Strengthening infection prevention and control and systematic surveillance of healthcare associated infections in India

A ntimicrobial resistance (AMR) and the spread of multidrug resistant bacteria is a global patient safety problem and a major public health concern. In India, as elsewhere in South East Asia, many interlinked factors—including overuse of antibiotics, limited clinical diagnostic and laboratory capacity, and poor infection control, hygiene, and sanitation—have contributed to the emergence and spread of AMR. Healthcare facilities are high risk environments for the development and spread of drug resistance and frequently have the highest burden of multidrug resistant pathogens, such as carbapenem resistant Enterobacteriaceae. Healthcare associated infections thus increase the threat of AMR and contribute to poor patient outcomes. The data available indicate that the burden of healthcare associated infections in low and middle income countries like India is high, with an estimated pooled prevalence of 15.5 per 100 patients, more than double the prevalence in Europe and the US. Infection prevention and control measures and practices reduce the opportunities for resistant pathogens to spread in healthcare facilities. They are therefore important to efforts to contain AMR. At present, however, a lack of adequate systems and infrastructure for infection prevention and control in many healthcare facilities contributes to the development of healthcare associated infections and the spread of resistant pathogens. 14 We describe the critical role of effective measures to detect, monitor, and prevent healthcare associated infections and to strengthen infection prevention and control programmes in Indian healthcare facilities as part of a comprehensive national response to AMR.