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International Society for Infectious Diseases — First series of position papers, with a focus on implementing infection prevention and control measures in low- and middle-income settings

Open AccessPublished:August 14, 2019DOI:https://doi.org/10.1016/j.ijid.2019.08.009
      Healthcare-acquired infections cause significant morbidity and mortality, particularly in low- and middle-income settings (
      • Vilar-Compte D.
      • Camacho-Ortiz A.
      • Ponce-de-Leon S.
      Infection control in limited resources countries: challenges and priorities.
      ). Lack of adequate training underpinning infection prevention and control, lack of defined infection prevention policies and procedures and lack of funding from governments and hospital administrators are of particular concern in these settings. Unsafe water and sanitation facilities, inconsistent surveillance, lack of vaccines, inappropriate use of antimicrobials, poor waste management in hospitals and communities alike, and poor hand hygiene can further contribute to the spread of infections in the healthcare setting. Implementation of adequate infection prevention and control (IPC) measures as well as adequate microbiology laboratory support are critical to preventing, identifying and responding to healthcare acquired infections.
      In low and middle income countries (LMICs), the status of national IPC programmes varies widely within and between countries, from robust to non-existent IPC structures. The results of a recent survey conducted by ISID, involving more than 1100 healthcare workers from around the world, demonstrated that many disparities exist in the context of IPC between different national resource levels (
      • Desai A.N.
      • Ramatowski J.W.
      • Lassmann B.
      • Holmes A.
      • Mehtar S.
      • Bearman G.
      Global infection prevention gaps, needs, and utilization of educational resources: a cross-sectional assessment by the International Society for Infectious Diseases.
      ). The largest gaps identified in this survey were related to availability of personal protective equipment, availability of basic microbiology laboratory capacity, availability of antimicrobial sensitivity data, and availability of IPC support services. Lack of appropriate infrastructure, capacity and financial constraints were highlighted in other studies as explanations for IPC discrepancies that exist between regions (
      • Bardossy A.
      • Zervos J.
      • Zervos M.
      Preventing hospital-acquired infections in low-income and middle-income countries.
      ,
      • Lynch P.
      • Pittet D.
      • Borg M.
      • Mehtar S.
      Infection control in countries with limited resources.
      ). It is clear that available evidence-based IPC practices developed in high income countries have encountered barriers to implementation in LMICs. In addition, many resources are difficult to access, navigate and use (
      • Sastry S.
      • Masroor N.
      • Bearman G.
      • et al.
      The 17th International Congress on Infectious Diseases workshop on developing infection prevention and control resources for low- and middle-income countries.
      ). There is an urgent need to adapt and/or contextualize the available IPC approaches to implementable recommendations which address the reality in LMICs.
      The International Society for Infectious Diseases (ISID) is a not-for-profit organization founded in 1986 to improve the care of patients with infectious diseases, the professional development and standing of clinicians and scientists in the field, and the control of infectious diseases around the world. Since 1998, the ISID has developed and distributed “A Guide to Infection Control in the Healthcare Setting,” which is a free resource dedicated to summarizing the most up-to-date principles, interventions, and strategies for minimizing healthcare associated infections. When the 6th Edition was published online in 2019, Richard Wenzel, the Founding Editor of ISID’s Guide stated “I assembled a team of international authors who were enthusiastic supporters of the project, and my only condition was that no author or editor made money from the project and that the Guide would be distributed free to all medical personnel in LMICs. Within a few years, we had increasing requests to translate the Guide into various languages, adding to its value.” Currently, more than 70 authors from around the globe volunteer to write, revise and keep content up-to-date. Six Editors volunteer their time and expertise to provide oversight and to ensure content is evidence-based. Past editions of the Guide were translated into Chinese, Croatian, Greek, Polish, Russian, and Spanish. The Guide to Infection Control in the Healthcare Setting is freely available online through ISID’s webpage (https://www.isid.org/guide/).
      The ISID Position Paper Series is an exciting new initiative for the ISID to highlight key issues in international health and infectious diseases and to provide a consensus, developing these recommendations into manuscripts for publication in the International Journal of Infectious Diseases (IJID). The first series is based on content developed for the ISID’s 6th Edition of the Guide to Infection Control in the Healthcare Setting. The goal of this first series is to facilitate implementation of IPC measures in low- and middle-income countries and to provide evidence-based or, when evidence is not available, expert consensus recommendations. The IJID is the official publication of the ISID. Position papers are the official opinions and recommendations of the International Society for Infectious Diseases (ISID) and reflect the mission and values of the Society.
      ISID’s Publication Committee is a group of ISID members who, under the leadership of the Committee Chair, provide leadership in the development of position papers for the Society. The chair of ISID’s Publication Committee provides oversight of the development and peer-review of position papers and reports directly to the President of the Society. Relevant content for inclusion in the Position Paper series is selected by the ISID Publication Committee in conjunction with ISID’s Guide to Infection Control Editors and the Editor-in-Chief of the IJID. To ensure applicability across various resource settings and to reflect ISID’s diverse membership, co-authors from various regions and resource levels provide their insights and expertise by contributing to the manuscript. The authoring groups of the ISID Position Papers are required to disclose all conflicts of interest and affiliations with industry. The first ISID Position Papers were published earlier in 2019 with a focus on CLABSI (
      • Lutwick L.
      • Al-Maani A.S.
      • Mehtar S.
      • Memish Z.
      • Rosenthal V.D.
      • Dramowski A.
      • et al.
      Managing and preventing vascular catheter infections: A position paper of the International Society for Infectious Diseases.
      ) and Hand Hygiene (
      • Loftus M.J.
      • Guitart C.
      • Tartari E.
      • Stewardson A.J.
      • Amer F.
      • Bellissimo-Rodrigues F.
      • et al.
      Hand hygiene in low- and middle-income countries: A position paper of the International Society for Infectious Diseases.
      ).

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