|Year : 2017 | Volume
| Issue : 3 | Page : 102-117
Oral Paper Abstract
|Date of Web Publication||20-Jun-2018|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Oral Paper Abstract. J Patient Saf Infect Control 2017;5:102-17
| OP-1 Rg No: 299: Antibiotic Audit: Need of the Hour!!|| |
Category: Antimicrobial Stewardship
Department of Microbiology, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
Background: Improving the use of antibiotics is an important patient safety and public health issue as well as a national priority. Antibiotic stewardship is one of the novel steps in this direction.
Methods: It was a prospective study, conducted over a period of three months from July to September 2016. The case files of patients were examined and compliance to antibiotic policy checked.
Results: Higher class of antibiotics were started in category 1 and 2 patients.
The patients were categorized in 4 categories:
- Patient Type 1 (CAI)
- No contact with healthcare system
- No prior antibiotic treatment
- Patient young with no or few comorbid conditions
- Severity- No Organ Failure
- Patient Type 2 (HAI)
- Contact with healthcare system (eg. Recent hospital admission, nursing, home, dialysis)without invasive procedure
- Recent antibiotic therapy
- Patient old with multiple co-morbidities
- Severity – One- Organ Failure
- Patient Type3 (NI)
- Long hospitalization and or invasive procedure
- Recent & multiple antibiotic therapies
- Cystic fibrosis, structure lung disease, advanced AIDS, neutropenia, other severe immunodeficiency
- Severity- More than One Organ Failure
- Patient Type 4 (NI)
- Hospitalization>7days or length of ICU stay > 3days
- Severe acute necrotising pancreatitis
- Tertiary peritonitis
- Non response to broad spectrum antibiotic after 96 hours of treatment
- Look out for additional risk like TPN, Hemodialysis, Multi-focal co-morbid condition colonization, Surgery on ICU admission, severely deficient, Chemotherapy exposure, neutropenia, hematologic or solid organ malignancy.
- Severity- More than One Organ Failure- MODS and
- Hemodynamically unstable
Conclusion: Antibiogram to be shared with clinicians, restricted antibiotic justification form to be vigorously tracked, de-escalation or escalation of antibiotics after culture and sensitivity results to be monitored.
To promote a rational and judicious use of antibiotics, following interventions are needed.
- Antibiogram to be prepared and to be shared with clinicians
- Restricted antibiotic justification form to be vigorously tracked
- De-escalation or escalation of antibiotics after culture and sensitivity results to be monitored
| OP-2 Rg No: 066: Multidrug-Resistant Bacteria among Blood Culture Isolates in a Tertiary Care Hospital in Mumbai|| |
Disha Sharma, A. De, G. Gole, L. Dash, J. S. Shastri
Department of Microbiology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
Introduction: Bacterial pathogens remain an important cause of bloodstream infections as they lead to significant patient morbidity and mortality. The increasing resistance to many antibiotics result in narrowing of treatment options. Monitoring and analysing antimicrobial susceptibility pattern of frequently isolated microorganisms help clinicians to choose effective empirical therapy and develop rational antibiotic policy.
Aims and Objectives: The aim and objective of the study is to find out the bacterial causes of sepsis and their antimicrobial resistance pattern.
Materials and Methods: A prospective observational study of patients admitted to intensive care units (ICUs) and wards and clinically suspected of sepsis was conducted over a period of 1 year (December 2015–November 2016). BACTEC Series 9120 Instrument was used for rapid detection. Subcultures were done on blood agar and MacConkey agar plates from flash-positive bottles and the plates were incubated overnight at 37°C. Organisms were identified by standard biochemical tests. Antibiotic susceptibility test was performed by Kirby–Bauer disc diffusion method, according to the CLSI guidelines 2015.
Results: Of 1976 blood cultures received, 62.95% (1244/1976) were from paediatric age group and 37.05% (732/1976) from adults. Organisms were recovered from 200 (10.12%) blood cultures. Maximum rate of isolation of bacteria was seen in adult ICUs (18.21%), followed by intensive paediatric care unit (11.87%) patients. Incidence of neonatal sepsis was 8.29% (54/651). Among the 200 isolates, Gram-negative bacilli predominated (72.5%). Klebsiella pneumoniae was the most common isolate (28.5%), followed by Acinetobacter species (21%) and Pseudomonas aeruginosa (10%). K. pneumoniae predominated in neonatal ICU and Acinetobacter species in adult ICU. Overall, Staphylococcus aureus comprised 17.5% (35/200), methicillin-resistant S. aureus 9% (18/200) and Enterococcus species 6% (12/200) among all isolates. Maximum extensive drug resistance was seen in K. pneumoniae (71.93%) followed by Acinetobacter species (69.05%). Overall carbapenem resistance in Gram-negative bacilli was 54.48%. Vancomycin and linezolid susceptibility of MRSA was 100%. High-level gentamicin resistance was seen in 50% enterococcal isolates.
Conclusion: Increasing incidence of multidrug-resistant Gram-negative bacilli necessitates regular monitoring of these isolates and implementation of antimicrobial stewardship programme.
| OP-3 Rg No: 087: Post-Cataract Surgery Non-Tuberculous Mycobacterial Infection: Experience in Tertiary Eye Care Centre in North-East India|| |
Krishna Gogoi, J. Medhi, H. Bhattacharjee, M. J. Barman, J. Mahanta1
Sri Sankaradeva Nethralaya, Guwahati, Assam, India
Introduction: Ocular infections caused by non-tuberculous mycobacteria (NTM) are rare. NTM have been implicated in ocular infections as early as 1965 with the first report by Turner et al.1 of a case of chronic keratitis caused by Mycobacterium fortuitum, following the removal of a corneal foreign body. Post-operative infections related to cataract surgery primarily include endophthalmitis and corneal suture infection. This study highlights the clinical findings and clinical and laboratory diagnostic challenges encountered with NTM infections.
Methodology: This study is a retrospective, consecutive, non-comparative review of medical and microbiology records of all patients diagnosed (culture positive) and treated for NTM endophthalmitis between January 2003 and December 2015, i.e. the last 12-year duration. Of total 614 diagnosed patients having culture-positive endophthalmitis, six patients were diagnosed as post-operative endophthalmitis caused by NTM. All the patients had undergone cataract surgery elsewhere. The specimens submitted for laboratory investigations included vitreous aspirates, anterior chamber taps, intraocular lenses, sutures and corneal button. These specimens were processed as per the standard protocols in the microbiology laboratory. Data collected included demographic details, cause and duration of symptoms, presenting and final visual acuity, surgical interventions and microbiology data. The isolates were sent to Regional Medical Research Centre (RMRC), Dibrugarh, for confirmation and speciation.
Results and Conclusion: Of 614 clinically diagnosed post-operative endophthalmitis patients investigated during the study period (January 2003–December 2015), 188 (30.6%) were culture positive for bacteria. Of these, six (0.98%) were identified as non-tuberculous mycobacteria. The species of NTM were Mycobacterium chelonae and Mycobacterium abscessus. All isolates were sensitive to amikacin. The isolates were sent to RMRC, Dibrugarh (Dr. J. Mahanta), for confirmation and speciation. The median time duration of onset of symptoms from time of surgery is 22.5 days. The mean duration for a primary culture to become positive was 7 days. The initial treatment strategy was intraocular antibiotics (IOABs) and combined pars plana vitrectomy and IOAB. One case was lost to follow-up. There were episodes of multiple recurrences in two cases. In majority, the visual prognosis was poor. This study reports a series of six cases of NTM post-cataract surgery endophthalmitis. Despite aggressive management strategies and culture-guided therapy, the visual prognosis is poor. As NTM infections are rare, a high threshold of suspicion should be entertained in patients with late-onset endophthalmitis not responding to standard treatment protocols. To the best of our knowledge, this is the first report of NTM endophthalmitis from Assam.
| OP-4 Rg No:274: Introduction of a Novel Closed Peripheral Intravenous Catheter System|| |
Sheeba John, Priyanka Patil, Seema Rohra Satyajeet Bhoite, Aruna Poojary
Infection Control Team, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
Background: Peripheral intravenous catheters (PIVCs) are the most commonly used invasive devices for parenteral therapy. The complications associated with PIVCs are thrombophlebitis, extravasation, infiltration, infections and risk of needlestick injury (NSI) to the health-care workers (HCWs). We introduced a novel closed PIVC, a three-in-one integrated device, comprising a safety intravenous cannula with blind channel and one extension with two Luer access split septum connectors.
Aim: The aim of the study is the introduction of a novel closed PIVC system and analysis of its advantages over a 6-month period.
Materials and Methods: The device under study was introduced in our setting in January 2016. To start with, a few clinical areas were given sample devices. Feedback was taken and discussed in the Hospital Infection Control Committee (HICC) meeting. HICC recommended the product for use in all clinical departments from April in parallel to the existing angiocath with the intension of phasing out the existing angiocath eventually. IC team trained the HCWs on insertion techniques with the help of audiovisual aids, training with dummy arm and onsite training as and when required.
Results: We faced challenges during implementation with regard to the insertion practices, leakage of dye and increased device cost which were overcome subsequently. After the introduction of this device, the incidence of thrombophlebitis decreased by 50%. No incidence of exposure to blood during insertion was documented. NSI during insertion and removal was not reported. The indwelling time increased by 66%. The device was also found to be cost-effective.
Conclusion: Introduction of new devices is always a challenge. To overcome this, a stepwise approach must be adopted and a smooth transition ensured from the previous device to the new device. Continuous training, feedback and support to the HCWs are also the essential elements of this process.
| OP-5: An In-House Designed Surgical Site Infection Prevention Bundle Checklist and Its Implementation for Tracking Coronary Artery Bypass Grafting Patients|| |
Category: Prevention Strategies
Kavita Sangma, Sanjeeta Singh, Smita Sarma1, Kanchan Raghuwanshi2, Sharmila Sengupta1
Departments of Infection Control, 1Infection Control and Clinical Microbiology and 2Infection Control and Administration, Medanta - The Medicity Hospital, Lucknow, Uttar Pradesh, India
Introduction: Quality work cannot be achieved without comprehensive documentation of the important check points at each stage of process. The documentation emphasizes the role of fact finding (not fault finding) and preventive action (not post mortem) on problems that affects the quality of the process. The use of checklist has been demonstrably associated with significant reductions in morbidity and mortality in diverse health care associated infections with improvement in compliance to infection control practices. Checklist from WHO on surgical safety has been adopted globally for both developed and developing countries. However our experience with the WHO checklist fell short of analysis of causes of SSI. Finding specific reason for the development of the infection has always been inconvenient as there are multiple contributing and confounding factors for SSI. Hence we developed and introduced a comprehensive checklist to cover all important checkpoints for SSI prevention during entire process of surgery.
Materials and Methods: Patients who have undergone coronary artery bypass grafting (CABG) in 2016 in our hospital were followed from the time of admission till 90 days after procedure using the newly developed checklist.
Results: Total number of CABG performed from January 2016 to June 2016 is 1505, for which the rate of SSI is 0.46%, and the total number of CABG from July 2016 to December 2016 is 2315.
Conclusion: After the analysis of SSI audit tool and implementation of the necessary changes, a down fall in SSI rate was seen from July 2016 to December 2016 compared to the set of previous six months data. It was observed that the checklist proved to be an active reminder and awareness tool for healthcare workers during the surgery. Thus can conclude that appropriately designed checklist proved to be an effective quality tool for process improvement. Apart from the implementation of the checklist, continuous staff education and communication with the primary team should always be the priority.
| OP-6 Rg No: 251: Incidence of Multidrug-Resistant Organisms in Immunocompromised Patients in a Tertiary Care Cancer Centre|| |
Ravikumar C. Ubhare, Rohini Kelkar, Sanjay Biswas
Tata Memorial Centre, Mumbai, Maharashtra, India
Introduction: Irrational use of antimicrobials has resulted in alarmingly high prevalence of multidrug-resistant organisms (MDROs). For epidemiological purposes, MDROs are defined as microorganisms predominantly bacteria that are resistant to one or more classes of antimicrobial agents. These highly resistant organisms deserve special attention in health-care facilities. Common MDROs are extended-spectrum beta-lactamase (ESBL) producing Escherichia More Details coli and Klebsiella pneumoniae, Enterobacter species, Acinetobacter baumannii and Pseudomonas aeruginosa.
MDROs have been associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalisation and those who are critically ill and exposed to invasive devices such as ventilators or central venous catheters. Laboratory identification of MDROs will be critical for limiting the spread of this resistance mechanism. We undertook this retrospective study to assess the presence of MDROs in cancer patients who are more vulnerable to infections.
Materials and Methods: A total of 34,719 samples were received from January 2016 to November 2016 in the Department of Microbiology, Tata Memorial Centre. All the samples were processed and characterised to the species level as per the standard microbiological procedures. Antibiotic susceptibility testing was performed by the Kirby–Bauer disc diffusion method.
Results: Of the 34,719 samples received during the study period, 8012 showed growth. A. baumannii (53.76%) was the most common multidrug-resistant isolate followed by K. pneumoniae (39.92%), E. coli (23.65%), P. aeruginosa (18.41%) and Enterobacter spp. (8.58%). ESBL positivity was 74.6%. MDROs were isolated from samples, bronchoalveolar lavage (BAL)/NDBAL (22.58%), pus (4.69%), sputum (3.61%), urine (2.56%) and blood (2.38%).
Conclusion: High prevalence of MDROs is related to extensive usage of antibiotics in the hospital. Empirical usage of antibiotics should be on the basis of susceptibility pattern. Infection control practices need to be strengthened.
| OP-7 Rg No: 215: Milestones in Sharps Safety|| |
Shamita Binod, Sandeep Tandon, Rajput, Sabeena Ansari, Sanjay Biswas, Rohini Kelkar
Tata Memorial Centre, Mumbai, Maharashtra, India
Background: Health-care workers (HCWs) are vulnerable populations for infections with blood-borne pathogens. This timeline analysis of data over a period of two decades is to determine the prevalence and trends of occupational exposures to blood and body fluids.
Methods: A retrospective analysis of all the accidental exposure cases documented at the staff clinic of TMH, during 1998–2000, 2010–2011 and 2015–2016, was done. The objective was to study the impact of various continuing medical education (CME) as also trends following the introduction of safety devices. The study included doctors, nurses, laboratory technicians and labour staff.
Results: The 2-year period from 1998 to 2000 showed 40 cases of accidental exposures. Sixty-seven needlestick injuries were registered during 2010–2011, followed by 178 cases of accidental exposures in 2015–2016. The incidences of exposures have shown a 19% increase in the doctors as compared to the 1998 study period, followed by 10% in the nursing services. There has been a decline in the incidences among labour staff and technical staff. The decreased numbers are due to safe disposal practices. Forty-seven per cent of the accidental exposures in 2015–2016 have occurred during patient related procedures/interventions.
Conclusion: Prevention of sharp injuries is an integral part of the prevention programmes in workplace. Training of HCWs regarding safety practices indispensably needs to be an on-going activity in a health-care setup. To facilitate planning of further preventive measures, the epidemiology and trends of blood body fluids exposures need to be surveyed at appropriate intervals. The time–trend analysis has shown that the CME conducted during the awareness programmes had had a positive response. The markers of the same were increased compliance to vaccination programmes, increased documentation of baseline viral markers and decreased incidences of injuries due to recapping. A remarkable trend observed in this analysis is the increasing awareness towards reporting of sharp injuries. This is clearly evident from the increased number of documented cases, wherein injuries with sterile needles have also been reported alongside accidental splashes and sharp injuries.
| OP-9 Rg No: 155: Detection Of BlaNdm-1 Gene in the Multidrug-Resistant Gram-Negative Bacilli Isolated from Tertiary Care Hospital of Assam|| |
Richa Agarwal, Reema Nath, Purnima Barua
Department of Microbiology, Jorhat Medical College and Hospital, Jorhat, Assam, India
Background: Bacteria from hospital settings are becoming increasingly resistant to conventional antibiotics. A decade ago, the concern which centred on Gram-positive bacteria has now been shifted to resistance in Gram-negative bacteria. The resistant bacteria pose a great threat to human health and have become an issue of major concern worldwide. New-Delhi metallo-beta-lactamase-1 (NDM-1) is a novel type of metallo-beta-lactamase (MBL) which is named after the city of origin.
Methods: The study was conducted in the Department of Microbiology, Jorhat Medical College and Hospital, from January 2016 to December 2016, a retrospective laboratory-based study. A total of 281 consecutive, non-duplicate multidrug-resistant Gram-negative isolates were cultured from various clinical specimen and identified using conventional method. Antimicrobial susceptibility test and modified Hodge test for carbapenemase production were performed according to the CLSI guidelines. Molecular detection was performed on 7500 Fast Dx Real-Time polymerase chain reaction (PCR) according to the CDC protocol (kpc-ndm-protocol-2011).
Results: Of 281 multidrug-resistant Gram-negative bacilli, 93 isolates (33.1%) for MBL production and 42 isolates (14.94%) were positive for bla NDM-1 gene by PCR. Hospitalised patients (69%) had a preponderance over the non-hospitalised (31%) with predominantly samples coming from the paediatric ward and specialised newborn care units and nutritional rehabilitation centre. Various clinical specimens were urine (59.9%), sputum (14.28%), blood (9.5%), pus (7.1%) and endotracheal tube and stool (4.7%). Organisms most commonly isolated are Klebsiella sp. (45.2%), Escherichia coli (35.7%) and Pseudomonas (11.9%). Colistin, tigecycline and polymyxin B showed 100% sensitivity.
Conclusion: The spread of bla NDM-1 gene among the bacterial pathogen is of major concern, for which they are resistant not only to carbapenems but also to other multiple antimicrobials, which leaves very few choices for treatment. The other negative isolates can be tested for the presence of other genes such as VIM, IMP and SPM.
| OP-10 Rg No: 306: Study of Effect of Novaerus 200 (Dielectric Barrier Discharge Technology) on Aerial Suspension of Mycobacterium Tuberculosis: a Pilot Study|| |
Category: Prevention Strategies
Roopa Viswanathan Iyer
Department of Microbiology, Qualilife Diagnostics, Mumbai, Maharashtra, India
Background: Transmission of Mycobacterium tuberculosis (MTB) in health-care facilities is a problem worldwide. A pilot study was conducted to study the effectiveness of dielectric barrier discharge (DBD) technology on aerial suspension of MTB.
Methods: Air samples collected from a plastic enclosure placed in a biosafety cabinet aerolised with clinical isolate of MTB post-exposure to Novaerus 200 air purifier based on DBD technology were tested.
Results: There was no growth of MTB in Löwenstein-Jensen and mycobacteria growth indicator tube media post-exposure to Novaerus 200 checked with adequate controls.
Conclusion: The lack of growth of MTB in the air samples collected from the enclosure post-exposure to DBD technology shows the effectiveness of the technology on the MTD rendering it non-viable.
| OP-11 Rg No: 174: Trends and Strengthening of Biomedical Waste Management in a Tertiary Care Hospital|| |
Sikander Hayat, M. Jais, P. Sharma, R. Kaur
Lady Hardinge Medical College and associated Hospitals, New Delhi, India
Background: Although biomedical waste (BMW) constitutes a small portion of the total municipal waste generated, it needs special handling treatment and disposal as it is highly toxic and infectious and can pose a serious threat to human health if not managed in a scientific manner.
Materials and Methods: The BMW team checked segregation, monitored disinfection of waste on site, compliance with the use of facilities by health-care worker (HCW), prepared waste audit, weighed the waste and monitored final disposal. We also gave training to HCWs.
Results: The total BMW for infectious waste (yellow category), disposable plastics (red category) and waste sharps (white category) was 0.16, 0.23 and 0.023 kg/bed/day, respectively, in 2016. The cumulative BMW in 2016 was 0.40 kg/bed/day. There is a significant rise in BMW from 2005 to 2016. Among the biomedical waste, there is significant rise in plastic and sharp wastes; however, there is no significant rise in infectious waste. The total number of doctors and nursing staff trained in 2015 was 550 and 396 and in 2016 was 391 and 454, respectively.
Conclusion: Training is an important component, and type of training matters a lot for improving the segregation of BMW. The increasing amount of BMW in a tertiary care hospital is a big challenge. Every hospital should follow three basic principles of BMW management, i.e. reduce, recycle and reuse as far as possible.
| OP-12 Rg No: 114: Outbreak Of Burkholderia Cepacia In Paediatric Intensive Care Unit in a Tertiary Care Hospital|| |
Hema Paul, J. S. Michael, V. Balaji1, S. Selvan, V. P. Verghese, Kala Ranjini2
Hospital Infection Control Committee, 1Department of Clinical Microbiology, 2Department of Pediatric Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
Burkholderia cepacia complex (BCC) is a non-fermenting Gram-negative bacillus which widely distributed in the environment. It is an opportunistic pathogen in hospitalised and immunocompromised patients and colonises the lungs of patients with cystic fibrosis. It is widely associated with outbreaks in intensive care units, haemodialysis units, bone marrow transplant units and chemotherapy day-care units. The sources of the outbreak are commonly intravenous (IV) fluids, nebulisation solutions, contaminated medication, antiseptic solutions, heparin, ultrasound gel and water for injection.
Here, we describe a 3-week outbreak of nosocomially acquired BCC bacteraemia in a Paediatric Intensive Care Unit, at a large tertiary care teaching hospital in South India.
On investigation, isolates phenotypically similar to the blood culture strains were isolated from 10% to 50% dextrose vials, opened and unopened ultrasound gel and IV fluid in use for two of the affected patients.
Standard precautions including patient isolation and hand hygiene were re-emphasised through education and hands-on training. Terminal disinfection of the environment with standard disinfectants was done. The sterility report of the unopened ultrasound gel was communicated to the vendor. Frequency of hand hygiene and IV line care audits increased.
Strict adherence to the standard precautions and regular surveillance are necessary to control the spread of nosocomial pathogens in intensive care units. Identification of the source and appropriate control measures are essential to eradicate the causative pathogens and prevent further such nosocomial outbreaks.
| OP-13 Rg No: 288: Improving Knowledge and Practices of Nurses Regarding Hospital Infection Control in a Tertiary Care Centre|| |
Category: Prevention Strategies
Rup Jyoti Chandak, Poonam Sood Loomba, Bibhabati-Mishra, Vinita-Dogra
Department of Microbiology, GIPMER, New Delhi, India
Background: Nurses take the upper hand in providing bedside care to the patients in a hospital, thus play a crucial role in hospital infection control. Therefore, nursing staffs should be trained and monitored by conducting regular training sessions on hospital infection control.
Methods: The study included 89 nurses from different wards and Intensive Care Unit. A pre-test and a post-test were conducted with a set of 20 self-designed multiple-choice questions in 3-day session of training covering important aspects.
Results: Response rate of the questionnaire was 100%. The mean pre-test score was 9 (standard deviation [SD] 3.06) while the mean post-test score was 14 (SD 6.34). The difference in pre-test and post-test was statistically significant (P < 0.00001).
Conclusion: Conducting regular training sessions and workshops for health-care workers will help fighting nosocomial infections and providing a better health care.
| OP-14 Rg No: 213: Ventilator-Associated Pneumonia in Paediatric Intensive Care Unit in a Tertiary Care Hospital in Delhi: Incidence and Aetiology|| |
M. Jais, Madhumita Debbarma, M. Sharma, P. Gupta, R. Kaur
Department of Microbiology and Paediatrics, Lady Hardinge Medical College, New Delhi, India
Introduction: ventilator-associated pneumonia (VAP) is a frequent intensive care unit (ICU)-acquired infection. Knowledge of the incidence of VAP and its causative organisms is important for the development and use of more effective preventive measures.
Objectives: The objective of the study is to find out the incidence, aetiology and sensitivity pattern of the VAP causing isolates in paediatric ICU of a tertiary care hospital.
Methodology: we performed a prospective study over a period of 17 months to determine the incidence and causative organisms for the development of VAP in patients admitted to the paediatric ICU of Lady Hardinge Medical College, a tertiary care hospital in Delhi, India.
Result s: A total of 103 patients were enrolled with a mean age of 2.95 years and male:female ratio 1.7:1. Thirty-one (30%) patients developed VAP. Incidence of VAP was 26.13 per 1000 ventilator days and the mortality attributed to VAP was 58.1%. Nine cases (29%) were early-onset VAP and 22 (71%) cases were late-onset VAP. Predominant isolates from endotracheal aspirate were Acinetobacter sp. (37.5%) followed by Pseudomonas sp. and Klebsiella sp. (27.5%) in VAP patients.
Conclusions: Stringent surveillance activity for the early identification of VAP cases is required. Knowledge of organisms likely to be present and a rationale antibiotic regimen will result in reducing mortality.
| OP-15 Rg No: 281: Quantum of Biomedical Wastes Generated from an Oncology Hospital in Eastern India: Trend Analysis and Cost Implications|| |
Category: Environmental Surveillance
Srabanti Bose, Saswati Rakshit
Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
Background: Data on biomedical wastes (BMWs) generated from cancer hospitals in India are lacking. The current study aims to know the quantum of BMW generated from an oncology centre in Kolkata.
Methods: The study was conducted at Tata Medical Center, Kolkata (an oncology hospital with a bed strength of 183). BMWs were segregated according to the rules of the West Bengal Pollution Control Board.
Results: The cost of clearing the BMW was Rs. 299,770 in 2014, Rs. 334,232 in 2015 and Rs. 356,510 in 2016. Operation cost of waste autoclave for the microbiological waste was Rs. 1,025,305 in the financial year 2015–2016.
Conclusion: Appropriate disposal of BMWs is not cheap.
| OP-16 Rg No: 078: Using Innovative (Bar Code) Technology to Improve Biomedical Management in Sri Shankara Cancer Hospital and Research Centre, Bengaluru|| |
Sri Shankara Cancer Hospital & Research Centre, Bengaluru, Karnataka, India
Introduction: The concern for hospital waste management has been felt globally with the rise in infectious diseases and indiscriminate disposal of waste. Thus, government bodies are emphasising and regulating the implementation of Bio-Medical Waste (BMW) Management Rules 2016, which recommends Bar Coding System (Page No. 4), and this model is an attempt to highlight the meticulous management of BMW in hospitals.
An ingeniously designed software with Bar Coding System would track the BMW bags on real-time basis from the point of generation to final disposal. The software is used to help the staff to conveniently segregate, label, transport and dispose the hospital BMW which is integrated into the hospital information system. This would enable the institution to analyse the loopholes in segregation, collection, transportation, weighing and disposal. The reports generated are being used to take mid-course corrective actions and thus develop plans for continuous quality improvement.
Project Aims: The project aims to have clean environment and green environment and to eliminate the following issues in handling of BMW.
- Undue mixing of infectious and non-infectious waste with the proportion of waste generated in particular area
- Check excess duration of storage of waste by decrease waste generation of particular area from baseline
- According to the census, we can check extra generation of waste (undue wastage of resources)
- Timely scavenging helps in reducing the turnaround time (segregation to disposal) of BMW based on the guidelines within 48 h
- Reduces possibility of intentional or downstream reuse of unprocessed BMW
- Accounting of resources such as workforce and material by reducing manual supervision and auditing of BMW management
- Enables supervision, monitoring and auditing to take corrective actions in real-time fashion, even easily monitors the staff practices during night.
Patients Benefit: This system reduces the risk of cross-transmission of infectious diseases, health-care-associated infections and multidrug-resistant organisms and helps to reduce patient length of stay, cost and mortality.
Hospital Benefits: Real-time monitoring helps to achieve project aims.
Health-care Worker Benefits: Decrease infection and their transmission to family members occur with the proper time-bounded hospital waste management system. Continuous training by BMW management team on entire BMW modules helps for their job satisfaction.
Benefits to Community at Large: The menace of infectious waste has been greatly reduced to community by streamlining the entire process of BMW management.
| OP-17 Rg No: 033: Active Surveillance Cultures and Cohorting in a Neonatal Intensive Care Unit: Impact on Blood Culture-Positive Rates With Multidrug-Resistant Organism: a Before-After Study|| |
Category: Prevention Strategy
Kalyan Chakravarthy Bhalla, Celin Arul, Shaila Suresh, Savitha Nagaraj1, P. N. Suman Rao
Departments of Neonatology and 1Microbiology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
Introduction: Hospital-acquired sepsis is a major cause of mortality and morbidity amongst neonates admitted to intensive care. Prevention of spread of infections due to multidrug-resistant organism (MDRO) is proving to be a major challenge due to prior colonisation of babies.
Aims and Objectives: The aim and objective of the study is to determine the impact of active surveillance cultures (ACS) on the incidence of MDRO sepsis in the Neonatal Intensive Care Unit (NICU).
Setting: The study was conducted at tertiary-level NICU catering to intramural and extramural babies.
Materials and Methods: Weekly active surveillance of the skin (surface culture) and gastrointestinal colonisation (stool culture or rectal swab) for MDROs (methicillin-resistant Staphylococcus aureus [MRSA]/vancomycin-resistant Enterococcus [VRE]/meropenem-resistant Gram-positive bacterium) were done for all NICU babies from July 2015 to June 2016. MDRO-colonised neonates (either ACS) were cohorted till their discharge. The incidence of MRDO sepsis was studied for 1 year before surveillance (July 14 to June 15) and compared with the incidence in the year following. Chi-square test was used to compare pre–post-infection rates.
Results: Of 1139 samples cultured, 196 from 124 babies tested positive for MRDO (meropenem-resistant Escherichia coli, Klebsiella, Acinetobacter and Enterobacter species, VRE and MRSA). 31% of the babies were out-born. Before surveillance (July 2014–June 2015), 20 infants had MDRO sepsis; the incidence of culture-positive sepsis with MDROs was 2.53 per 1000 patient days (1.8% of NICU admissions [n = 1118]). Post-introduction of surveillance and cohorting, four infants had MDRO sepsis, reducing the incidence to 0.44 per 1000 patient days (P = 0.0003) (0.3% of NICU admissions [n = 1274], P = 0.0008). Six MDRO sepsis babies from pre-surveillance group had poor outcome (death/discharged against medical advice) compared to none from the post-surveillance group.
Conclusions: New-borns are susceptible to become colonised with resistant bacteria due to contact with the mother, health-care personnel and the environment. Active surveillance and cohorting, though labour intensive, can result in dramatic decrease in the incidence of MDROs and could feature as a part of quality improvement projects to reduce nosocomial sepsis rates.
Keywords: cohorting, multidrug-resistant organisms, surveillance
| OP-18 Rg No: 115: Hospital-Associated Mucormycosis: Experience of a Tertiary Care Hospital from North India|| |
Jagdish Chander, P. Singh, N. Singla, N. Gulati, R. P. S. Punia1, A. Attri2, A. Das3
Departments of Microbiology, 1Pathology, 2Surgery and 3Otorhinolaryngology, Government Medical College Hospital, Chandigarh, India
Introduction: Mucormycosis is an aggressive and life-threatening angioinvasive fungal infection, cited to be the third most common opportunistic infection following candidiasis and aspergillosis in immunocompromised patients. It is caused by a saprophytic filamentous fungus belonging to class Mucormycetes and order Mucorales, which is present ubiquitously in soil, dead and decaying organic material. Infection is acquired either via the respiratory tract, through injured skin or via the percutaneous route, e.g. transmission of spores by contaminated needles or catheters. Hospital-associated or nosocomial mucormycosis is usually related with a health-care procedure (medical devices and surgery, including solid organ transplantation or diagnostic or therapeutic invasive procedures) with a suspected source of infection as the preceding event.
Materials and Methods: Necrotic tissue/pus samples from the suspected lesions were received in the Department of Microbiology and were processed in accordance to the standard mycological procedures. A parallel sample was also sent for histopathological examination for haematoxylin and eosin and periodic acid–Schiff staining. Diagnosis of mucormycosis was established on direct examination KOH wet mount, positive fungal growth and positive histopathological findings.
Results: A total of seven patients were diagnosed of hospital-acquired mucormycosis in a period of 18 months, of which four presented with cutaneous lesions following intramuscular injection and surgical intervention, two presented with lesions of rhino-orbital region following dental extraction and application of some unknown indigenous medication in the oral cavity and one developed oro-antral fistula following dental extraction. Direct examination of KOH wet mount showed the presence of broad aseptate hyphae in the clinical specimen obtained from all the seven patients; fungal culture grew Apophysomyces variabilis in two, Rhizopus microsporus in one and Rhizopus arrhizus in one patient, whereas it was sterile in three patients. Histopathological examination was positive in four patients. Of the four patients who presented with cutaneous mucormycosis, management was done by surgical debridement and intravenous and topical amphotericin B; two patients survived following the treatment. Two patients who presented with rhino-orbital mucormycosis were managed with amphotericin B, along with surgical debridement and orbital exenteration, following which one patient survived. Patient who presented with oro-antral fistula underwent Caldwell-Luc operation and was not administered amphotericin B, following which the patient recovered well.
Conclusion: Hospital-acquired mucormycosis is a preventable entity and care should be taken while treating patients who are at risk such as immunocompromised or diabetic. All aseptic precautions should be taken while taking up any surgical intervention. Reversal of predisposing risk factors, regular extensive surgical debridement and timely antifungal therapy remain the cornerstones of therapy for this life-threatening condition.
| OP-19 Rg No: 082: Tigecycline: Upward Minimum Inhibitory Concentration Creep among Enterobacteriaceae|| |
Category: Health-care Epidemiology
Mandira Chakraborty, Anuradha Agarwal
Department of Microbiology, Belle Vue Clinic, Kolkata, West Bengal, India
Background: Tigecycline (TG) is often one of the few therapeutic options for infections by multidrug-resistant Gram-negative bacteria. It is the first drug to be approved from the glycylcyclines, a new class of semisynthetic agents, being developed to overcome bacterial mechanisms of tetracycline resistance such as ribosomal protection and efflux pumps. However, its rampant use has led to the emergence of isolates with reduced susceptibility and 'minimum inhibitory concentration (MIC) creep' among strains. Our objective was to determine the changing MIC trends of TG against Enterobacteriaceae at Belle Vue Clinic from 2013 to 2016.
Methods: All isolates obtained from clinical specimens submitted to the Department of Microbiology, Belle Vue Clinic, from 2013 to 2016 were included in the study. In vitro antibiotic profiling was performed with the VITEK-2 System (bioMerieux, Mercy I'Etoile, France). Isolates with TG MIC ≤2 μg/ml were considered susceptible while those with MIC ≥8 were resistant and MIC 4 μg/ml was considered as intermediate (USFDA). Only one isolate per patient was included, in case of multiple isolates the first isolate was included. A chart was plotted and proportion of isolates with different MIC of the index year (2013) was compared with the corresponding years to determine the 'MIC creep'.
Results: All members of Enterobacteriaceae family that are normally sensitive to TG, except Klebsiella species, showed no significant MIC variation and majority was sensitive to TG. As shown in [Table 1], percentage of Klebsiella species sensitive to TG was almost same over the 4-year period; it was between 40% and 55%. However, percentage of Klebsiella species having MIC 4 μg/ml (intermediate) steadily declined showing a concurrent increase in percentage of isolates having MIC 8 μg/ml (resistant). Hence, there is definitely a 'creeping in MIC' from 4 μg/ml (intermediate) to 8 μg/ml (resistant).
|Table 1: Distribution of minimum inhibitory concentration among Klebsiella species over the year 2013-2016|
Click here to view
Conclusion: The overall sensitivity percentage of Enterobacteriaceae to TG appears to be reassuringly similar over the years (2013–2016). However, the most significant change in MIC distribution for Klebsiella species was the reduction in isolates with a MIC of 4 μg/ml (40.9%–17.09%) and the increase in isolates with a MIC of 8 μg/ml (4.6%–34.19%) over the 4-year period.
| OP-20 Rg No: 103: Hospital-Acquired Bloodstream Infection by Multidrug-Resistant Bugs: Alarming and Challenging Issue in Intensive Care Units at Present Era|| |
Barnini Banerjee, Soumayan Mondal, K. E. Vandana, Chiranjay Mukhopadhyay, Muralidhar Varma, Kiran Chawla
Departments of Microbiology and Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
Background: Hospital-acquired bloodstream infections (BSIs) pose a significant problem to patients admitted to the Intensive Care Units (ICUs) than other hospital wards. It represents about 15% of all nosocomial infections. Furthermore, multidrug-resistant (MDR) microbes are burgeoning in ICUs making the situation serious. We sought to investigate the possible MDR organisms contributing to ICU-acquired BSI and the source of the BSI by MDR pathogens in the ICUs.
Methods: We conducted a single-centre–based prospective study in four ICUs for 6 months, and patients who developed features of BSI 48 h after admission to the ICUs were included. Blood culture was performed by Automated BacT/ALERT ® 3D System. Patients' demographics, indwelling device usage, microbiological culture reports, drug resistance patterns and the outcomes were recorded. Microbiology culture results for clinical site samples were taken within 48 h of the positive blood culture and analysed in an attempt to identify the source of infection.
Results: A total of 50 patients (25%) had an ICU-acquired BSI. Of 50 patients, 74% of them had bacterial aetiology. 31 patients (62%) among them developed MDR bacteraemia. A high degree of multidrug resistance was observed among Gram-negative (56%) compared to Gram-positive (6%) isolates. Resistance to carbapenem was 42% in this study. The most common MDR Gram-negative isolate was Klebsiella pneumoniae (n = 12, 38.7%), and the most common source of MDR bacteraemia in the ICU was pulmonary infection (26.7%, n = 12).
Conclusion: Most isolates in our study were MDR and carbapenems resistant, which suggests the need for a proper antibiotic policy in the ICUs. Higher ICU-length of stay and longer duration of mechanical ventilation were associated with these infections and ICU mortality was 38%.
| OP-22 Rg No: 070: Opinion-Based Survey of Reserve Antibiotic Usage among Clinicians in a Tertiary Care Hospital from Southern India|| |
Vinod Abishek, Manasa C. Tantry, Muralidhar Varma1, K. E. Vandana, Chiranjay Mukhopadhyay
Departments of Microbiology and 1Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
Background: The backbone of antimicrobial stewardship programme (AMSP) is an appropriate antimicrobial use which can control the development of resistance in the hospital and community setting, reduce the length of stay, cost of treatment and morbidity of the patients. This study aimed at the attitude and the practice of the clinicians in a tertiary health-care setting in prescribing reserve antibiotics.
Methods: This study was carried out to assess the utilisation of reserve antibiotic usage from among prescribers during March–September 2016 in a tertiary health-care setting with 2030 beds from Southern India. We also assessed the indications of prescription of reserve antibiotics.
Results: A total of 603 forms were analysed. Beta lactam-beta lactamase inhibitor combinations were most frequently used, of which 23.05% was given as empirical therapy for suspected health-care-associated infections among patients who had been exposed to broad-spectrum antibiotics in other health-care facilities before admission. Other antibiotics that were used in higher frequencies were carbapenems followed by glycopeptides.
Conclusion: Judicious use of reserve antibiotics with appropriate justification at right dose and duration can save us from moving fast towards the 'Post-Antibiotic Era'. This study strongly highlights the gaps in the antibiotic prescription practices, which can be bridged only through the implementation of AMSP.
| OP-23 Rg No: 175: Incidence of Rectal Carriage of Carbapenem-Resistant Enterobacteriaceae And Their Risk Factors among Patients With Haematological Malignancy|| |
Sarita Mohapatra, Amarjeet Kumar, Arti Kapil, Sameer Bakhshi1, Manoranjan Mahapatra2
Departments of Microbiology, 1Medical Oncology and 2Haematology, AIIMS, New Delhi, India
Introduction: Bloodstream infection (BSI) due to carbapenem-resistant Enterobacteriaceae (CRE) is the leading cause of morbidity and mortality in patients with haematological malignancy. These patients receive chemotherapy during their treatment, which leads to severe mucositis of gastrointestinal tract and myelosuppression. It was hypothesized that the gut coloniser translocates into the blood circulation causing BSI. Colonisation rate with CRE among these patients in India is unknown.
Materials and Methods: A prospective study was carried out to determine the carriage rate of CRE in cancer patients. Rectal swab of 78 patients was collected and processed as per the Centers for Disease Control and Prevention protocol for the detection of CRE. The CRE isolated was identified by the standard phenotypic tests and confirmed for carbapenem resistance by disc diffusion test using all carbapenem discs (imipenem, meropenem, doripenem and ertapenem), and Carba-NP test. Resistant to any of the carbapenem disc is considered as carbapenem resistant.
Results: A total of 78 isolates were detected from the rectal swab, out of which 23 were identified as Gram-positive cocci and 55 (71%) were CRE (Escherichia coli: 45, Klebsiella pneumoniae: 6, Klebsiella oxytoca: 1, Enterobacter spp. : 3). Acute myeloid leukaemia was the most common clinical presentation followed by acute lymphoid leukaemia and thalassaemia. Forty-five out of 78 patients were on chemotherapy. Twenty-six patients were diagnosed with neutropenia. Forty-nine isolates out of 55 (89%) were positive by Carba-NP test, doubtful in two, and negative in four isolates.
Conclusion: This is the first study from India showing CRE carriage rate among the haematological malignancy patients. The prevalence of CRE carriage rate is observed to be highest among the published reports. This confirms the need for infection control prevention activities among the haematological malignancy patients.
| OP-24 Rg No: 180: Device-Associated Nosocomial Infections in Neonatal Intensive Care Units|| |
Category: Health-care Epidemiology
Saurabh Singh, Varnit Shanker1
Department of Neonatology, DACH, Mahatma Gandhi Medical College, Neocare Hospital, 1Department of Pediatrics, DACH, Jaipur, Rajasthan, India
Background: Patient and Intensive Care Unit (ICU) characteristics in the neonatal ICUs (NICUs) suggest that the pattern of nosocomial infections experienced may differ from that seen in adult ICUs.
Methods: Data were collected between January 2014 and December 2015 from NICUs of three leading paediatric hospitals in Rajasthan. Standard surveillance protocols and nosocomial infection site definitions were used.
Results: Data on 3476 neonates with 186 nosocomial infections were analysed. Primary bloodstream infections (31%), pneumonia (24%) and urinary tract infections (16%) were most frequent.
Conclusion: In NICUs, bloodstream infections were the most common nosocomial infection. The distribution of infection sites and pathogens did not differ with gestational age.
| OP-25 Rg No: 037: A Survey Of Staphylococcus Isolates Amongst Commonly Used Fomites of Hospital Personnel With Special Reference to Methicillin Resistance|| |
Department of Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Background: Multidrug-resistant Staphylococcus isolates in hospitals have been recognized as one of the major challenges in the hospital infection control. Methicillin-resistant Staphylococcus spp. present in hospital personnel may act as carriers and can serve as a focus of nosocomial spread of multidrug-resistant staphylococci in tertiary level hospitals and cause problems to hospital infection control programmes. The objective of the study was to find the prevalence of Staphylococcus spp. carriage amongst the fomites commonly used by hospital personnel with special emphasis on methicillin resistance.
Methodology: Bacteriological sampling of commonly used hospital fomites of the hospital personnel involved in patient care was done. Isolates were identified by the standard bacteriological methods up to species level. Each of the Staphylococcus isolates was screened for methicillin resistance using cefoxitin disc.
Results: Of the 152 samples included in the study, 74 showed growth of bacteria, out of which 13 were Staphylococcus aureus and 61 were coagulase-negative Staphylococcus. Out of these, six were methicillin-resistant S. aureus (MRSA) and 21 were methicillin-resistant coagulase-negative Staphylococcus (MRCoNS). Amongst the fomites screened, mobile phone and pen were the largest number of items screened.
Conclusion: The presence of MRSA and MRCoNS provides a definite source of hospital-acquired infection. Periodic surveillance and prompt necessary action in these aspects are necessary to curtail the menace.
| OP-26 Rg No: 300: Days of Therapy Measurement in Antibiotic Stewardship Program-First Step from India|| |
Suresh Kumar Dorairajan MD, FNB (Inf Disease)
Consultant Infectious Disease, Apollo Children Hospital, Chennai, Tamil Nadu, India
Background: Quantification of antimicrobial usage in hospitals usingdaily defined doses (DDDs) & days of therapy (DOTs) are critical for measuring the impact of antibiotic stewardship (ASP) interventions. Latest ASP guidelines insist to monitor DOT rather than DDD for its advantages. However, none of the ASP in India started to measure DOT. Here we reporting the 8 months DOT data from Chennai.
Methods: We prospectively measured the DOT per 1000 patient days of common parenteral antibiotics in a 50 bed pediatric hospital from Chennai for 8 months period between February and September 2016.
Results: The DOTs of ceftriaxone & cefuroxime were consistently high and amikacin&amox- clav DOT varied considerably in this study as shown in [Table 1] below.
Conclusion: This first prospective DOT measurement from India showed wide variation in DOT among different parenteral antibiotics. DOT measurement by other hospitals is urgently required for promotion of rational antimicrobial use within in the hospital & between hospitals.
| OP-27 Rg No: 262: Surveillance for Nasal Colonisation of Methicillin-Resistant Staphylococcus Aureus In Students, Sports Group, Livestock and Their Associates: a Community-Based Approach|| |
Methods: This was a prospective surveillance for nasal colonisation of methicillin-resistant Staphylococcus aureus (MRSA) in students (Gp-1), athletes (Gp-2) and livestock and their associates (Gp-3). Gp-1 consists of 280 nasal samples from apparently healthy school children; 200 samples were in Gp-2 and samples from 100 cows, 50 pigs and 40 live-stock contacts and 10 veterinary personnel (total – 200) were in Gp-3. The S. aureus isolates were subjected to catalase and coagulase tests and the MRSA was characterised by cefoxitin (30 μg) screening and later polymerase chain reaction (PCR) carried out on phenotypically positive MRSA samples for mecA and SCCmec and PVL toxin.
Results: Nasal MRSA positivity was seen in 2/280 (0.7%) (Gp-1), 1/200 (0.5%) (Gp-2) and 1/50 (2%) (Gp-3), totalling four contacts. Genotyping revealed all four MRSA isolates to be mec A and PVL positive by PCR and SCCmec type V alone in two isolates, III and V both positive in one isolate and III alone in one isolate. In all the carriers, decolonisation by topical application of 2% mupirocin for 5 days and 2% chlorhexidine bath for 2 week with 2 and 4 weeks post-treatment follow-up had no recurrence.
Conclusion: Our results indicate that students, sports group and livestock associates represent a relevant reservoir in the community and the import of MRSA into human health care, hence recommending nasal surveillance a worthwhile tool. The genotypic characterisation further would picturise the genotype, relatedness, transmission pattern thus contributing to the epidemiology, treatment, prevention and control of spread in the community from human–human or human to animals or vice versa.
| OP-28 Rg No: 161: Needlestick Injury among Health-Care Workers and Its Aftermath in a Tertiary Care Hospital in North India|| |
Category: Health-care Epidemiology
Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
Background: Needlestick injuries (NSIs) present serious occupational threat to health-care workers (HCWs). The present study was conducted to estimate incidence rate of NSI, identify factors associated, assess awareness of HCWs and evaluate post-injury seroreactivity rates.
Methods: The study involved 524 HCWs interviewed using a validated questionnaire. Blood collected from those who reported NSI within the last 28 days and after 1, 3 and 6 months. Screening for hepatitis B virus (HBV) surface antigen, HCV and HIV was performed by ELISA.
Results: A total of 63 HCWs gave a history of NSI in preceding 28 days. The most frequent procedure of NSI included recapping needles and suturing in 28.57%, while the most common root cause was haste in 61.91%. None became HBV, HCV or HIV seropositive.
Conclusion: Recapping needles, suturing and haste were the major factors responsible while training programmes on safe techniques were the most effective in preventing NSI. HCWs with long working hours are allowed to take breaks.
| OP-29 Rg No: 056: Comparison of Milk Agar With Chocolate Agar for Sampling of Hospital Air and Door Swab Samples|| |
Category: Oral Paper
S. Bhattacharyya, A. Sarfraz, A. Sengupta, D. Kumar, S. Singh, N. Anjum
Department of Microbiology, AIIMS, Patna, Bihar, India
Introduction: Air sampling and hospital environmental sampling are routine procedures for hospital infection control practice and nosocomial infection surveillance. Different methods are there for air sampling, such as settle plate method and slit sampling. Chocolate agar handling may be hazardous and it can be difficult to make, and nutrient agar may be not as sensitive in recovery of colonies from air as compared to chocolate agar. Milk agar is a good enriched medium that enhances pigment production in staphylococci and other bacteria. Hence, our study was aimed at comparing milk agar with chocolate agar for settle plate air sampling and recovery of colonies from swabbing door of hospital wards and departments.
Materials and Methods: Samples were taken from general wards, two different outpatient departments and three laboratories, thrice from each site. Air was sampled by settle plate method while door swab sample was taken by sterile cotton swab moistened with saline. Plates were incubated at 37°C for 24 h.
Results: Milk agar was superior to chocolate agar in retrieving Staphylococcus aureus and Bacillus cereus, which produced distinct golden yellow pigment and halo around colonies on it, respectively. Furthermore, it was better for growing filamentous fungi which formed cottony colonies. Number of colonies was same in both.
Conclusion: Milk agar can be a good replacement for chocolate agar and other media for air and other hospital sampling.
| OP-30 Rg No: 059: Quality Assurance In Blood Culture: A Prospective Blood Culture Contamination Rate in a Tertiary Care Hospital in Southern India|| |
Manasa C. Tantry, Vinod Abishek, K. E. Vandana, Chiranjay Mukhopadhyay
Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
Background: Blood culture (BC) contamination affects health-care quality by decreasing the efficiency and safety of care provided to patients and requires increased resource utilisation. Patients with contaminated BCs often receive unnecessary antibiotics and additional tests to identify the reason for the positive BC, leading to increased hospital length of stay and costs and exposure to potential harm.
Methods: The data regarding BC positivity rates and thereafter the contamination were analysed using Q-probe methods by College of American Pathologists (CAP). Data were obtained prospectively for 1 month in the microbiology laboratory of a tertiary care hospital.
Results: Data regarding 1000 BC were collected and processed. A total of 126 BCs were positive. Fifty-three were identified as contaminants contributing to 42% of the total positives. BC contamination rate was 5.3%.
Conclusion: Clear recommendations and continuous monitoring of standardised BC collection combined with quality control of critical factors of the pre-analytical phase are essential for diagnostic BC improvement.
| OP-31 Rg No: 123: Hospital-Associated Infection Control Surveillance in Gnrc Hospitals: a Prospective Study of 5 Years in Gnrc Hospitals|| |
Department of Microbiology, GNRC Hospitals, Dispur, Guwahati, Assam, India
Introduction: Hospital-associated infection control surveillance programme plays a key role in hospital-associated infection prevention and control. It increases the awareness for infection prevention and control amongst the health-care worker and doctors and control the infection in real sense.
Objectives : The objectives of this study are as follows:
- Reducing infection rate in the hospital
- Establishing baseline rates
- Identifying and controlling outbreaks
- Evaluating and monitoring all infection control measures
- Monitoring antibiotic susceptibility pattern
- Culture swab testing from different area and items used in hospital
- Bacterial air sampling from different critical area by settle plate method
- Water bacteriological test
- Water chlorine content estimation from different water tap
- Canteen food item bacteriological testing.
Materials and Methods: This is a prospective study of 5 years. Following data are recorded on a daily basis for every patient.
- Record of catheter days for central lines and urinary catheter and total infection
- Records of ventilation days and ventilator-associated pneumonia (VAP) infection
- Records of surgical site infection and bed sore
- Records of needlestick injury
- Records of isolated organisms and sensitivity pattern
- Bacteriological analysis of water use in hospital and food supply to the patient
- Air sample analysis for operation theatres and swab culture from different patient care area
- Methicillin-resistant Staphylococcus aureus screening for every health-care worker or trainee before assignment to patient care
- Records of hand washing practising amongst the health-care workers including doctors.
Results: In 2012, the catheter-associated urinary tract infection per 1000 catheter days was 16, and in 2016, it was reduced to 3.1, and so also VAP, In 2012, it was 3.5/1000 days, and in 2016, it was reduced to 0.6/1000 days. The rate of central line-associated bloodstream infection was 4/1000 catheter days in 2012 and was 3.3/1000 catheter days in 2016.
Conclusion: Vigorous training and surveillance can definitely prevent and control the hospital-associated infection which directly decreases the hospital stay of the patients and patient care cost, thereby increases the patient footfall in the hospital and patient admission rate.
| OP-32 Rg No: 316: Prevention and Control Of Clostridium Difficile Infection at a Quaternary Care Hospital in Mumbai, India|| |
Sweta Shah, Tanu Singhal, Havovi Fouzdar, Reshma Tejam
Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
Background: Clostridium difficile infection (CDI) incidence is a growing concern. It is a major cause of hospital-acquired diarrhoea and is most commonly associated with changes in normal intestinal flora caused by the administration of antibiotics and inadequate cleaning and disinfection of the environment.
Methods: This is a prospective cohort surveillance study over 1 year from January 2016 to December 2016 at a 750-bedded private hospital in Mumbai. Screening of glutamate dehydrogenase (GDH) is carried out by enzyme-linked fluorescent immunoassay (ELFA) for hospitalised patients (>4 days of admission) who all are had new onset of diarrhoea. For patients suspected to have severe CDI, C. difficile polymerase chain reaction (by GenExpert) was considered. If the patient was admitted from another health-care facility, his previous admission days and antibiotics were considered. All GDH-positive specimens were further tested for C. difficile toxin A and B (CDAB) by ELFA. Patients with known or suspected CDI were advised contact isolated. C. difficile prevention bundle was followed. All health-care personnel, doctors, nurses, housekeeping staff, etc. were sensitized and trained. Regular surveillance was done for every admission.
Results: A total of 712 patients had new-onset diarrhoea during hospital stay from January 2016 to December 2016. A total of 88 (12%) patients were GDH positive and 44 (50%) of these were CDAB (by ELFA) positive. A total of 42% were from critical unit. A total of 69% of these patients were admitted for medical ailment. All GDH-positive patients were from the age group of 28–85 years. Seven patients came with the CDAB positive. Incidence of the infection decreased from 0.37/100 admitted patients in the first quarter of the year to 0.27/100 admitted patients in the last 1 year.
Conclusions: Although there are a very few reports available, there is an increasing incidence C. difficile in India. Appropriate tests, contact isolation, appropriate disinfection and hand hygiene are needed to decrease the incidence of infection. Restriction on antibiotics, hand hygiene and strict barrier precautions, disinfection of environmental surfaces with sodium hypochlorite (sporicidal) help to control the spreading of infections from one to another.
| OP-33: 'rigour and Vigour' Campaign: Environmental Hygiene Is an Integral Part of Infection Prevention and Control|| |
Sardana Raman, Mendiratta Leena, J. M. Dua, R. S. Uberoi, Butta Hena
Indraprastha Apollo Hospitals, New Delhi, India
Background: Recent evidence-based studies have traced that environmental surfaces, although not directly involved in disease transmission, indirectly contribute to healthcare-associated infections (HCAIs). There is increased risk of acquisition of HCAI, especially where the previous occupant was colonised or infected with multidrug-resistant organisms (MDROs). Even with robust protocols of cleaning and decontamination in place, there exists a potential of breach in practice of protocols, especially with health-care workers and professionals having high attrition rate. Emphasising the adherence to recommended cleaning protocols, our Infection Control Committee initiated a multidisciplinary 'Rigour and Vigour' Campaign, wherein the main aim lays in minimising the risk of exposure of our patients to microorganisms and hence reduce the relative risks of disease transmission.
Methods: The project lay out a systematic hygiene improvement plan with strategies aimed at aggressive cleaning and decontamination practices of rooms of colonised/infected patients not only on a routine basis but also after discharge (terminal cleaning) to reduce the risk of acquiring pathogens in subsequent patients. Disinfection strategies of portable equipment between patients were re-enforced. Re-enforcement of existing protocols was aggressively taken up by the Infection Control Team through on-site rounds and quantified with the help of ATP-based swabs. A cleaning grid was created which identified 'grey zones' within the patients' vicinity which identified areas that were earlier ignored by both house-keeping and nursing. Training of staff on-site was through live demonstrations. Communication practices of identified MDROs were strengthened so that timely contact precautions be initiated and continued throughout patient stay.
Results: Monitoring and providing feedback to the housekeeping and nursing staff have streamlined cleaning practices. Our MDROs decreased by average of 24.44%. We realised that the focus of aggressive cleaning should include all rooms and not only the high-risk rooms (patients with MDROs) as some carriers may not be identified or identified only after long delays.
Conclusions: Post-Campaign, till date, no outbreak has been identified where environmental transmission is deemed to play a role.
| OP-34: First Hand Sanitising Relay World Record from India: This One Is for Humanity!|| |
Jaideep Gupta, Anupam Sibal, L. R. Sharma, Rohit Kapur, Leena Mendiratta, Raman Sardana
Indraprastha Apollo Hospitals, New Delhi, India
Background: Hand hygiene forms the backbone of any infection prevention and control programme of a health-care facility. Being one of the international patient safety goals, increased compliance to hand hygiene forms the mainstay for prevention of infections in healthcare as well as the community.
Methods: With this in mind, our Infection Prevention and Control Unit, Indraprastha Apollo Hospitals, New Delhi, set towards devising an interactive behavioural toolkit which could integrate hand hygiene as a compulsive behaviour in a team-based approach. This unique strategy was devised and spearheaded by our Head, Infection Control. The key lay in enthusing our entire workforce – medical task force (doctors, nursing) as well as our support services (housekeeping, finance, marketing, engineering) towards working in unison to a common goal. We aimed to create a Guinness World Record under the banner of 'Clean Hands, Healing Hands' on 5 May 2016 (World Hand Hygiene Day) by involving 1711 staff in a hand sanitisation relay at a single location. Hectic person-hours was involved into coordination of a gigantic team of participants by synchronisation of their actions according to laid down the Guinness guidelines and repeated sessions of training and re-enforcing each participant, especially non-medical, on the correct technique of hand sanitisation. The 2-day-long pre-event rehearsals helped to rectify our errors and bring to precision and accuracy. About 80 L of sanitiser was used in preparation and final execution of the event.
Results: On 5 May 2016, we formed a human chain relay, each following similar steps in sanitising their hands with an alcohol-based sanitiser, following the rules and regulations as per the Guinness World Record guidelines, strictly and independently witnessed by people of prestige and stewarded by 36 independent stewards not associated with the hospital. The culmination of this mission has given us long-lasting benefits as evidenced by the sustained and increasing hand hygiene compliance in the last few months (increase by an average of 46%).
Conclusion: Being the first in India to create this Guinness World Record, we hope that this competitive spirit shall drive a cascading effect and a massive global hand hygiene chain reaction, benefitting humanity worldwide.
| OP-35 Rg No: 086: Surgical Site Infections In Neurosurgery: Rates And Prevention Strategies in a Tertiary Care Centre|| |
M. Aruna, Thangathirupathi Rajan, M. Kalyani, S. S. M. Umamageswari, P. Neelu Sree
Departments of Microbiology and Neurosurgery, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
Background: Post-operative surgical site infections in neurosurgery have high morbidity and mortality. World-renowned neurosurgical centres report an overall post-operative infection rate of about 2%. Various antibiotic regimens and aseptic precautions are recommended. We report our post-operative infection rate with aseptic procedures and antibiotic prophylaxis in our institute which is very economical and efficient.
Objectives: It is a retrospective analysis of all neurosurgical cases operated in the Department of Neurosurgery, Saveetha Medical College and Hospital, from the time of establishment May 2013 to November 2016 with regard to post-operative infection rates and prevention strategies.
Materials and Methods: This study dated from 1st May 2013 to 31st November 2016 and included 463 patients who had undergone neurosurgical procedures (cranial and spinal) both elective and emergency in the Department of Neurosurgery. The incidence of post-operative fever, wound infections, meningitis, subdural empyema and bone flap infections was recorded in these patients. Patients were given a single dose of appropriate parental antibiotic pre-operatively and three doses post-operatively. All the cerebrospinal fluid (CSF) cultures, blood cultures and wound swabs from the department were also analysed. Clinical signs of infection such as fever after 48 h of surgery, raised white blood cells and raised erythrocyte sedimentation rate were also recorded.
Results: Among 463 cases, the distribution of the cases was as follows: 33% (152/463) cranial, 56% (258/463) spinal, 3% (16/463) ventriculoperitoneal shunt (CSF diversion procedures), 7% (31/463) re-operated cases and 1% (6/463) endoscopic procedures. Immediate post-operative fever rates of 2.5% (12/463), delayed post-operative fever (>48 h) rates 0.21% (1/463) and CSF and blood culture-positive rates 0.21% (1/463) were noted. Total incidence of post-operative infection was 0.21%, morbidity was 0.21%, and mortality due to post-operative infection was nil. The one patient with post-operative infection and fever after 48 h (positive CSF and blood culture) had re-do surgery for spinal dysraphism.
Conclusion: Simple and effective strategies of strict adherence to sterile techniques and rigorous operation theatre protocols enabled to obtain near-complete prevention of post-operative infections. With this protocol, the need for antibiotics can be reduced to minimum. With these simple steps, world standard infection control rates can be obtained in all centres. As stated in the literature, in our study also, re-do surgery carries higher post-operative infections.
| OP-36 Rg No: 323: Interventions to Reduce Ventilator-Associated Pneumonia After Paediatric and Congenital Heart Surgery in a Tertiary Care Hospital|| |
Shashikala Shivaprakash, Swapna Pawar, Amish Vora, Sandip Katkade, Jeril Kurein, Gananjay Salve, Shivaprakash Krishnanaik
Departments of Microbiology and Laboratory Medicine, Infection Control (Nursing), Paediatric Intensive Care Unit and Paediatric Cardiac Sciences, Sir H. N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
Background: The frequency of ventilator-associated pneumonia (VAP) after paediatric cardiac surgery varies from 2.9 to 21.6 per 1000 ventilator days. It represents an important cause of morbidity and mortality, for which Indian data are scarce.
Methods: Between January and June 2016, the interventions were planned after reviewing of intubation procedure and infection control practices in the Intensive Care Unit (ICU), based on prospective analysis of VAP surveillance data. Interventions included reinforcing hand hygiene practices, chlorhexidine mouthwash, pre-operative mini-bronchoalveolar lavage (mini-BAL) culture and maintaining strict asepsis during intubation, strict adherence to VAP bundle, closed suction, ensuring standard practices of cleaning and disinfection of suction jar and accessories, dedicated sterile distilled water bottle per patient. The data of post-intervention phase (July–August 2016) were reviewed and compared.
Results: A total of 226 patients who underwent cardiac surgery were included in the study. VAP rate during pre-intervention phase was 18.63/1000 ventilator days and post-intervention phase was 12.3/1000 ventilator days, showing 34.6% reduction. Pre-operative mini-BAL sample analysis of 45 patients showed culture positivity rate of 26.7%. Organism trend for mini-pre-operative BAL and VAP cases is shown in [Figure 1]a and [Figure 1]b. As per the clinical and radiological indication of community-acquired pneumonia (CAP), nine patients with positive culture were treated. All VAP cases were treated as per the culture report. Three of them required re-intubation. One required diaphragmatic plication. Mortality was noted in one patient. He had dental caries, low cardiac output, multiple episodes of sepsis and hence long ICU stay.
|Figure 1: Organism trend of pre-operative mini-bronchoalveolar lavage samples|
Click here to view
Conclusion: A reduction in VAP rate was achieved following interventions. Pre-operative mini-BAL cultures were helpful in identifying CAP for appropriate treatment and exclusion of nosocomial pulmonary infection.
| OP-37 Rg No: 320: Contamination of Bar Soap and Liquid Soap With Pathogenic and Non-Pathogenic Bacteria in Critical Units of Hospital|| |
Shveta Sethi, Shashi Vig, Kulbeer Kaur, Surria Rajpoot, Rupinder Kaur, Harinder Kaur, Navneet Dhaliwal1, Manisha Biswal
Departments of Medical Microbiology and 1Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Background: The WHO hand hygiene guidelines recommend using liquid soap, but the vast majority of Indian hospitals continue to use bar soap. This is the retrospective study to find out any bacterial contamination in liquid and bar soaps. The objective was to accumulate evidence to switch over to less contaminated type of soap.
Methods: Soap samples were collected from various Intensive Care Units and operation theatres of our tertiary care hospital from 2014 to 2016. A total of 107 bar soap cakes were swabbed and 63 liquid soap samples were tested for the presence of any bacterial contamination. Media used were blood agar and MacConkey agar. Identification was done by matrix-assisted laser desorption ionisation-time of flight mass spectrometry (score ≥ 2 = genus identification, ≥1.8 = spp. identification).
Results: Of total 107 bar soap cakes, 67 (62.6%) of them were found to be contaminated with various organisms. The most common organisms were Pseudomonas mendocina (n = 17), Corynebacterium spp.(n = 12), Pseudomonas aeruginosa (n = 11), Acinetobacter haemolyticus (n = 6), Halomonas aquamarina (n = 7), Acinetobacter spp. (n = 4), Citrobacter spp. (n = 3), Arthrobacter spp. (n = 2), mycelial fungi (n = 3), methicillin-resistant Staphylococcus aureus (n = 2) and others (Vibrio shiloi, Alishewanella fetalis, Nesterenkonia lacusekhoensis, Escherichia coli, Bacillus spp., and non-lactose-fermenting Gram-negative bacilli, Pseudomonas oleovorans, Serratia marcescens, Pseudomonas viridiflava and Halomonas striatum; n = 1 each). Out of 63 liquid soap samples tested, 4 (6.34%) were found to be contaminated with Citrobacter spp., P. oleovorans, Klebsiella pneumoniae, H. aquamarina and P. aeruginosa. In both cases, a repeat microbiological culture from an unopened can of the same batch was sterile. There was a very significant difference in the contamination rates between bar soap cake and liquid soap samples (P < 0.0002).
Conclusion: Bar soap was found to be contaminated with bacteria in almost 63% samples tested, whereas the contamination was very low in liquid soap samples. Therefore, to conclude, liquid soap usage should be promoted over bar soap for hand decontamination universally.
[Table 1], [Table 2]