Improving outcomes and reducing costs by modular training in infection control in a resource-limited setting.

OBJECTIVE To study the impact of modular training and implementation of infection control practices on all health-care-associated infections (HAIs) in a cardiac surgery (CVTS) program of a tertiary care hospital. DESIGN Baseline data were compared with post-intervention (with modular training) data. SETTING This study was conducted in a cardiovascular surgical unit. PARTICIPANTS In total, 2838 patients were admitted in cardiovascular surgical service. INTERVENTIONS Two training modules and online continuous education were delivered to all health-care workers in CVTS unit. MAIN OUTCOME MEASURES All four HAIs, such as surgical site infections (SSI), central line-associated blood stream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CA-UTI), were studied. Additional outcome measures included average length of stay cost of avoidance mortality and readmission rates. RESULTS The SSI rate had decreased in the post-intervention phase from 46 to 3.27% per 100 surgeries (P < 0.0001), CLABSI had decreased from 44 to 3.10% per 1000 catheter days (P < 0.009), VAP was reduced from 65 to 4.8% per 1000 ventilator days (P < 0.0001) and CA-UTI had reduced from 37 to 3.48% per 1000 urinary catheter days (P < 1.0). For every $1 spent on training, the return on investment was $236 as cost of avoidance of healthcare associated infections (HAIs). CONCLUSIONS Standardization of infection control training and practices is the most cost-effective way to reduce HCAIs and related adverse outcomes.