will be provided by the hospital coordinators from the Vice Ministry who are responsible for overall hospital supervision. SPS has been working with the team of coordinators to develop and test a supervisory check list and to support and monitor the hospital progress using monthly reports submitted by each hospital IC team.

Hospitals included in the pilot experience commented that the IC committees felt strengthened and empowered by the presence of tools to use and that the data collected served as a powerful advocacy tool to directors and administrators who then became more involved.

 Guatemalan Infection Control Assessment Tool (ICAT)

Infection Control Assessment Tool, Guatemala (Spanish) - PDF (3.60 MB)

User's Manual for the Infection Control Assessment Tool, Guatemala (Spanish) - PDF (2.12 MB)

Surveillance of Nosocomial Infections

To measure impact of the improved infection control practices, SPS is supporting the MoH Vice Ministry to improve the surveillance of nosocomial infections in the hospitals. As a baseline, information is being collected from the hospitals on the rate, number, types, and sites of nosocomial infections for the year 2008. However, no standardized system is used in all hospitals and not all hospitals track the data so this baseline is incomplete. SPS is collaborating with the national centre for epidemiology to conduct a full review and revision of the collecting forms and the protocol for collecting data to improve the available information on the rate of nosocomial infections.