Table 4.

Summary of Themes from Qualitative Analysis, BSI Surveillance Evaluation, India, 2022

1. Developed a context-specific resource-appropriate case definition: Simple case definitions and easy-to-follow SOPs permitted implementation in low-resource settings

2. Established surveillance through a network-based approach: Starting with a few committed, well-resourced sites before gradually expanding to more sites was important

3. Regular IPC training and use of QI to improve IPC: Regular IPC and QI training helped sites use data for targeted IPC interventions to improve patient care

4. Awareness and acceptance of BSI surveillance among participating sites: Site representatives felt joining this network helped them prioritize scarce resources to tackle the threat of HAIs

5. Limited human resources: Limited staff allotted to surveillance impacted data collection and reporting in sites

6. Lack of digitalization of medical and laboratory records: Without hospital and laboratory management systems, it was difficult to track patients outside of ICUs and follow multiple positive cultures for a single patient

7. Variable blood culturing practices: Surveillance protocols were not always followed; instead, some decisions to collect blood cultures were based on the treating physician's judgment, the availability of culture bottles, and the patient's ability to pay

8. Inconsistent information sharing and data use: Analyzed data was not always shared with physicians; even when it was shared, they did not always accept the results

9. Funding and sustainability: Funding commitment was important to maintain and expand the surveillance network and to retain staff

10. Impact of the COVID-19 Pandemic: Surveillance stopped in many sites. Staff were reassigned for COVID-19 duties in other sites, which reduced the number of reporting ICUs