Table 6 Integration of qualitative themes and quantitative indicators, HAI Network’s BSI surveillance evaluation, India, 2022
Domain | Qualitative themes | Corresponding quantitative indicator result |
|---|---|---|
Best practices | Developed a resource-appropriate case definition | Simplicity: easy to apply case definition |
| Â | Established a network-based surveillance to detect BSI trends and outbreaks | Stability: All 21 (100%) sites checked had access to 24 by 7 lab facility Sensitivity and PPV: Checked events had 100% PPV and 100% sensitivity Sensitivity: Sensitive in detecting BSI trends from May 2017 to Dec 2021 One outbreak of Burkholderia cepacia detected in the network using surveillance data |
| Â | Ensured regular ongoing IPC trainings with Quality Improvement (QI) projects | Acceptability: 90% physicians surveyed starting a QI initiative in their ICU based on the feedback received from surveillance Usefulness: 70% reported the feedback and trainings affecting care in the ICU by improving documentation of, and increasing adherence to, recommended central-line practices, 31% sites implemented one or more QI measures to decrease BSI rates |
Challenges | Limited human resources | Â |
| Â | Lack of digitalization of medical and laboratory records | Stability: 76% sites had access to all positive cultures, required for classifying BSI type, rest 24% did not have LIS, recorded lab results in manual registers Stability: 71% sites capture missing cases at end of month Simplicity: 80% of surveyed surveillance staff reported spending two hours or more per day collecting data from paper-based reports |
| Â | Variable blood culturing practices | Representativeness: 55% had their blood cultured with 44% cultured within 24Â h of a febrile episode Survey: 50% physicians reported culturing 80% of the febrile patients Timeliness: 44% of the febrile episodes reviewed had blood cultured within 24Â h |
| Â | Inconsistent information sharing and data use | Timeliness: 6/10 (60%) ICU physicians reported getting consistent monthly feedback |
| Â | Funding and sustainability | Stability: reporting ICUs decreased to 63/131 (48%) and reporting sites to 30/39 (77%) during quarter 4, 2021 when funding was interrupted |
|  | Impact of the COVID-19 pandemic | Stability: Surveillance stopped in 22/39 (56%) sites during March–April 2020 as staff were absorbed in COVID-19 duties |
Opportunities | Awareness and acceptance of BSI surveillance among participating sites | Acceptability: Acceptable among stakeholders at national and site level |