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This paper examines the drivers that influence the green marketing awareness and addresses the role of corporate social responsibility (CSR) as a mediator. Data was collected from 250 respondents by self-administered questionnaire through convenience sampling. The results indicate that competitive advantage, environmental sustainability, green purchase intention are significant influencers for green marketing awareness. CSR enjoys a positive and significant mediating effect on the relationship between the independent variables and green marketing. CSR mediates the relationship between environmental sustainability (ES), competitive advantage (CA) and green purchase intention (GPI) which can provide insights for corporates with respect to the factors influencing green marketing awareness. Also, this paper highlights the importance of green purchase intention, competitive advantage, environmental sustainability and their linkage towards green marketing awareness.

This book Hospital Infection Control Guidelines: Principles and Practice aims to provide comprehensive, acceptable, implementable and effective guidelines on Infection Control in various healthcare facilities. The book deliberates on all aspects of infection control in healthcare facilities including prevention, processes, infrastructure and training. Analyses the existing guidelines on infection control and recommends micro- and macro-guidelines appropriate to healthcare facilities at various levels, i.e. primary, secondary and tertiary. As per the World Health Organization statistics, at any

There is substantial variability in immunization coverage trends across the globe which can be attributed to a number of factors such as demographic profile, socioeconomic characteristics and political environment. Vaccine preventable diseases contribute to severe disease burden when coverage is low, particularly, in slums. Present qualitative study explored barriers, opportunities, and key facilitators of childhood immunization. This was a community based cross-sectional study conducted in the slum areas of Mumbai, India. Data from the observations of immunization sessions and interviews of end users, healthcare service providers, and influencers were collected and analyzed. Lack of time, poor awareness, fear of adverse event, loss of daily income, and migrant population were some of the major reasons to not get immunized. Also, lack of good behavior of staff was another crucial factor perceived by caretakers as barrier in the immunization. Stakeholders agreed that immunization is a shared responsibility involving community, service providers, and policy makers. There was general consensus that immunization practices have improved over the last few years. However, its positive impact is yet to be fully seen in populations that belong to lower socioeconomic strata, thus warranting additional efforts to improve the immunization coverage in slums. Effective communication, process improvement at various levels, active involvement of communities in the immunization activities, building trust and accountability, and constructive feedback are some of the essential elements to strengthen the immunization program. Strategies to improve immunization services in such settings should be based on interactions with stakeholders and understanding their perspectives.

Background: To understand the role of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in Indian healthcare organizations. Methods: Mixed method approach using quantitative survey and qualitative interviews was applied. Through key informants, healthcare professionals from 69 hospitals (public & private) were invited to participate in online survey and follow up qualitative interviews. Thematic analysis was applied to identify the key emerging themes from the interviews. The survey data were analyzed using descriptive statistics. Results: 60 healthcare professionals from 51 hospitals responded to the survey. Eight doctors participated in semi-structured telephone interviews. 69% (27/39) of the respondents received E&T on AMS during undergraduate or postgraduate training. 88% (15/17) had not received any E&T at induction or during employment. In the qualitative interviews three key areas of concern were identified: (1) need for government level endorsement of AMS activities; (2) lack of AMS programs in hospitals; and, (3) lack of postgraduate E&T in AMS for staff. Conclusion: No structured provision of E&T for AMS currently exists in India. Stakeholder engagement is essential to the sustainable design and implementation of bespoke E&T for hospital AMS in India.

INTRODUCTION: Permanent vascular access is an essential intervention in patients with advanced chronic kidney disease (CKD) and its success depends on various non-modifiable and modifiable factors. Considering the element of unpredictability and failure, we attempted to analyze various factors responsible for primary arteriovenous fistula (AVF) failure in presumed high-risk groups. MATERIALS AND METHODS: We conducted an observational study of newly created AVFs at a tertiary referral government hospital in Eastern India between January 2014 and June 2015. All adult CKD patients undergoing AVF creation were included. Primary AVF failure was assessed at 12 weeks and total follow-up was 24 weeks in presumed high-risk groups of females, patients aged ≥65 years and those with diabetes mellitus. RESULTS: Female gender was at a higher risk of primary AVF failure if aged ≥65 years (P = 0.0026), second AVF creation (P = 0.03), loupe magnification not used (P = 0.03), arterial plaque (P = 0.028), absent immediate thrill, and with radiocephalic AVF (P = 0.02). Absent immediate thrill (<0.0001) and AVF size ≤5 mm (P = 0.002) were important independent risk factors for primary failure. Diabetes or elderly age did not have additional risk, except with uncontrolled hypertension and female gender. CONCLUSION: Female gender was at a higher risk of poor unassisted AVF patency if their age was ≥65 years, had second AVF creation, loupe magnification not used or if arterial plaque was present. An absence of thrill immediately or at 24 hours or an AVF diameter ≤5 mm were independent intraoperative factors for poor outcome. On the contrary, diabetics, elderly males and intimal thickness were essentially noncontributors for AVF failure, except in few subsets.

In many parts of the world, including in India, pharmacist roles in antimicrobial stewardship (AMS) programmes remain unexplored. We describe the evolution and effect of the role of adding clinical pharmacists to a multidisciplinary AMS at a tertiary care teaching hospital in Kerala, India. Through effective leadership, multidisciplinary AMS (February 2016) and antitubercular therapy (ATT) stewardship programmes (June 2017) were established. Clinical pharmacists were introduced as core members of the programmes, responsible for the operational delivery of key stewardship interventions. Pharmacy-led audit and feedback monitored the appropriateness of antimicrobial prescriptions and compliance to AMS/ATT recommendations. Between February 2016 and January 2017, 56% (742/1326) of antimicrobial prescriptions were appropriate, and 54% (318/584) of recommendations showed compliance. By the third year of the AMS, appropriateness increased to 80% (1752/2190), and compliance to the AMS recommendations to 70% (227/325). The appropriateness of ATT prescriptions increased from a baseline of 61% (95/157) in the first year, to 72% (62/86, June 2018–February 2019). The compliance to ATT recommendations increased from 42% (25/60) to 58% (14/24). Such a model can be effective in implementing sustainable change in low- and middle-income countries (LMICs) such as India, where the shortage of infectious disease physicians is a major impediment to the implementation and sustainability of AMS programmes.

BACKGROUND: The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. STRATEGIES: Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. CONCLUSION: Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement ...

Background: Globally, a significant increase in the emergence of antibiotic resistant (ABR) path-ogens has rendered several groups of antibiotics ineffective for the treatment of life-threatening infections. It is an endemic in hospital settings and a major concern while handling pathogens involved in an epidemic or pandemic. ABR is a matter of great concern due to its recusant impact on public health and cost to the healthcare system, especially in developing country like India. An indiscriminateand inappropriate usage of antimicrobials, poor infrastructure and sanitation are the major factors driving the evolution of ABR in such countries. Therefore, in addition to the devel-opment of novel therapeuticsand safeguarding the efficacy of existing antibiotics, there is an ur-gent need for a programme focussed on the education in risk management and prevention of ABR. Aim: To promote qualitative teaching activities in academia and society to visualize a future where every individual is aware of ABR and empowered with right education to address the issue.Methods: The project 'Risk Management and Prevention of Antibiotics Resistance -PREVENT IT', funded by the ERASMUS+ Programme of the European Union, converges academicians and non-government organizations (NGOs) to inculcate a sense of awareness towards the increase in the frequency of ABR pathogens, judicial usage of antimicrobials and the economic/health burden of ABR, in students, academicians, clinicians and population at large. Expected outcome: The project commissioned envisages a behavioural change in individuals and attempts to support policymakers by executing stable changes in the curricula of institutes of higher education, developing advanced workshop modules for the training of academicians and disseminating ABR-related information through conferences/seminars, social media campaigns and an online platform dedicated to ABR. In addition, the project aims to develop a European-Indian network for the management of risk and prevention of ABR.

Background: Globally, a significant increase in the emergence of antibiotic resistant (ABR) path-ogens has rendered several groups of antibiotics ineffective for the treatment of life-threatening infections. It is an endemic in hospital settings and a major concern while handling pathogens involved in an epidemic or pandemic. ABR is a matter of great concern due to its recusant impact on public health and cost to the healthcare system, especially in developing country like India. An indiscriminate and inappropriate usage of antimicrobials, poor infrastructure and sanitation are the major factors driving the evolution of ABR in such countries. Therefore, in addition to the devel-opment of novel therapeutics and safeguarding the efficacy of existing antibiotics, there is an ur-gent need for a programme focussed on the education in risk management and prevention of ABR. Aim: To promote qualitative teaching activities in academia and society to visualize a future where every individual is aware of ABR and empowered with right education to address the issue. Methods: The project 'Risk Management and Prevention of Antibiotics Resistance - PREVENT IT', funded by the ERASMUS+ Programme of the European Union, converges academicians and non-government organizations (NGOs) to inculcate a sense of awareness towards the increase in the frequency of ABR pathogens, judicial usage of antimicrobials and the economic/health burden of ABR, in students, academicians, clinicians and population at large. Expected outcome: The project commissioned envisages a behavioural change in individuals and attempts to support policymakers by executing stable changes in the curricula of institutes of higher education, developing advanced workshop modules for the training of academicians and disseminating ABR-related information through conferences/seminars, social media campaigns and an online platform dedicated to ABR. In addition, the project aims to develop a European-Indian network for the management of risk and prevention of ABR. Conflicts ...

Background: Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning. Methods: A cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains - Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks. Results: 928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. Conclusions: The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.

Background Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning. Methods A cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains – Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks. Results 928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. Conclusions The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.