Hospital Infection Control Committee Research Articles

Current Global Occurrence of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Infections in Hospitalized Patients: A Literature Review

Antimicrobial resistance (AMR) is an escalating global issue. One of the primary resistance mechanisms is the ability of microbes to deactivate antimicrobial drugs through the production of expanded-spectrum β-lactamases enzymes (ESBL), such as carbapenemases. Among the pathogens associated with multidrug resistance, Klebsiella pneumoniae has a high frequency, particularly in hospital settings. This study presents a narrative review of the literature from the scientific databases of the National Library of Medicine (PubMed) and the Cochrane Library on the occurrence of carbapenem-resistant K. pneumoniae (CRKP) infections in hospitalized patients, identifying current studies that may contribute to understand the spread of resistant bacteria. The review was conducted in September 2023 with the aim of summarizing evidence. Inclusion and exclusion criteria were applied, and 20 articles were included, covering the continents of the America, Africa, Asia, and Europe, to select the most recent studies about CRKP. In the studies analyzed, nosocomial isolates predominantly originated from sputum samples, followed by urine and blood. Molecular analysis revealed that most microorganisms exhibiting resistance to carbapenems harbored the blaKPC, blaNDM, and blaOXA-48 genes. However, there is epidemiological variation among continents, underscoring the need for more knowledge about genetic diversity and the implementation of active surveillance culture programs to facilitate prompt action with appropriate therapy and minimal patient risk. These findings indicate a necessity for heightened vigilance by hospital infection control committees to prevent potential spread and outbreaks of bacteria carrying carbapenem resistance genes.

Assessment of Hospital Infection Prevention and Control Practices: Insights from Kampala International University Teaching Hospital, Ishaka, Uganda

The study aimed to identify factors affecting hospital infection prevention and control practices among medical personnel at Kampala International University Teaching Hospital in Ishaka, Uganda. The research was conducted using a quantitative descriptive research design. The result revealed that 76% of respondents felt they had sufficient knowledge about infection control and prevention practices. However, 34% of respondents found precautionary measures interfered with their work, and 70% recap needles after use. Only 32% reported a 0.3% chance of acquiring HIV after a needle stick injury. The study also showed 44% of respondents had received training on hand washing within 6 months. Most respondents 78% were able to wash hands before and after procedures. Only 44% of respondents had received training on waste segregation within a 6-month period. Policies and guidelines also influenced infection prevention and control practices. 52% of respondents considered the hospital infection prevention and control committee active, and 78% of them believed that waste segregation and post-exposure prophylaxis policies were available in their departments. The study found that hand washing is being carried out as recommended due to adequate on-the-job training. However, 54% of staff perceive hand washing as a challenge, and 78% were able to wash hands before and after every procedure as recommended. Only 30% of workers have access to a regular supply of soap and detergents for washing hands. Waste segregation is being practiced as recommended, but challenges persist for medical personnel. The management team should integrate infection prevention and control into the regular supervision of healthcare providers. The study suggests that promoting hand washing in a hospital requires adequate training, facilities, supplies, staffing, and a positive attitude. It recommends frequent hand washing training, accessible running water infrastructure, disposable towels, and soap and detergents. Staff should be trained on attitude change and proper waste segregation. Keywords: Hospital, Infection, Waste, Hand washing, supplies, training.

Assessment of Knowledge and Compliance with Hand Hygiene among Health Personnel to Reduce Methicillin Resistant Staphylococcus aureus Nosocomial Infections: A Prospective Observational Study from a Tertiary Care Hospital in Southern India

Introduction: Following a significant recovery from Coronavirus Disease-2019 (COVID-19) pandemic, the world has recognised that Hand Hygiene (HH) and facial masks are key preventive measures against various cross infections, particularly in hospital settings. Studying the incidence of Methicillin Resistant Staphylococcus aureus (MRSA) as a part of Healthcare Associated Infections (HAI) surveillance is crucial, as MRSA transmission can be effectively prevented through HH. Aim: To assess the knowledge and compliance of HH among health personnel using the World Health Organisation (WHO) HH questionnaire. Materials and Methods: A prospective observational study was conducted at Bhaarath Medical College and Hospital, Chennai, Tamil Nadu, India, over one year, from December 2020 to November 2021. The Hospital Infection Control Committee (HICC) team carried out an HH survey using the WHO HH questionnaire to evaluate knowledge and attitudes among 115 Healthcare Workers (HCWs), including doctors and nursing staff, in a tertiary care hospital in Kanchipuram, Southern India. The study also involved monitoring monthly MRSA incidence density rates in Intensive Care Unit (ICU) settings as part of HAI surveillance, followed by regular HH audits. MRSA infectivity rates were statistically analysed using paired t-tests with Statistical Package for Social Sciences (SPSS) software version 21.0 to determine p-values and address standard deviations. Results: In this study, 26 (65%) of doctors had undergone training, while 57 (76%) of nurses reported recent formal HH training. Only 16 (40%) of doctors and 21 (28%) of nurses used alcohol-based handrub. Doctors exhibited knowledge ranging from 60-77.5% on germ transmission and hand rub-related questions, while nurses demonstrated better knowledge ranging from 72-93.3%. HH adherence was 30% among doctors and 72% among nurses. The MRSA infectivity rate varied over the year, starting at 1.33 per 1000 resident days before HH audits and decreasing to 0.3. Each HH audit led to a significant improvement in MRSA rates, with a p-value <0.0001, indicating statistical significance. Conclusion: Present study evaluated HCWs knowledge and attitudes toward HH, along with the impact of HH audits on reducing MRSA rates, has proven to be beneficial for hospital infection control practices, particularly during the COVID-19 pandemic and its aftermath, when vigilance tends to decrease over time.

Management of mattresses in the prevention of healthcare-associated infection: a cross-sectional study

Introduction: Healthcare Associated Infection (HAI) threatens patient safety and can be associated with contamination of surfaces such as mattresses. This study aimed to identify the criteria for the acquisition and conservation of mattresses in hospitals and Homes for the Aged (HA) as an infection prevention strategy. Outlining: Cross-sectional study carried out with 18 institutions. Data were collected through a structured interview with the person responsible for administration, hospitality sector or the Hospital Infection Control Committee, using a validated instrument. Data analysis was performed using descriptive statistics. Results: Five HA and 8 Hospitals partook the study. Acquisition by direct purchase prevails (94.4%), with a periodicity of 1 to 5 years (50%). All mattresses purchased are foam ones, due to user comfort (44.4%) and resistance (38.9%). Waterproof cover is used by 83% of the services, made of “napa” (72.2%) and “corvin” (66.7%) for easy sanitizing (77.8%). “During the concurrent cleaning” is the most mentioned time to evaluate the integrity of the mattress (38.8%) and coating (50%). Implications: it was observed that there is no systematic management for the acquisition and maintenance of mattresses. This highlights the need to improve the care with patient bed in order to prevent healthcare-associated infections.

Assessment of Knowledge, Attitude, and Practices (KAP) Toward Hepatitis B Infection, Its Prevention, and Vaccination Among Health Care Workers.

Health Care workers (HCWs) have an approximate four-fold increased risk of contracting hepatitis B infection than the normal population. A lack of knowledge and practicesregarding precautions has been frequently observed. We aimed to do a knowledge, attitude, and practices (KAP) study regarding hepatitis B prevention measures among HCWs. The study enrolled 250 HCWs.A questionnaire-based proforma regarding KAP towards hepatitis B, its causation, and prevention was filled out by each participant. Mean age (SD) of participants was 31.8 ± 9.1 years with 83 males and 167 females. Subjects were divided into two groups: Group I (House Surgeons and Residents) and Group II (Nursing staff, Laboratory Technicians, Operation Theatre Assistants). All Group I and 148 (96.7%) of Group II subjects had adequate knowledge regarding the professional risk of hepatitis B virus transmission.Knowledge regarding different modes of transmission was less in Group II subjects (Blood (96.1%), Sex (84.3%), percutaneous route (85.6%), and During Birth (83%)) as compared to Group I (100% in all).All subjects in Group I and 134 (90.9%) Group II subjects knew about vaccination as a preventive measure.There was a slight discordance between attitude and practices towards universal precautionary measures in Group II subjects (Use of gloves 96.1% vs 94.8%; Safe needle disposal 96.7% vs 96.1%; Vaccination 94.8% vs 67.9%). Of the subjects in Group I,94.8% were vaccinated and 67.9% were vaccinated in Group II, withcomplete vaccination rates being 76.3% and 43.1%, respectively, and the difference was statistically significant (P < 0.001). Better knowledge and attitude led to more adoption of preventive practices. But, still, there is a gap in the KAP towards hepatitis B preventive practices and knowledge is not getting transformed into practices. We recommend that all HCWs should be questioned about their vaccination status.In addition, vaccination coverage, various preventive campaigns, and the hospital infection control committee (HICC) need to be strengthened.

The Prevalence of Colonization with Carbapenem-resistant Enterobacteriaceae, Escherichia coli, Klebsiella and Enterobacter, and Related Risk Factors in Children

Background: Carbapenems are broad-spectrum antibiotics used to treat the family of gram-negative Enterobacteriaceae, especially those that are resistant to first-line antibiotics. Because these drugs are usually prescribed as the last line of treatment, resistance to these antibiotics carries irreparable risks to treatment systems, and screening high-risk individuals in medical centers and using infection control measures are critical strategies for eliminating them. Objectives: We investigated the prevalence of colonization of different strains of Enterobacteriaceae, Klebsiella, Enterobacter, and Escherichia coli and their risk factors in hospitalized children. Methods: In this descriptive cross-sectional study, stool samples were taken from patients during the first 48 hours of hospitalization in a tertiary children’s hospital and were cultured on Makcanki culture medium or EMB. Cultured Enterobacteriaceae samples were transferred to Müller-Hinton agar medium, and their antibiotic susceptibility was evaluated with meropenem and imipenem discs by disc diffusion method. In the next step, five common carbapenemase genes, including (VIM, IMP, OXA-48, NDM-1, and SPM-1) were examined by PCR method and reported accordingly. Results: Two hundred and ninety-five stool samples were examined, of which 242 (82%) samples were cultured positively with Enterobacteriaceae. The prevalence of carbapenem resistance was reported to be 37% among 295 samples using the phenotypic method. Resistance rates were high in patients with a history of antibiotic use, with frequent hospitalizations (more than two episodes in the last six months), and in patients with an underlying disease) malignancy, GI diseases, immunodeficiency, neurologic diseases such as cerebral palsy and epilepsy, endocrine diseases. Most of the genes found were OXA-48, followed by IMP and VIM. NDM-1 was found in 3 samples, and SPM was not found in any of the samples. In 13% of resistant samples, more than one carbapenemase gene was found. Conclusions: The results of this study showed that the frequency of carbapenem resistance in stools colonized with Enterobacteriaceae is high in our patients. On the other hand, the presence of carbapenemase genes in these bacteria, which are located on the plasmids that can be rapidly spread in the hospital environment, is an alarm for the hospital infection control committee to take preventive measures in order to prevent the spread of these bacteria in the hospital.

Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective.

Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world's major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption. Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements. Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of "structure", "process" and "result" proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021. Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44). Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations.

A STUDY TO ASSESS THE EFFECTIVENESS OF INFECTION CONTROL COMMITTEE IN THE PUSHPAGIRI MEDICAL COLLEGE HOSPITAL, TIRUVALLA

Background of the study: American Medical Association first recommended in 1958 that hospital set up Infection Control Committee. Though not widely accepted with modification of original policy in 1976, Infection Control Committee functions effectively to reduce the spread of infectious diseases. Infection control reduces mortality and morbidity due to nosocomial infection. It helps to maintain employee health and morale. Objectives of Study was to analyse the effectiveness of Infection Control Committee of Pushpa Giri Medical College Hospital Tiruvalla and also to study the function and importance and functions of hospital infection control committee. Methodology: The study was conducted at Pushpa Giri Medical College Hospital Tiruvalla. The population selected was 2 set of populations which consist of all Infection control committee members and all ward in charge Pushpa Giri Medical College Hospital Tiruvalla as sample. A pre tested questionnaire was used to collect the data and distributed among 15 hospital infection control committee members and 35 wards in charge. The period of study was 45 days from 6-5-2019 to 28-6-2019. The filled in questionnaires were collected, classified and analysed. Results: The study revealed that the infection control committee is effective. It is vital in rendering service to the patients. The infection control committee functions efficiently and follows the international guidelines. Conclusion: The observations revealed that the policies and procedures of this hospital is based on CDC and WHO guidelines. There are too many factors influencing the effectives functioning of Hospital Infection Control Committee

Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study.

Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.

Portable Biosafety Barrier Innovations to Limit Transmissibility of Infectious Diseases during Patient Care in Resource-limited Settings during the COVID-19 Pandemic.

ABSTRACTBackgroundThe coronavirus disease-2019 (COVID-19) pandemic has brought about a change in healthcare practices that are likely to persist into the foreseeable future. In particular, is the exposure risk to the healthcare practitioners in the emergency department (ED) and the intensive care units. Mitigating this issue in a low-resource setting remains challenging, and in particular, in developing nations such as India, where ED patient flows can overwhelm a system and its human resources, breaking down processes and infecting healthcare workers (HCWs).TechniqueTo tackle this and the possible lack of appropriate personal protective equipment (PPE), we designed and built biosafety barrier devices using local resources for use in patient stabilization, transport, and continued care in the ED or the intensive care units.ResultsFour biosafety devices bio-safe levels 1 and 2, ultra-ductile portable interface of interventions in infections, and tented transport trolley for transmissibility (4T) were tested for the feasibility of usage for patient care during the pandemic with simulation.ConclusionWe anticipate that with time it may be common practice for in situ isolation of patients in the emergency departments with a suspicion of an infectious disease. With the proof of concept, simulation, hospital infection control committee (HICC) approval, and trial run, we look to close the gaps that exist in these initial innovations.How to cite this articleBalakrishnan JM, Sirur FM, Prakash N, Bhat R, Wilson W, Angadi B, et al. Portable Biosafety Barrier Innovations to Limit Transmissibility of Infectious Diseases during Patient Care in Resource-limited Settings during the COVID-19 Pandemic. Indian J Crit Care Med 2022;26(9):1036–1038.

Ten Practice Changes in COVID-19 Intensive Care Unit of a Tertiary Care Teaching Hospital in India during the Peak of Pandemic: Adapt and Improve.

During the peak of the coronavirus disease-2019 (COVID-19) pandemic, 10 practice-changing decisions were adopted which led to an improved standard of clinical care in the face of overwhelming burden to the healthcare setup. Formation of a control unit with the piggyback team, briefing before donning, replacement of personal protective equipment (PPE) with impermeable surgical gowns, a dedicated prone team and the prone bundle of care, weaning-extubation and tracheostomy protocol, online audiovisual family-patient meet, daily rounds by hospital infection control committee member, each one clean one policy, focused onsite training of healthcare support staff and discharge policy with post-discharge follow-up were the 10 important changes adopted.How to cite this articleSoni L, Pangasa N, Baidya DK, Subramaniam R. Ten Practice Changes in COVID-19 Intensive Care Unit of a Tertiary Care Teaching Hospital in India during the Peak of Pandemic: Adapt and Improve. Indian J Crit Care Med 2022;26(6):710–711.

An Epidemiological Study of Nosocomial Infection in Post-Operative Patients.

A Nosocomial infection-also called” hospital acquired infection” can be defined as “An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission.” The term Nosocomial infection is applied to any clinical infection that was neither present nor was in its incubation period, when the patient entered the hospital. Nosocomial infections are one of the most common adverse events during healthcare delivery and a major public health issue affecting morbidity, mortality, and quality of life. At any time, up to 7% of patients in developed and 10% in developing countries will acquire at least one Healthcare-associated infection (HAI), causing a considerable economic burden to the society. It is evident that HAIs result in prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, additional cost on health systems, high cost for patients and their family, and preventable deaths. The objective of the study was to find out the morbidity pattern in post-surgical wound infections and suggested measures to minimize exogenous and endogenous sources of Nosocomial infections. Out of total 300 patient's details collected, 98 patients were affected by surgical site nosocomial infection. Staphylococcus aureus is found to be the leading pathogens in post-surgical wound infection. In this study, we also found that reducing preoperative stay can reduce the postoperative surgical site infection. In conclusion, we should clearly understand and identify the nosocomial infections and device a system to track, analyse, monitor prevent and treat. Hospital infection control committee should meet regularly and make recommendations at all levels for prevention of Nosocomial infections. Total prevention may not be possible but can be minimized to significant extent by implementing the guidelines developed during the present study.&#x0D;

Preparation of operating room for COVID-19 suspects at a tertiary care teaching hospital in New Delhi, India

The continuous rise in the number of cases of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), generated an urgent need to transform the facilities of our existing operating rooms (OR) to cater for emergency surgeries for patients with suspected COVID-19. The aim was to minimise the spread of infection and to achieve the lowest risk for patients and staff while caring for COVID-19 suspects undergoing surgery. We devised a protocol in our hospital to prepare OR for patients suspected to be suffering from COVID-19 but in whom the surgical intervention could not be deferred until the result of the COVID-19 test was obtained. The key consideration was that we cater to suspected and confirmed COVID-19 patients who required emergency surgery while adhering to strict infection control measures. The study was undertaken as a pilot exercise in consultation with treating surgeons, hospital infection control committee members, hospital administrators, and engineers, along with a literature review, to transform the design and functioning of existing facilities to prepare for emergency surgeries of COVID-19 suspects at the beginning of the pandemic. While this required significant planning on paper and onsite by members of the OR staff, hospital infection control committee, administration, and engineers, the creation of a safe operating environment was possible within a 48-h period with minimal structural alterations.

810. Cardiac Pacemaker Implantation Surgery: Automated Prediction of Surgical Site Infection

BackgroundA research focused on surgical site infection (SSI) was performed in patients undergoing cardiac pacemaker implantation surgery. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through pattern recognition algorithms, in this case the Multilayer Perceptron (MLP).MethodsData were collected from five hospitals in the city of Belo Horizonte (more than 3,000,000 inhabitants), between July 2016 and June 2018, on SSI by the Hospital Infection Control Committees (CCIH) of the hospitals involved in the search. All data used in the analysis during their routine SSI surveillance procedures were collected. So, three procedures were performed: a treatment of the collected database for use of intact samples; a statistical analysis on the profile of the hospitals collected and; an assessment of the predictive power of five types of MLP (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay, and Quick Propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% and 75% for testing, 35% and 25% for validation). They were compared by measuring AUC (Area Under the Curve - from 0 to 1) presented for each of the configurations.ResultsFrom 1394, 572 records were: 21% of deaths and 2.4% patients had SSI; from the confirmed SSI cases, approximately 64.3% had sites classified as “clean”; length of hospital stay ranged from 0 to 175 days (from 1 to 70 days); the average age is 67 years. The prediction power of SSI, the experiments achieved from 0.409 to 0.722.ConclusionDespite the considerable loss rate of more than 65% of the database samples due to the presence of noise, it was possible to have a relevant sampling for the profile evaluation of Belo Horizonte hospitals. Moreover, for the predictive process, although some configurations reached 0.722. To optimize data collection and enable other hospitals to use the SSI prediction tool (available in www.nois.org.br ), two mobile application were developed: one for monitoring the patient in the hospital and the other for monitoring after hospital discharge.Disclosures All Authors: No reported disclosures

Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them?

Background and objectiveThe prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital.Materials and methodsA prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting.ResultsThe surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7).ConclusionDUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.

Developing an Infection Prevention and Control Educational Program for Critical Care Nurses:Intervention Mapping Protocol and Social Cognitive Theory

Aim: This study aims to apply the Intervention Mapping protocol and Social Cognitive Theory in thedevelopment of an infection prevention and control education program aimed at critical care nurses.Background:Education programs have been widely used to improve awareness toward infection preventionand control, but the development of an integrated theory- and evidence-based education program tailored tocritical care nurses has not yet been discussed.Subject and Methods: Data are from the Hospital Universiti Sains Malaysia infection control records. The6-step Intervention Mapping protocol and the Social Cognitive Theory were used to develop an infectionprevention and control education material tailored to critical care nurses. The educational material was alsoinfluenced by Previous literature, hospital infection control committee, and in-charge nurses of intensivecare unit.Results: The educational material was tailored to target knowledge, self-efficacy, and risk perception thatidentified as the individual determinants of critical care nurses health behavior during assessment phase. Inaddition to physical environment and organizational support that determined as external determinants. Amatrix of change objectives was mapped out for each health behavior determinant, teaching methods, andtheir practical applications.Conclusion: Applying the Intervention Mapping protocol and the Social Cognitive Theory is effective indeveloping educational material tailored to critical care nurses to improve their self-confidence and promoteknowledge-based practice in infection prevention and control.

Adherence to Infection Prevention and Control Practices among Health Care Workers and its Outcome in Non-COVID Areas in a Tertiary Care Hospital

International Journal of Medicine and Public Health,2021,11,3,146-149.DOI:10.5530/ijmedph.2021.3.26Published:August 2021Type:Original ArticleAdherence to Infection Prevention and Control Practices among Health Care Workers and its Outcome in Non-COVID Areas in a Tertiary Care HospitalMini Palathingal Narayanan, Anuja Mohan, Priya Chandran, Durga Neelakandan, and Beena Philomina Jose Mini Palathingal Narayanan1,*, Anuja Mohan1, Priya Chandran2, Durga Neelakandan1, Beena Philomina Jose1 1Department of Microbiology, Government Medical College Kozhikode, Kerala, INDIA. 2Department of Community Medicine, Government Medical College Kozhikode, Kerala, INDIA. Abstract:Aim and Objective: 1. To study the adherence to Infection Prevention and Control (IPC) practices by health care workers in Non-COVID areas. 2. To compare the proportion of COVID affected health care workers among those adhering to proper IPC and those with non-adherence. Background: Hospitals serve as frontline health care institutions caring for the increased number of COVID-19 patients. The health care personnel working in hospitals are at increased risk of acquiring the disease during the pandemic. It is the prime responsibility of the Hospital Infection Control Committee to protect the health care workers (HCW) and prevent nosocomial transmission. Materials and Methods: In the cross sectional study,all health care workers from non-COVID areas of the hospital who were exposed to COVID-19 patient during the study period were assessed according to the risk assessment criteria. Results: A total of 1049 health care workers had contact with COVID-19 patients. Of this only 6 health care workers were diagnosed with COVID-19. Conclusion: The HCW diagnosed with COVID-19 was less than one percentage of exposed. This implies the impact that the IPC training had on the HCW which made them ensure their own safety and prevent the nosocomial spread of SARS-CoV-2 within the hospital. Keywords:Adherence, Frontline health care workers, Nosocomial infectionView:PDF (150.3 KB)

Prevalence of Nosocomial Infection Microorganisms and the Presence of Antimicrobial Multi-Resistance

BACKGROUND AND OBJECTIVES: hospitals represent the place where multidrug-resistant bacteria are concentrated and from where they spread within the institution and to the community. Thus, this research aimed to verify the profile of microorganisms related to nosocomial infection and to analyze the existence of multidrug-resistant bacteria at the Hospital de Caridade de Santo Ângelo/RS, the largest hospital in the city. METHODS: hospital infection data from 100 medical records, from August/2016 to March/2017, maintained by the Hospital Infection Control Committee were used. Bacterial identification was carried out by the Microbiology Laboratory of the hospital using morpho-tinting and biochemical methods; and antimicrobial susceptibility was determined by the disk diffusion method. Bacterial multidrug-resistance was considered based on resistance to three or more classes of antimicrobials. RESULTS: the three most prevalent microorganisms were Acinetobacter baumannii (17%), Escherichia coli (16%), and Staphylococcus aureus (8%). The hospital unit with the highest number of isolates was the adult Intensive Care Unit, with 41% of the cases. Tracheal secretion, urine, and wound secretion samples provided the highest number of isolates. Sixteen different species/groups of multidrug-resistant bacteria were identified, as follows: Morganella morganii (100%), Hafnia alvei (100%), Enterobacter sakazaki (100%), Serratia spp. (100%), Enterobacter aerogenes (100%), Proteus vulgaris (100%), Acinetobacter baumannii (100%), Klebsiella pneumoniae (83%), Enterobacter spp. (75%), Klebsiella ozaenae (66%), coagulase-negative Staphylococcus (66%), Escherichia coli (56%), Serratia rubidaea (50%), Serratia marcensces (50%), Staphylococcus aureus (37%) e Pseudomonas aeruginosa (28%). CONCLUSION: the large number of multidrug-resistant isolates reinforces the importance of isolation and restriction strategies to avoid cross-contamination to inside and outside the hospital.

Prevalence of COVID19 infection in health care workers in first wave of pandemic and role of hospital infection control committee in subsequent waves of pandemic

: Corona virus disease 2019 (COVID-19) is a new emerging infectious disease, first identified in China in December 2019, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). : To study and analyze the prevalence, demographic characteristics of healthcare workers (HCWs) who tested positive for COVID-19 in a dedicated Covid hospital in Mumbai.This was a retrospective observational study of HCWs with COVID-19 in a dedicated Covid Hospital, Mumbai from April to October 2020.HCW tested positive for COVID-19 was 55 from April to October 2020.The percentage of infected hospital staff was 9.8%. Most of the infected HCWs were in the age group of 51 to 60. Mean age was 42 years. Mortality was 0.1%. Majority HCWs (70.9%) acquired infection from community; 20% acquired from the hospital and 9.1% acquired infection from infected coworkers. Majority of the affected HCWs were nurses followed by doctors. Comorbidities were reported in 23.6% of infected HCWs. 5.4% of infected HCWs received infection because of aerosol generated procedures. 58.1% of HCWs got infection despite receiving prophylaxis like HCQ, Arsenicumalbicum.HCWs are at an increased risk of COVID-19 in the workplace. Preparedness of HICC (Hospital Infection Control Committee), frequent training sessions and mock drills are of paramount importance in preventing spread of infectious disease. Coordination between Hospital Administrators, Public Health Officials of national and international organizations, Engineering Department, Occupational Health and Safety staff is essential in combating pandemic.

Device associated and surgical site infections, quality indicators in a tertiary care hospital: A 5 year study

Purpose: In the present study, an attempt is made to understand the pattern of HAIs (Healthcare Associated Infections) [device associated infections such as Catheter Associated Urinary Tract Infection (CAUTI), Ventilator Associated Event (VAE), Central Line-Associated Bloodstream Infection (CLABSI) &amp; Surgical Site Infection (SSI) by analyzing statistical tool of quality indicators] and to establish a bench mark for HAIs in a single hospital for a period of 5 years. Methods: The Microbiologist &amp; ICN’s conduct rounds in ICU’s &amp; wards and collect data for active surveillance. The details of culture positive samples are collected by Microbiologist from the laboratory for passive surveillance. The surveillance forms (active &amp; passive) capture details of individual patients. The data collection forms are prepared and updated as per Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN) guidelines. The data is analyzed and presented in the meeting of Hospital Infection Control Committee meeting &amp; discussed with clinicians. Results: The cumulative (5 years) CAUTI rate is 0.45, VAE is 2.42, CLABSI is 1.35 &amp; SSI is 0.21. HAI rates were highest for VAE (2.42/1000 ventilator days), the next was CLABSI (1.35/1000 central line days), followed by CAUTI (0.45/1000 urinary catheter days). SSI rate was 0.21/ 100 surgeries. Conclusions: Before the study was started, the benchmark were 2 for CAUTI, 5.5 for VAE, 3 for CLABSI and 2 for SSI. We could able to reduce the baseline benchmark and established our new benchmark as 1 for CAUTI, 3 for VAE, 2 for CLABSI and 1 for SSI that can be used in developing HAI prevention policies by the institution.