PAHEF Project Keeps Patients Healthier by Reducing Health Care-Associated Infections in Bolivia

petri-dish-for-webIn Bolivia, PAHEF has played a critical role in reducing the number of health care-associated infections (HCAIs), which has greatly improved patient safety.


People enter the hospital to get well, not to acquire life-threatening infections. Unfortunately, for many patients throughout the world, including the U.S., that is what happens. The very young, elderly, and infirm, which comprise a large portion of a hospital’s patients, are the people most susceptible to HCAIs.

In developing nations, HCAIs can infect between 10 percent to 20 percent of patients. One half or more of these infections are caused by pathogens resistant to common antibiotics.

HCAIs in Bolivia

HCAIs are a serious problem in Bolivia. In 2004, the issue became dramatically evident in Santa Cruz when an outbreak of HCAIs caused by a multidrug resistant bacterium caused the deaths of 12 newborns during a week at a single hospital. Source contamination, poor infection control measures, and lack of staff training were responsible. At the time, an infection control curriculum for students in the health sciences was nearly non-existent in the nation. This contributed to a deadly gap in knowledge for new health care workers.

PAHEF Collaboration
With the technical support of PAHEF, the Ministry of Health of Bolivia identified the following issues about HCAI control:
1. The lack of procedures manuals for the prevention and control of HCAIs
2. The lack of trained personnel
3. The lack of epidemiologic data on the prevalence of HCAIs made it difficult to judge the full scope and impact of the problem
4. The lack of information about the responsible pathogens and the best antibiotics to fight them
5. The lack of standardized methods for laboratories to use when isolating and identifying the pathogens
6. The lack of integration between microbiology laboratory results, the clinical picture caused by those pathogens, and the selection of the best antibiotic therapy

Through the Bolivian National Institute of Health Laboratories (INLASA), the Ministry of Health turned to the Pan American Health and Education Foundation (PAHEF) for assistance in correcting these deficiencies. The ministry contacted PAHEF’s board member Dr. Luis Jauregui, who is a native of Bolivia. PAHEF was approached because its 40-year commitment to improving health in the Americas and experience promoting health education made the Foundation the ideal partner. Dr. Jauregui, who is the chief of the division of infectious diseases at St. Vincent Mercy Medical Center in Toledo, Ohio, served as the point person within PAHEF for the project’s coordination. He is a recognized expert in this field and his hospital has collaborated with Bolivian institutions on numerous occasions.

PAHEF immediately responded and the board of directors agreed to provide two grants to INLASA. INLASA developed the projects while PAHEF managed them financially, with money from PAHEF’s own reserves and monies from the Fund from the People of Taiwan, a donor-advised fund managed by PAHEF. 

Achievements
In 2004, a manual of procedures for the control of HCAIs was created with technical support from PAHEF. This publication was followed by the First and Second International Congresses on the Prevention of HCAIs held in La Paz in 2004 and 2006, respectively. In these congresses, convened by INLASA and supported by PAHEF and its partners, members of the Bolivian Ministry of Health, PAHO, as well as academics from Bolivian universities and experts from Chile and the United Kingdom extensively trained physicians, nurses, and public health and laboratory personnel in the prevention of HCAIs.       

Pilot Study
The prevalence of HCAIs and the impact of preventive measures were determined in a pilot study in 2007 involving seven hospitals in the cities of La Paz and El Alto. The hospitals were selected for the study because they each serve indigenous populations, provide maternal care, and have neonatal intensive care units. The study showed an overall HCAI prevalence rate of 16.5 percent.

After the creation of a group of infection control nurses and the introduction of preventive practices, the prevalence rates of HCAIs initially decreased to 5.4 percent and then to 3.4 percent, at the completion of the study. This study reduced the HCAI prevalence rates to levels below those reported in North America, Europe, and other Latin American countries. It also confirmed the significant impact that a group of nurses dedicated exclusively to the prevention of HCAIs can have. 

With grants funds, INLASA created the National Computerized Network of Bacteriology Laboratories. Monies from the People of Taiwan Fund were used to purchase computers and servers. This equipment handles bacteriology data from 31 sentinel laboratories throughout Bolivia.

INLASA created a software package (Registro Unico en Bacteriologia Clinica-RUBAC) to test and identify pathogens. The data are then incorporated into a central repository in INLASA and used to create regional maps that show physicians which pathogens are the most common. This helps physicians determine the most appropriate antibiotics to use in each area of the country. The program analyzed more than 20,000 strains in its first year of operation alone. RUBAC tracks changes in the types of pathogens that cause HCAIs. These data help clinicians select the best antibiotic therapy for the situation.

Bridging the Gap with Books
To bridge the gap in knowledge between the identification of pathogens, their clinical behavior and the current therapy courses, INLASA published three
upinfection-control-book-for--to-date extensive books between 2005 and 2007 covering infections and the impact of antibiotic resistance in Bolivia. These works included articles by Bolivian academics, which were compiled with the technical assistance of PAHEF board member Dr. Luis Jauregui. 
 
In Bolivia, INLASA and PALTEX published a reference book in 2010 that covers the theory and practice of all facets of surveillance, prevention, and control of HCAIs. This book gathers the contributions of more than 40 experts from Bolivia, Chile, Great Britain, and the United States, all of whom donated their time and expertise to this worthwhile enterprise.

The publication of this reference book acknowledges the important advances that have been made in Bolivia in the field of HCAIs between 2004 and the present; many of which were achieved through the collaboration and financing of PAHEF and its partners, including support from the People of Taiwan Fund. These advances have gone beyond the material covered in the original manual published in 2004. This groundbreaking book will continue to educate the next generation of Bolivian and Latin American health personnel and protect more people from HCAIs. 

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