Association of a context-adapted multi-modal infection prevention intervention with surgical-site and bloodstream infection rates in a resource-constrained hospital: an interrupted time-series study.

BACKGROUND

Healthcare-associated infections remain a major challenge in resource-constrained hospitals, particularly surgical-site infections (SSIs) and bloodstream infections (BSIs). We evaluated the association of a context-adapted Minimum Antibiotic and Sterilisation Guideline (MASG) with infection rates in a secondary-level teaching hospital.

METHODS

We conducted a single-centre interrupted time-series study using 18 consecutive monthly observations, including nine months before and nine months after MASG implementation. The intervention combined enhanced environmental cleaning, reinforced aseptic wound care, structured 48-72-h antibiotic review, and surveillance-feedback measures. Primary outcomes were monthly SSI and BSI rates per 1000 patient-days. Segmented regression analysis was used to assess level and trend changes.

RESULTS

A total of 7120 patient-days, 328 surgical procedures, and 2715 intensive care unit patient-days were included. Mean SSI rates decreased from 3.52 to 1.47 per 1000 patient-days following MASG implementation (58.2% reduction). Interrupted time-series analysis demonstrated a significant immediate reduction in SSI rates (β2 = -1.71, P < 0.001) and a significant postintervention downward trend (β3 = -0.22 per month, P < 0.001). Mean BSI rates decreased from 1.04 to 0.66 per 1000 patient-days (36.5% reduction). No significant immediate level change in BSI rates was observed (β2 = -0.05, P = 0.54), although a significant postintervention decline in trend occurred (β3 = -0.11 per month, P < 0.001). Antimicrobial consumption, environmental contamination, healthcare-worker carriage, and multi-drug-resistant organisms also decreased during the postintervention period.

CONCLUSIONS

MASG implementation was associated with reduced infection burden and antimicrobial utilisation in a resource-constrained hospital setting, supporting the potential value of low-cost multi-modal infection prevention and stewardship strategies.