Device-associated infection rates and median length of acquiring device-associated infection in an intensive therapeutic unit of an Indian hospital

Abstract

Background: Hospital acquired infection (HAIs) nowadays is one of the leading causes of mortality in the ITU. Limited data is available regarding burden of HAIs specially device associated infections (DAIs) in Indian ITU. This study was aimed at determining the occurrence of DAIs including magnitude of device associated infections per 100 hospital admission, magnitude of device associated infection cases per 1000 bed days, incidence of infections per 1000 device days, median time for detection of DAIs, prevalent organisms and their antibiogram. Patients included in this study were taken from a 25 bedded intensive therapeutic unit (ITU), in a hospital in India. Methods: A prospective surveillance was performed over two years duration from July 2011 to June 2013. 578 patients were followed until discharge who admitted to this ITU and stay for more than 48 hours. HAIs were identified according to the CDC/NNIS definition. Data were analyzed with descriptive statistics. Results: The incidence rate for DAIs was 19.55%(113/578). More than 50% were associated with different comorbid illness mainly malignancy (47%). The device utilization was very high in case of urinary catheter (0.838) and IV catheter (0.742) but the incidence density was maximum in case of ventilator associated pneumonia (VAP = 13.89%). Median time of acquiring VAP, CAUTI, CRBSI were maximum in between (9 to 14 days), (16 to 21 days) and (12 to 17) days respectively demands need for regular follow up of this devices within that periods. Major pathogens for VAP were Klebsiella (28.95%), Acinetobacter (26.3%); CA-UTI mostly caused by E. coli (18.2%). CRBSI mainly caused by MRSA (25.9%), Acinetobacter (18.5%). Conclusion: A high rate of device associated infections, particularly VAP, were observed in this study. One of the main strategy to prevent nosocomial infections in the ITU is early change of invasive devices based on its median time of infection and to avoid its unnecessary prolong use.