Reduce Health Care-associated Infections Research Articles

ROLE OF PERFORMANCE IMPROVEMENT MEASURES TO IMPROVE THE QUALITY OF INFECTION PREVENTION PROGRAMS IN TERTIARY CARE HOSPITAL

Healthcare-associated infections (HAIs) pose a significant risk in hospital settings. Performance improvement measures can enhance the quality of infection prevention programs, leading to better outcomes for patients. Objective: To assess the impact of performance improvement measures on enhancing the quality of infection prevention programs in a tertiary care hospital. Methods: This quasi-experimental study was conducted with healthcare workers (HCWs), including doctors, nurses, infection prevention officers, and support staff, at a tertiary care hospital. The intervention included comprehensive performance improvement measures: rigorous training, educational initiatives, regular audits with feedback, adherence to standard operating procedures (SOPs), checklists, monitoring tools, and hand hygiene promotion. Quantitative data on infection rates, infection control compliance, hand hygiene adherence, and antibiotic usage were collected at baseline and 3, 6, and 12 months post-intervention. Qualitative data were gathered from semi-structured interviews and focus groups to explore barriers and facilitators to infection prevention. Results: The intervention group showed a significant reduction in HAIs per 1,000 patient days compared to the control group (3.06 ± 1.09 vs. 8.23 ± 5.18; p = 0.00). Compliance with infection control practices (71.0% vs. 61.0%; p = 0.13) and hand hygiene adherence (64.0% vs. 48.0%; p = 0.02) were also higher in the intervention group. However, no statistically significant difference in antibiotic usage was observed between the two groups (59.0% vs. 49.0%; p = 0.1). Conclusion: The study demonstrates that performance improvement measures significantly reduce HAIs and improve compliance with infection control protocols. These targeted strategies are essential for enhancing infection prevention in healthcare settings and improving overall patient safety.

The Factors Affecting Surgical Room Nurse's Compliance in Performing Sterile Handwashing in the Central Surgery Installation of RSUD Banyumas

Background: Surgical site infection, as a part of Healthcare-Associated Infections (HAIs), can be prevented by proper handwashing among the surgical team members. Compliance with handwashing has been proven to reduce healthcare associated infections. Method: This was quantitative research with a descriptive correlation design using a cross sectional approach. A total sampling technique was used with a sample size of 35 surgical room nurses’s in the central surgery installation of RSUD Banyumas who met the inclusion and exclusion criteria. The research instrument was aquestionnare. Data analysis was conducted using the chi-square test. Results: The study result show that the majority of nurses have good knowledge (45,7%), high motivation (77,1%), perceive good supervision (74,3%) and are compliant in performing sterile handwashing (71,4%). There is a correlation between knowledge, motivation and supervision with the compliance of surgical room nurses in performing sterile handwashing in the central surgery installation of RSUD Banyumas. Conclusion: Factor such as nurses knowledge and motivation in the surgical room and supervision from the department head are related to the compliance of surgical room nurses in performing sterile handwashing.

World Health Organization World Hand Hygiene Day, 5 May 2024. SAVE LIVES: Clean Your Hands campaign: Promoting knowledge and capacity building on infection prevention and control, including hand hygiene, among health and care workers.

The World Health Organization's (WHO) World Hand Hygiene Day continues to "bring people together and accelerate hand hygiene action at the point of care in health care to contribute to a reduction in health care-associated infections and the achievement of safer, quality health care for all."

Infection Control in Dentistry: An Evaluation

The dental environment is associated with significant amount of risk for exposure to various micro- organisms. Infection control is one of the prime elements of a successful dental practice. There are many infectious diseases that can be transmitted in a dental environment. New diseases with serious consequences and a high rate of transmission have evolved in the recent past. Infection control is directed at prevention to exposure of such infections and also to prevent it being transferred from person to person. Purpose: The goal of an infection control program is to provide a safe working environment for dental health care personnel and their patients. Practitioners can achieve this by adopting measures that reduce health care-associated infections among patients and occupational exposures among dental health care personnel. It is crucial for all dental practitioners to be up to date on current Centers for Disease Control and Prevention guidelines, equipment, and techniques for proper infection control. Continuous evaluation of infection control practices is important. Patients and dental providers should be confident that oral health care can be delivered and received in a safe manner. Summary: Most steps in infection control routine are directed at prevention of contact with infectious agent. Personal protection barriers are of great significance in this process. Various methods like sterilization, decontamination and disinfection are indispensable. The WHO and CDC have issued certain guidelines regarding prevention and dealing with certain infective conditions. Dentists need to update themselves about these guidelines, to be able to administer these policies effectively. Use of disposable items may be expensive but is an effective and simple means of infection control. More and more disposable items are being inducted into dental practices especially critical items like needles, syringe etc. With careful evaluation and analysis, infection control routine can be employed in daily practice with the resources available. Constant monitoring and evaluation of infection control routines is required for good effectiveness.

Effectiveness of educational interventions to reduce healthcare- associated infections in adult intensive care units: a scoping review

Healthcare-associated infections (HAIs) represent a serious threat to patients admitted to hospitals and particularly to ICUs, as they contribute to increased mortality, prolonged length of stay and consequently increased healthcare costs. The aim of the present scoping review was to evaluate the effectiveness of educational interventions for the reduction of these infections in the adult ICU. A systematic literature search was conducted from December 2022 to March 2023, making use of official electronic databases such as PubMed, SCOPUS, CINAHL and Cochrane Database of Systematic Reviews; the key terms used for the search were the following: "Healthcare Associated Infections"; "educational interventions"; "intensive care unit" in all possible combinations and making use of the Boolean operators "AND" and "OR"; the application of the PRISMA methodology allowed a final screening of ten[MOU2] (10) studies on which the present review was based. In the selected studies, it was evident that education was essential and should be shared between multidisciplinary care teams, patients, their families, and caregivers. Statistical significance was found in two studies that demonstrated a reduction in HAIs. Despite considerable variation in the duration and type of educational intervention, the importance of establishing continuing education to maintain intervention results.

The impact of autocancellation of uncollected Clostridioides difficile specimens after 24 hours on reported healthcare-associated infections: A quality improvement intervention.

To assess the impact of a 24-hour autocancellation of uncollected Clostridioides difficile samples in reducing reported healthcare-associated infections (HAIs). Quality-improvement, before-and-after implementation study. The study was conducted in 17 hospitals in Pennsylvania. Clostridioides difficile tests that are not collected within 24 hours are automatically canceled ("autocancel") through the electronic health record. The intervention took place at 2 facilities (intervention period November 2021-July 2022) and subsequently at 15 additional facilities (April 2022-July 2022). Quality measures included percentage of orders canceled, C. difficile HAI rate, percent positivity of completed tests, and potential adverse outcomes of canceled or delayed testing. Of 6,101 orders, 1,090 (17.9%) were automatically canceled after not being collected for 24 hours during the intervention periods. The reported C. difficile HAI rates per 10,000 patient days did not significantly change. These rates were 8.07 in the 6-month preintervention period and 8.77 in the intervention period for facilities A and B combined (incidence rate ratio [IRR], 1.09; 95% CI, 0.88-1.34; P = .43), and were 5.23 HAIs per 10,000 patient days in the 6-month preintervention period and 5.33 in the intervention period for facilities C-Q combined (IRR, 1.02; 95% CI, 0.79-1.32; P = .87). From the preintervention to the intervention periods, the percent positivity rates of completed C. difficile tests increased by 1.1% for facilities A and B and by 1.4% for facilities C-Q. No adverse outcomes were observed. The 24-hour autocancellation of uncollected C. difficile orders reduced testing but did not result in reported HAI reduction.

Development of a Broth Microdilution Method To Characterize Chlorhexidine MICs among Bacteria Collected from 2005 to 2019 at Three U.S. Sites.

Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms has been adopted by many U.S. hospitals, but increasing chlorhexidine use has raised concerns about possible emergence of resistance. We sought to establish a broth microdilution method for determining chlorhexidine MICs and then used the method to evaluate chlorhexidine MICs for bacteria that can cause health care-associated infections. We adapted a broth microdilution method for determining chlorhexidine MICs, poured panels, established quality control ranges, and tested Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae complex isolates collected at three U.S. sites. Chlorhexidine MICs were determined for 535 isolates including 129 S. aureus, 156 E. coli, 142 K. pneumoniae, and 108 E. cloacae complex isolates. The respective MIC distributions for each species ranged from 1 to 8 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 1 to 64 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 4 to 64 mg/L (MIC50 = 16 mg/L and MIC90 = 32 mg/L), and 1 to >64 mg/L (MIC50 = 16 mg/L and MIC90 = 64 mg/L). We successfully adapted a broth microdilution procedure that several laboratories were able to use to determine the chlorhexidine MICs of bacterial isolates. This method could be used to investigate whether chlorhexidine MICs are increasing. IMPORTANCE Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms and reduce health care-associated infections has been adopted by many hospitals. There is concern about the possible unintended consequences of using this agent widely. One possible unintended consequence is decreased susceptibility to chlorhexidine, but there are not readily available methods to perform this evaluation. We developed a method for chlorhexidine MIC testing that can be used to evaluate for possible unintended consequences.

The Effects of an Advanced Air Purification Technology on Environmental and Clinical Outcomes in a Long-Term Care Facility.

Long-term care facilities (LTCFs) are constantly working to reduce sources of infectious pathogens to improve resident care. LTCF residents are particularly susceptible to health care-associated infections (HAIs), many of which originate from the air. An advanced air purification technology (AAPT) was designed to comprehensively remediate volatile organic compounds (VOCs) and all airborne pathogens including all airborne bacteria, fungi, and viruses. The AAPT contains a unique combination of proprietary filter media, high-dose ultraviolet germicidal irradiation, and high-efficiency particulate air (HEPA) filtration. The AAPT was installed in an LTCF's heating, ventilation, and air-conditioning ductwork and 2 floors were studied: the study floor with comprehensive AAPT remediation and HEPA filtration and the control floor with only HEPA filtration. VOC loading and airborne and surface pathogen loading were measured in 5 locations on both floors. Clinical metrics such as HAI rates were also studied. There was a statistically significant 98.83% reduction in airborne pathogens, which are responsible for illness and infection, an 89.88% reduction in VOCs, and a 39.6% reduction in HAIs. Surface pathogen loading was reduced in all locations except 1 resident room where the detected pathogens were linked to direct touch. The removal of airborne and surface pathogens by the AAPT led to a dramatic reduction in HAIs. The comprehensive removal of airborne contaminants has a direct positive impact on resident wellness and quality of life. It is critical that LTCFs incorporate aggressive airborne purification methods with their current infection control protocols.

Development and Application of an Educational-Training Programme for Infection Control Practitioners in Long-Term Care Hospitals

Elderly persons are at risk of infection due to underlying diseases and weak immune systems. All elderly persons do not require hospitalization in LTCHs, even if have chronic illness or weakened immune systems, but they require care in long-term care hospitals (LTCHs) that have well-trained infection control practitioners (ICPs). This study aimed to develop an educational-training programme for ICPs working in LTCHs using the Developing A Curriculum (DACUM) method. Based on the results of the literature review and the DACUM committee workshop, 12 duties and 51 tasks of ICPs were identified. A total of 209 ICPs participated in the survey, rating 12 duties and 51 tasks on a 5-point scale in terms of frequency, importance, and difficulty. An educational-training programme consisting of five modules was developed, focusing on tasks higher than the mean for each of frequency (2.71 ± 0.64), importance (3.90 ± 0.05), and difficulty (3.67 ± 0.44). Twenty nine ICPs participated in a pilot educational-training programme. The mean programme satisfaction level was 93.23 (standard deviation: ±3.79 points) out of 100 points. The average total knowledge and skill scores were significantly higher after the programme (26.13 ± 1.09, 24.91 ± 2.46, respectively) than before the programme (18.89 ± 2.39, 13.98 ± 3.56, respectively) (p < 0.001, p < 0.001, respectively). This programme will improve the knowledge and skills of ICPs, and thereby contribute to the reduction in healthcare-associated infections in LTCHs.

Direct and indirect healthcare and carbon savings with ACTIVE Particle ControlTM air-purification.

Controlling airborne transmitted disease remains a challenge to clinicians, healthcare administrators, and engineers. Engineering measures are critical to any infection control program but can require extensive installation procedures, may be expensive to maintain, and may not always demonstrate clinical or financial benefit. We determined the financial and carbon benefits of an engineering solution to combat air pollutants and to control airborne transmitted disease. We determined the costs of healthcare associated infections (HAIs), and the costs of installation, maintenance, energy demands, and carbon impacts of an ACTIVE Particle ControlTM (APC) air-purification system. In a 20 month study with over 65,000 patient days the significant reductions in HAIs resulted in significant financial, energy, maintenance, and carbon savings from this engineering solution. Positive clinical and financial outcomes are possible with novel air-purification solutions such as APC.

Resource conservation from the perspective of infection prevention

Procedures to prevent surgical site infections require ahigh input of human, technical and natural resources. This paper explores ways to optimize the use of resources in caring for patients who undergo asurgical procedure without compromising patient safety. Review of the contribution of selected procedures for infection prevention in surgical patients considering current evidence and recommendations by comparing current guidelines and results of clinical trials. Analysis of interventions to implement and increase compliance. Knowledge of current evidence-based recommendations enables not only the identification of procedures with proven effect on infection prevention but also those that are ineffective and thus dispensable. There is still need for further controlled studies, e.g. on the use of antiseptics, that can confirm the evidence level of preventive procedures. Infection surveillance in combination with process and compliance monitoring by infection prevention specialists with afeedback system to healthcare workers are suitable control instruments for infection control management. In the case of increased infection rates, the implementation of evidence-based recommended measures through tailored bundle interventions is successful. Technical measures to maintain environmental conditions must be included in the control process. The reduction of healthcare-associated infections by implementing tailored interventions of infection prevention measures and elimination of ineffective procedures conserves resources and promotes patient safety.

Use of Ozonized Water in the Prevention of Surgical Site Infection in Children Undergoing Cardiovascular Surgery.

Since the reduction of healthcare-associated infections has been a focus for quality patient care, this study aimed to evaluate the surgical site infection rate of children who underwent cardiovascular surgery after implementation of ozonized water system for hand and body hygiene allied to previously implemented preventive measures. Two uniformly comparable groups of pediatric patients underwent cardiovascular surgery. Group A (187) patients were operated prior to installation of ozonized water system (March 1 to August 31, 2019), and group B (214) patients were operated after installation of ozonized water system (October 1, 2019, to March 31, 2020). Ozonized water was used for professional hand hygiene and patient body hygiene. There was statistical significance for surgical site infection reduction in group B (P=0.0289), with a relative risk of 0.560 (95% confidence interval = 0.298 to 0.920), inferring the risk of being diagnosed with surgical site infections in group B was 44% less than in group A. There was no statistical significance regarding mechanical ventilation time (P=0.1998) or mortality (P=0.4457). Ozonized water for professional hand hygiene and patient body hygiene was an adjuvant combined with traditional preventive methods to reduce the risk of surgical site infection, although no impact on hospital stay or mortality was observed.

Development and implementation of a centralized surveillance infection prevention program in a multi-facility health system: A quality improvement project.

To develop, implement, and evaluate the effectiveness of a unique centralized surveillance infection prevention (CSIP) program. Observational quality improvement project. An integrated academic healthcare system. The CSIP program comprises senior infection preventionists who are responsible for healthcare-associated infection (HAI) surveillance and reporting, allowing local infection preventionists (LIPs) a greater portion of their time to non-surveillance patient safety activities. Four CSIP team members accrued HAI responsibilities at 8 facilities. We evaluated the effectiveness of the CSIP program using 4 measures: recovery of LIP time, efficiency of surveillance activities by LIPs and CSIP staff, surveys characterizing LIP perception of their effectiveness in HAI reduction, and nursing leaders' perception of LIP effectiveness. The amount of time spent by LIP teams on HAI surveillance was highly variable, while CSIP time commitment and efficiency was steady. Post-CSIP implementation, 76.9% of LIPs agreed that they spend adequate time on inpatient units, compared to 15.4% pre-CSIP; LIPs also reported more time to allot to non-surveillance activities. Nursing leaders reported greater satisfaction with LIP involvement with HAI reduction practices. CSIP programs are a little-reported strategy to ease burden on LIPs with reallocation of HAI surveillance. The analyses presented here will aid health systems in anticipating the benefit of CSIP programs.

Infection Prevention and Control Practice among Healthcare Professionals in Two Public Hospitals in Edo State, Nigeria.

Background: Effective infection prevention control (IPC) have been shown to reduce healthcare associated infections and to curtail epidemics and pandemics. Compliance by healthcare professionals (HCPs) is an important part of IPC measures. Objectives: This study investigated IPC practice, barriers and enablers among healthcare professionals (HCPs) in secondary and tertiary healthcare facilities. Methods: This was a cross-sectional study among 370 HCPs in a tertiary and secondary healthcare facility. Data was collected using an interviewer-administered questionnaire and the assessment was done using defined scoring systems. SPSS version 22 and Graphpad Instat were used for data analysis. Associations between variables were assessed using Chi-square and student’s t tests with significance level set at p&lt;0.05. Results: Of the 370 participants, 195 (52.7%) had an average score for IPC practice and 269 (72.7%) of participants had good score for hand hygiene. HCPs in tertiary institution had a higher mean score compared to those in secondary institution on IPC (41.52±5.96/41.07±8.46-p=0.0009) and hand hygiene practice (30.72±5.979/29.08±5.63; p=0.1747) respectively. Nurses had a higher mean score compared to physicians on IPC (31.19±4.801/25.60±7.937; p=&lt;0.001) and hand hygiene (43.34±4.170/39.83±3.673; p=0.001). Barriers to IPC are work overload 299(80.8%), lack of adequate materials 319 (86.3%) and lack of hand hygiene facilities 260 (70.8%). Conclusion: This study revealed that many HCPs had moderate practice of IPC and good practice of hand hygiene. Differences in practice among HCPs was observed which can be addressed with hospital leaders creating a stronger IPC culture and routine training of HCPs.

Infection Prevention and Control in Three Tertiary Healthcare Facilities in Freetown, Sierra Leone during the COVID-19 Pandemic: More Needs to Be Done!

Infection Prevention and Control (IPC) measures are critical to the reduction in healthcare-associated infections, especially during pandemics, such as that of COVID-19. We conducted a hospital-based cross-sectional study in August 2021 at Connaught Hospital, Princess Christian Maternity Hospital and Ola During Children’s Hospital located in Freetown, Sierra Leone. We used the World Health Organization’s Infection Prevention and Control Assessment Framework Tool to assess the level of IPC compliance at these healthcare facilities. The overall IPC compliance score at Connaught Hospital was 323.5 of 800 points, 313.5 of 800 at Ola During Children’s Hospital, 281 of 800 at Princess Christian Maternity Hospital, implying a ‘Basic’ IPC compliance grade. These facilities had an IPC program, IPC committees and dedicated IPC focal persons. However, there were several challenges, including access to safe and clean water and insufficient quantities of face masks, examination gloves and aprons. Furthermore, there was no dedicated budget or no healthcare-associated infection (HAI) surveillance, and monitoring/audit of IPC practices were weak. These findings are of concern during the COVID-19 era, and there is an urgent need for both financial and technical support to address the gaps and challenges identified.

Success factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil

OBJECTIVE: To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. METHODS: This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. RESULTS: The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. CONCLUSION: The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

BackgroundHand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures. AimTo systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I2 statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. FindingsSeven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%). ConclusionsDuring the COVID-19 pandemic, the compliance of health care providers’ HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for “before contact with patients” should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.

Reducing the Healthcare-Associated Infections in a Rehabilitation Hospital under the Guidance of Lean Six Sigma and DMAIC.

The reduction of healthcare-associated infections (HAIs) is one of the most important issues in the healthcare context for every type of hospital. In three operational units of the Scientific Clinical Institutes Maugeri SpA SB, a rehabilitation hospital in Cassano delle Murge (Italy), some corrective measures were introduced in 2017 to reduce the occurrence of HAIs. Lean Six Sigma was used together with the Define, Measure, Analyze, Improve, Control (DMAIC) roadmap to analyze both the impact of such measures on HAIs and the length of hospital stay (LOS) in the Rehabilitative Cardiology, Rehabilitative Neurology, Functional Recovery and Rehabilitation units in the Medical Center for Intensive Rehabilitation. The data of 2415 patients were analyzed, considering the phases both before and after the introduction of the measures. The hospital experienced a LOS reduction in both patients with and without HAIs; in particular, Cardiology had the greatest reduction for patients with infections (−7 days). The overall decrease in HAIs in the hospital was 3.44%, going from 169 to 121 cases of infections. The noteworthy decrease in LOS implies an increase in admissions and in the turnover indicator of the hospital, which has a positive impact on the hospital management as well as on costs.

Surveillance of device-associated infections at a tertiary care hospital of Punjab

Background: Surveillance of health-care-associated infections (HAIs) plays a key role in the hospital infection control programme and reduction of HAIs. Device-associated infections (DAIs) are an important cause of excessive stay and mortality. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. Aims and Objectives: The aim of the study was to know the rate and microbiological profile of DAIs. Materials and Methods: This surveillance study was conducted over a period of 2 years. Patients with indwelling devices were included. The data were collected and analysed by infection control team and labelled DAIs as per the CDC guidelines. The rates of HAIs and the profile of pathogens isolated were analysed. Results: A total of 294 patients developed DAIs, of which 181 were male and 113 were female. A total of 239 device-associated infections were reported in 2019 and 55 in 2020 and overall rate of DAIs was 1.81 and 0.58/1000 device days, respectively. Among DAIs, 50 were ventilator-associated pneumonia (VAP), 71 central line-associated bloodstream infections (CLABSI) and 173 catheter-associated urinary tract infection (CAUTI) cases. Overall, the rate was 2.02,1.21,1.21/1000 device days for VAP, CLABSI and CAUTI, respectively. In DAI's, majority were males and maximum cases developed after 6–10 days, 15 days and 11–15 days of device use in VAP/CAUTI and CLABSI, respectively. Gram-negative isolates (85.1%) were predominant, and among these, most common were Klebsiella spp, Acinetobacter spp and Escherichia coli. A high rate of multidrug resistance was observed. Conclusions: The present surveillance shows high resistance pattern of Gram-negative organisms causing DAIs. To reduce the risk of infection in hospitalised patients, DA-HAI surveillance is of primary importance as it helps in implementing preventive measures.

Perspectives of hospital leaders and staff on patient education for the prevention of healthcare-associated infections.

Device-related healthcare-associated infections (HAIs), such as catheter-associated urinary tract infections (CAUTIs) and central-line-associated bloodstream infections (CLABSIs), are largely preventable. However, there is little evidence of standardized approaches to educate patients about how they can help prevent these infections. We examined the perspectives of hospital leaders and staff about patient education for CAUTI and CLABSI prevention to understand the challenges to patient education and the opportunities for improvement. In total, 471 interviews were conducted with key informants across 18 hospitals. Interviews were analyzed deductively and inductively to identify themes around the topic of patient education for infection prevention. Participants identified patient education topics specific to CAUTI and CLABSI prevention, including the risks of indwelling urinary catheters and central lines, the necessity of hand hygiene, the importance of maintenance care, and the support to speak up. Challenges, such as lack of standardized education, and opportunities, such as involvement of patient and family advisory groups, were also identified regarding patient education for CAUTI and CLABSI prevention. Hospital leaders and staff identified patient education topics, and ways to deliver this information, that were important in the prevention of CAUTIs and CLABSIs. By identifying both challenges and opportunities related to patient education, our results provide guidance on how patient education for infection prevention can be further improved. Future work should evaluate the implementation of standardized approaches to patient education to better understand the potential impact of these strategies on the reduction of HAIs.