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Infection control in El Salvador: the Hospital Rosales experience
J A Marinero Cáceres1, Y de Sotello
1Departmento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de El Salvador, San Salvador.
Abstract:
We describe circumstances at the Hospital Rosales, located in San Salvador, El Salvador, and some salient observations from an infection control program begun in 1978. Findings include overuse of antibiotics, especially of penicillin and chloramphenicol; a predominance of gram-negative rod infections, especially Pseudomonas aeruginosa; a relative infrequency of Staphylococcus aureus infections; an apparent doubling of the mean duration of hospitalization for patients with nosocomial infections compared with other patients (22.1 days versus 11.0 days); documentation and partial correction of deficiencies in aseptic and antiseptic practices; an outbreak of Pseudomonas aeruginosa endophthalmitis traced to the hospital's factory for the manufacturing of intravenous fluids; and attitudinal problems such as the care of patients with rabies on open wards. Prevalence surveys conducted during 1981 and 1986 suggest a dramatic increase in the recent incidence of surgical wound infection (44% upsilon 28%, P less than 0.001). This latter observation suggests a direct relationship between infection rates and the hardships imposed by poverty and civil war.
Insights
An infection control program at Hospital Rosales revealed widespread antibiotic overuse and a rise in hospital-acquired infections, particularly Pseudomonas aeruginosa. These findings suggest a link between infection rates and socioeconomic hardships like poverty and civil war.
Area of Science:
- Hospital infection control
- Public health in developing nations
Background:
- Observations from an infection control program at Hospital Rosales in El Salvador, initiated in 1978.
- The program identified several critical issues impacting patient care and outcomes.
Purpose of the Study:
- To describe the circumstances and observations from an infection control program at Hospital Rosales.
- To analyze the prevalence and types of hospital-acquired infections (nosocomial infections) and associated risk factors.
Main Methods:
- Review of infection control practices and antibiotic usage patterns.
- Prevalence surveys of surgical wound infections in 1981 and 1986.
- Analysis of hospitalization duration for patients with nosocomial infections.
Main Results:
- Overuse of antibiotics (penicillin, chloramphenicol) and a predominance of gram-negative rod infections (Pseudomonas aeruginosa).
- Increased duration of hospitalization for nosocomial infections (22.1 days vs. 11.0 days).
- A significant rise in surgical wound infection rates from 28% to 44% between 1981 and 1986.
Conclusions:
- Deficiencies in aseptic practices and an outbreak of Pseudomonas aeruginosa endophthalmitis linked to intravenous fluid manufacturing were documented.
- The study suggests a correlation between rising infection rates and socioeconomic challenges, including poverty and civil war.
- Improvements in infection control are crucial, especially in resource-limited settings affected by conflict.