Table 6.

Integration of qualitative themes and quantitative indicators, HAI Network’s BSI surveillance evaluation, India, 2022

Domain	Qualitative themes	Corresponding quantitative indicator result
Best practices	Developed a resource-appropriate case definition	Simplicity: easy to apply case definition
	Established a network-based surveillance to detect BSI trends and outbreaks	Stability: All 21 (100%) sites checked had access to 24 by 7 lab facility Sensitivity and PPV: Checked events had 100% PPV and 100% sensitivity Sensitivity: Sensitive in detecting BSI trends from May 2017 to Dec 2021 One outbreak of Burkholderia cepacia detected in the network using surveillance data
	Ensured regular ongoing IPC trainings with Quality Improvement (QI) projects	Acceptability: 90% physicians surveyed starting a QI initiative in their ICU based on the feedback received from surveillance Usefulness: 70% reported the feedback and trainings affecting care in the ICU by improving documentation of, and increasing adherence to, recommended central-line practices, 31% sites implemented one or more QI measures to decrease BSI rates
Challenges	Limited human resources
	Lack of digitalization of medical and laboratory records	Stability: 76% sites had access to all positive cultures, required for classifying BSI type, rest 24% did not have LIS, recorded lab results in manual registers Stability: 71% sites capture missing cases at end of month Simplicity: 80% of surveyed surveillance staff reported spending two hours or more per day collecting data from paper-based reports
	Variable blood culturing practices	Representativeness: 55% had their blood cultured with 44% cultured within 24 h of a febrile episode Survey: 50% physicians reported culturing 80% of the febrile patients Timeliness: 44% of the febrile episodes reviewed had blood cultured within 24 h
	Inconsistent information sharing and data use	Timeliness: 6/10 (60%) ICU physicians reported getting consistent monthly feedback
	Funding and sustainability	Stability: reporting ICUs decreased to 63/131 (48%) and reporting sites to 30/39 (77%) during quarter 4, 2021 when funding was interrupted
	Impact of the COVID-19 pandemic	Stability: Surveillance stopped in 22/39 (56%) sites during March–April 2020 as staff were absorbed in COVID-19 duties
Opportunities	Awareness and acceptance of BSI surveillance among participating sites	Acceptability: Acceptable among stakeholders at national and site level