Seeking solutions: scaling-up audit as a quality improvement tool for infection control in Gujarat, India

Quality problem or issue: Surgical-site infections (SSIs) give rise to significant demands on the health systems as well as economic and social sequelae for patients. This article describes an audit for infection control developed in a surgical unit of a tertiary care setting in Gujarat state, India that was scaled-up to all state-owned hospitals in the district.

Initial assessment: A retrospective baseline assessment of surgical infection rates in a general surgical unit revealed an infection rate of 30%.

Choice of solution: An audit was implemented based on guidelines for SSI prevention published by the Centres of Disease Control.

Implementation: Surveillance and hospital epidemiology were established and practice reforms implemented. Monthly and annual meetings to review implementation were held.

Evaluation: After 12 months, an 88% decrease in the infection rate in the surgical unit was demonstrated. Thereafter, the process was replicated across the surgical department and for all cases undergoing surgery. After 12 months, a 67% reduction in the infection rate was detected. The process has since been applied across the state.

Lessons learned: A locally owned and team-led process embedded within routine working conditions can challenge widely held perceptions, inform low-cost and no-cost remedial actions, and improve cultures of practice, quality of care and health outcomes. As urban populations grow, methods that are capable of continuously identifying, and responding to, problems and sustaining quality of care in facilities are necessary. SSIs may be largely preventable. With careful implementation, audit has the potential to be a major contributor to their reduction.