Monitoring health care–associated infections in Vietnam

October 14, 2022 by Tran Thi Thu Ha, Divyanka Pawaskar, and Linda Venczel

In low- and middle-income countries, 15 percent of patients will acquire a new infection when they visit a health care facility. PATH and partners are working to reduce this trend.

Mr. Hoang Thi Lau Huong, Deputy Director of Hue Central Hospital, explains th HAI surveillance program to visiting PATH program leader Linda Venczel. Photo: PATH.

Dr. Hoang Thi Lan Huong, Deputy Director of Hue Central Hospital, explains the health care–associated infection surveillance program to visiting PATH program leader Linda Venczel (at left). Photo: PATH.

Each year, hundreds of millions of people worldwide acquire infections while receiving medical care. These health care–associated infections (HAIs) are unrelated to the original illness they are admitted for and often result in prolonged hospital stays, increased morbidity and mortality, and higher health care costs. In addition, HAIs can spread in the community if people return to their homes with an ongoing infection.

HAI rates are often higher in low- and middle-income countries where hospitals are challenged by overburdened facilities, fewer health care personnel per patient, limited infection prevention and control (IPC) infrastructure, and limited or no surveillance data.

Improving Vietnam’s HAI surveillance system

Surveillance systems are critical for understanding the prevalence of HAIs, identifying susceptible patient populations, and evaluating interventions designed to control the spread of HAIs.

However, diagnostic standards are typically developed in countries where advanced facilities and expert personnel are more readily available. This makes it challenging for countries that lack personnel and financial support to reliably diagnose infections and monitor their prevalence.

In Vietnam, for example, hospitals tended to rely on doctors’ clinical judgment for HAI detection, leading to inconsistent and sometimes misleading data.

In 2016, PATH partnered with the US Centers for Disease Control and Prevention (US CDC) and the Vietnam Administration of Medical Services to develop a context-appropriate surveillance system for measuring the HAI burden and identifying high-risk populations.

Working with IPC units in six pilot hospitals, the partners identified infections they could monitor consistently and reliably, and then developed diagnostic criteria for those infections, including case definitions and surveillance protocols.

Over the next several years, the six hospitals implemented the new, standardized surveillance protocols with technical support from US CDC and PATH. Hospital staff were trained on case definitions, case finding procedures, data collection, and case reporting using a new electronic reporting system to improve data quality.

The new surveillance system was then linked with prevention, allowing pilot hospitals to evaluate the effectiveness of their prevention activities and modify as needed to achieve better results.

By 2022, all six hospitals had built highly functional HAI surveillance systems that both monitored and guided HAI prevention activities. Stakeholders attributed the project’s success to five key activities: engaging stakeholders, delegating responsibilities, forming a context-sensitive protocol, developing a robust surveillance implementation strategy, and linking HAI surveillance and prevention activities.

“The standardized surveillance system has made it much easier to collect hospital infection surveillance data,” says Dr. Ha Thi Kim Phuong, Head of the IPC Department in Vietnam’s Medical Services Administration. “We will continue to expand the surveillance network so that more hospitals can participate, providing a data set that accurately reflects the HAI burden in Vietnam.”

“The standardized surveillance system has made it much easier to collect hospital infection surveillance data.”
— Dr. Ha Thi Kim Phuong, Vietnam’s Medical Services Administration

Scaling and expanding HAI surveillance

Building on the success of the pilot, US CDC and PATH supported the Vietnam Ministry of Health in scaling the work to additional hospitals. IPC leaders from the pilot hospitals were trained as master trainers, and by May 2019, an additional 12 hospitals had been brought into the surveillance network.

Since then, an additional 32 hospitals have joined the network, bringing the total number of hospitals implementing the standardized HAI surveillance protocol to 50. The ultimate goal is to establish a nationwide network that promotes accurate IPC practices and creates a safer health care environment for all patients.

To supplement HAI standard surveillance protocols, Vietnam established Extended Infection Control and Investigation (EICI) units in three national hospitals. The EICI units bring together clinical leads from different units of the hospital along with IPC and surveillance focal points to strengthen outbreak response for emerging infections like COVID-19 and the growing threat of antimicrobial resistance.

In the short term, EICI units will integrate IPC practices with surveillance. In the longer term, the EICI units will train and mentor satellite hospitals to strengthen IPC practices and pilot new approaches for HAI detection, prevention, and control.

The successful implementation of a context-appropriate HAI surveillance and response system and the installation of EICI units demonstrates how PATH works together with US CDC, national governments, and health care providers to solve complex problems, and in this case improves a country’s capacity to detect, respond to, and control HAIs more effectively and appropriately.