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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 84-87

Patients as partners in infection prevention and control: An observational study in an Indian Ambulatory care setting


Department of Infection Control and Education and Research, Artemis Hospitals, Gurgaon, Haryana, India

Date of Submission04-Feb-2021
Date of Decision12-Feb-2021
Date of Acceptance17-Feb-2021
Date of Web Publication10-May-2021

Correspondence Address:
Dr. Namita Jaggi
Artemis Hospitals, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_4_21

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  Abstract 


Objective: (1) To evaluate the awareness and knowledge of Infection Prevention and Control (IPC) practices among patients and their families in an Indian ambulatory care setting. (2) To impart subsequent training and education to the subjects utilising innovative teaching modules.
Methods: The present study is a survey-based observational study conducted in the outpatient department (OPD) of a tertiary care setting. A sample size of 300 patients/visitors in the OPD was randomly selected for a questionnaire-based interview which had questions relevant to awareness of basic IPC practices and judicious use of antibiotics. Subsequently, training and education was imparted to all the patients/visitors arriving at the OPD by infection control (IC) nurses and IC-linked nurses through innovative role plays, pamphlets, posters, standees and banners. The data was compiled and statistically evaluated.
Results: The maximum awareness in the group for healthcare-associated infections and standard precautions was reported as 88.8% and 67.6%, respectively. Among the other important parameters, hand hygiene and infection prevention at home were reported as 63.8% and 64.5% awareness, respectively. An overall knowledge and awareness on judicious use of antibiotics was reported as 76.5%. Out of which, a relatively less awareness was reported 62% (185) in people regarding the increasing antimicrobial resistance.
Conclusions: Patient and family education in hospitals has been relatively unaddressed in the IC field. This study was successful in making a beginning to promoting this concept and effectively contributing to the culture of patient safety.

Keywords: Ambulatory care settings, antimicrobial stewardship in outpatient department treatment, patients and infection prevention


How to cite this article:
Jaggi N, Sissodia P, Chakraborty M, Sharma AP. Patients as partners in infection prevention and control: An observational study in an Indian Ambulatory care setting. J Patient Saf Infect Control 2020;8:84-7

How to cite this URL:
Jaggi N, Sissodia P, Chakraborty M, Sharma AP. Patients as partners in infection prevention and control: An observational study in an Indian Ambulatory care setting. J Patient Saf Infect Control [serial online] 2020 [cited 2021 Jun 15];8:84-7. Available from: https://www.jpsiconline.com/text.asp?2020/8/3/84/315745




  Introduction Top


The recent past has witnessed a significant transition of healthcare delivery from acute settings to a variety of ambulatory settings. Ambulatory health care is a personal healthcare consultation, treatment or intervention provided in a hospital-based outpatient clinic, nonhospital-based clinic, a physician's office or any other ambulatory surgical/non-surgical setting.[1] Every year the number of cancer patients receiving outpatient chemotherapy, radiation therapy or both cross the figure of one million.[2] Ambulatory settings provide numerous opportunities for transmission of infections leading to healthcare-associated infection (HAI) mainly due to inadequate awareness, infrastructure and resources. Hence, it becomes critical to aim at minimising or eliminating this risk of HAIs in such settings.[1] Misuse of antibiotics has been another area of concern in these settings contributing to the overall drug resistance in the healthcare system and community.

Healthcare workers (HCWs), world over, have been trained to focus on implementation of basic infection prevention practices such as standard precautions. There have also been numerous initiatives to educate healthcare staff about the judicious use of antibiotics to prevent the emergence of antibiotic resistance in healthcare settings both inpatient and ambulatory. However, there has not been enough focus on the education of patients and their families about good infection prevention and control (IPC) practices and the correct use of antibiotics. In spite of continuing education of HCWs in ambulatory settings, HAIs continue to occur and patient education forms an important component of prevention of HAIs and patient safety. Well-informed, educated and aware patients can not only look after their health but also assist HCWs to prevent HAIs.

There is clearly a need to educate this group as they are partners with the HCWs in the prevention of HAIs. Education about correct antibiotic usage can also be helpful in stemming the tide of antibiotic resistance considering the fact that community-acquired multidrug-resistant organisms are on the rise. To address this gap, this study was conducted in an ambulatory care setting where we have aimed to assess the basic awareness and then provide education to patients and their families regarding IPC and the judicious use of antibiotics.


  Methods Top


Setting

This study was undertaken for a period of 2 months (September 2014 to October 2014) at the Artemis Hospitals' Outpatient Department (OPD) which includes multiple specialties such as nephrology, oncology, cardiothoracic and vascular surgeries and reproductive medicine having a footfall of at least 300 patients/day.

Design: Survey-based observational study

Selection of subjects

A population of 300 patients and their families visiting the OPD waiting area were selected on a random basis for the study. This involved a mixed population of age group between 20 to 60 years including people from all classes of the society.

Survey

The selected population was then subjected to answer a questionnaire designed with an objective to assess and understand the mindset, knowledge and awareness of the outpatient group on IPC. The questionnaire designed was to contain demographic details and two parts. Part A comprised a set of 10 Yes/No questions related to the IPC, whereas Part B contained 10 questions on antimicrobial usage. Informed consent of each subject was obtained as part of the questionnaire prior to the survey. The IPC parameters for assessment included HAIs, hand hygiene, standard precautions, infection prevention at home, cross-infection, importance of restricted visitors and HCWs adherence to IPC practices.

Training and education

Subsequent to the survey, training and education was imparted to all the patients and families arriving at the OPD including the subjects. Trainers were the infection control (IC) nurses and the IC-linked nurses who are present at the OPD nursing station providing 8:00 am to 8.00 pm coverage. Modes of training included innovative role plays, pamphlets, posters, standees, videos displayed in TVs in waiting areas and banners, especially designed for providing basic infection prevention awareness to the community.

Data analysis

The collected data was compiled and statistically analysed using SPSS 20.0 program (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp).


  Results Top


Survey findings

The detailed demographic data for the study reported that among the 300 subjects studied, there were 171 (57%) males and 129 (43%) females. As per the professional status, it was found that only 72 (24%) of them had medical background and the rest 228 (76%) were from nonmedical professions. The working status of the females revealed that 62% (80/129) of the group was contributed by the working women, whereas the rest (38%, 49/129) were the homemakers.

The survey findings of the questionnaire Part A reported the maximum awareness in the group for HAIs and standard precautions as 88.8% and 67.6%, respectively. Among the other important parameters, hand hygiene and infection prevention at home were reported 63.8% and 64.5% awareness, respectively. Sixty-two per cent of people supported that visitors should have restricted access to the healthcare facility and 63.8% accepted the reason being increased risk of cross-transmission of infections. The awareness for individual IPC pratices measured in the study is summarissed in [Table 1].
Table 1: Observations on awareness of infection prevention and control practices

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Part B of the questionnaire on antimicrobial use reported that overall 76.5% of subjects had the desired knowledge and awareness of judicious use of antibiotics. In addition, a relatively less awareness was reported 62% in people regarding the increasing antimicrobial resistance rather 90% believed that this problem can be combated by adopting judicious use of antibiotics. Eighty-four per cent of subjects were aware of the purpose of antibiotic prescribed to them and 82% knew the side effects associated with its use.

The misuse of antibiotics has become a common problem of today leading to the spread of antimicrobial resistance. We reported 82% of people being aware of carrying the doctor's prescription before purchasing antibiotics and 73.3% knew not to take antibiotics for viral infections. Eighty-three per cent of people believed that HCWs play a prime role in preventing the spread of antimicrobial resistance. The degree of knowledge and awareness on the key aspects of the antibiotic use questionnaire is summarised in [Table 2].
Table 2: Observations on judicious use of antibiotics (n=300)

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Training and education

Hand hygiene, infection prevention at home and judicious use of antibiotics were identified as the key components that required focused training. These were chosen on the basis of their vital role in daily activities of infection prevention and the percentage of awareness reported in the study. Hence, these two areas were focused on by adopting multiple teaching modalities to target the mindsets of the study group.


  Discussion Top


According to the World Health Organisation,[3] the need for sound IPC practices has been recognised as a key element for development of strategies to address the issue of HAIs in ambulatory care. Maintaining a culture of patient safety in the healthcare settings and providing education to healthcare workers are few components of such like strategies that have proven to be remarkably effective in the improvement of IPC in the USA. The role of education of HCWs has been recognised and implemented worldwide and is now adopted to reduce HAI in all hospitals. However, imparting education to patients and their families is a relatively novel concept but one which would pay rich dividends. There is limited literature available documenting the education of patients and their families in outpatient settings towards the promotion of HAI.

In the present study, the demographic data showed that the awareness of infection prevention is becoming common in nonmedical group also which contributed to 76% of our study population. The survey findings reported that a relatively reduced awareness was reported about hand hygiene (63.8%) and infection prevention at home (64.5%) in patients and families who were surveyed. A review of evidence-based studies reported that compliance to hand hygiene and IPC is internationally suboptimal.[4] In addition, Burnett et al.[5] reported poor hand hygiene in patients in hospitals and that up to 60% of patients do not use any handwashing facilities even if provided.[6] Hand hygiene and infection prevention at home are the key components of infection prevention in ambulatory settings as patients may acquire infections due to inadequate hygiene practices. Moreover, immunoompromised, transplant and neutropenic patients require more focused training to improve their infection prevention practices at home.

Injudicious use of antibiotics for both humans and animals has long been recognised as a global problem.[7] Misconceptions regarding antibiotic usage in nonacute care hospital settings are also an important contributor. We have reported an awareness of 76.5% in the ambulatory setting about the correct use of antibiotics in the study group. The awareness of the increasing antimicrobial resistance was found to be lesser (62%) in the subjects and may be associated as a cause of the emerging multidrug-resistant organisms in the community.

The misuse of antibiotics occurs when they are sold over the counter and consumed for wrong indications.[8] As per our study, 82% of people were aware of carrying the doctor's prescription before purchasing antibiotics and 83% knew not to take antibiotics for viral infections.

Although awareness in the patients is high, as is the belief in the utility of IC practices (IPC) in preventing the spread of infection, there is much room for improvement in the actual practices. Studies on patient encouragement and empowerment have been conducted for several decades, and gradually, the effect is observed in terms of patients taking control of their own care.[9] Interventions to increase this awareness are still required to initiate a two-pronged attack on reducing HAIs and antimicrobial resistance.

There were certain limitations of the study; first, the study period was short to produce more effective and firm results. Second, as the patient population in the OPD keeps changing on daily basis, it was difficult to plan an education intervention and assess the effect of it in the subsequent period. Third, as the role of patients and their families in infection prevention in outpatient settings is a novel and unaddressed topic, we encountered a lack of availability of reference literature for this study. In a nutshell, our study indirectly reflects the general awareness in the community as the patients and their families visiting an ambulatory setting form a part of this group.


  Conclusions Top


Patient and family education in hospitals regarding IPC has been relatively unaddressed. It is vital for the patients to know the basic IPC related to their treatment and care to obtain quality care during the hospital stay and prevent HAIs after discharge. This study was successful in making a beginning to promoting this concept and effectively contributing to the culture of patient safety.

Acknowledgement

We owe great thanks to Artemis Hospitals for extending their kind support as a funding source and encouraging us in writing this article. No external grants or funds have been obtained for the study. All the authors (Namita Jaggi, Pushpa Sissodia, Meenakshi Chakravarty and Ajendra Pratap Sharma) have significantly contributed towards the accomplishment of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
CDC Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care; 2014. Available from: http://www.cdc.gov/HAI/pdfs/guidelines/Outpatient Care Guide withChecklist.pdf. [Last accessed on 2016 Apr 24].  Back to cited text no. 1
    
2.
Halpern MT, Yabroff KR. Prevalence of outpatient cancer treatment in the United States: Estimates from the medical panel expenditures survey (MEPS). Cancer Invest 2008;26:647-51.  Back to cited text no. 2
    
3.
Berman P. Organization of ambulatory care provision: A critical determinant of health system performance in developing countries. Bull World Health Organ 2000;78:791-802.  Back to cited text no. 3
    
4.
Edwards R, Charani E, Sevdalis N, Alexandrou B, Sibley E, Mullett D, et al. Optimisation of infection prevention and control in acute health care by use of behaviour change: A systematic review. Lancet Infect Dis 2012;12:318-29.  Back to cited text no. 4
    
5.
Burnett E, Lee K, Kydd P. Hand hygiene: What about our patients? British Journal of Infection Control. 2008;9:19-24. doi :10.1177/1469044607085549.  Back to cited text no. 5
    
6.
Lawrence M. Patient hand hygiene: A clinical enquiry. Nurs Times 1983;79:22, 24-5.  Back to cited text no. 6
    
7.
Shea KM. Antibiotic resistance: What is the impact of agricultural uses of antibiotics on children's health? Pediatrics 2003;112:253-8.  Back to cited text no. 7
    
8.
Gaur AH, English KB. Judicious use of antibiotics – An investment towards optimized healthcare. Indian J Pediatr 2006;73:343-50.  Back to cited text no. 8
    
9.
Department of Health. The NHS Improvement Plan: Putting People at the Heart of Public Services. London: DH; 2004. Available from: http://tinyurl.com/heart-of-services. [Last accessed on 2021 Jan 30].  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]



 

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