Implementing adaptive strategies for infection prevention and control in resource-limited settings.

Background: Healthcare-associated infections (HAIs) are a major challenge in resource-limited hospitals, where conventional infection prevention and control (IPC) protocols are difficult to implement because of infrastructure constraints, limited personal protective equipment (PPE), and understaffing. Adaptive IPC strategies that are tailored to local conditions may improve patient safety and compliance. This study aimed to evaluate the effectiveness, feasibility, and sustainability of adaptive strategies for reducing hospital-acquired infections and improving protocol adherence in a resource-limited hospital setting. Methods: A quasiexperimental mixed-methods study was conducted over 12 months in multiple inpatient wards of "A" Hospital in Yemen, with assessments at baseline, 3 months, 6 months, and 12 months. The interventions included locally optimized equipment disinfection protocols, low-cost staff training, peer mentorship, visual reminders, and spatial workflow reorganization. Intervention outcomes were compared with historical control data from comparable wards via a difference-in-differences approach. Hospital-acquired infection outcomes were analyzed via Poisson or negative binomial regression with patient days as the exposure offset, whereas adherence outcomes were analyzed via mixed-effects logistic regression. Results: The final analytic dataset included 2,420 admissions contributing 13,980 patient-days. The cumulative incidence of hospital-acquired infection decreased from 15.3% at baseline to 8.2% at 12 months, corresponding to an absolute reduction of 7.1 percentage points and a relative reduction of 46.4%. In the adjusted negative binomial regression using patient days as the exposure offset, the 12-months HAI rate was significantly lower than that at baseline (adjusted IRR 0.52). Difference-in-differences analysis revealed an additional 6.2-percentage-point reduction in cumulative HAI incidence compared with historical controls. Adherence to hand hygiene, PPE use, and equipment disinfection increased to 83.0%, 80.1%, and 76.1%, respectively. Resource utilization increased during the intervention period. Conclusion: Adaptive, context-specific infection prevention and control strategies were associated with significant reductions in hospital-acquired infection rates over a 12-months period and improved healthcare worker adherence in a resource-limited hospital setting. The findings suggest that low-cost, locally adapted interventions can be integrated into routine clinical workflows and implemented with manageable increases in resource use. This study provides a practical framework for implementing and evaluating adaptive infection prevention and control interventions in similar low-resource healthcare environments.