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 Table of Contents  
HISICON 2017
Year : 2017  |  Volume : 5  |  Issue : 3  |  Page : 97-101

Chaired Poster Abstract


Date of Web Publication20-Jun-2018

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How to cite this article:
. Chaired Poster Abstract. J Patient Saf Infect Control 2017;5:97-101

How to cite this URL:
. Chaired Poster Abstract. J Patient Saf Infect Control [serial online] 2017 [cited 2018 Jul 20];5:97-101. Available from: http://www.jpsiconline.com/text.asp?2017/5/3/97/234841




  CP-1 Rg No: 065: Bacteriological Profile and Antimicrobial Susceptibility Pattern of Isolates from Endotracheal Secretions of Patients Admitted in a Tertiary Care Hospital Top


S. Desai, G. Gole, A. De, L. Dash, J. S. Shastri

Department of Microbiology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India

Introduction: Respiratory tract infections are a critical issue amongst intubated patients, leading to significant morbidity and mortality. Knowledge of microbial flora from endotracheal (ET) secretion culture and their antibiogram is of great importance in timely institution of appropriate therapy for effective management of patients.

Aims and Objectives:

  1. To study the microbiological profile of ET secretions
  2. To determine the prevalence of multidrug-resistant (MDR) Gram-negative bacilli in ET secretions.


Materials and Methods: A prospective observational study of patients was done over a period of 1 year (December 2015–November 2016). Qualitative culture of ET secretions of patients was done by standard techniques. Bacterial isolates were identified by colony morphology and standard biochemical tests. Antimicrobial susceptibility test was performed on Mueller-Hinton Agar by Kirby–Bauer disc diffusion method, as per Clinical and Laboratory Standards Institute guidelines (2015).

Results: Out of 193 ET secretions, 58.55% were from Intensive Care Units (ICUs) and 41.45% were from wards. All patients from ICUs were on ventilators. Of these, 112 (58.03%) samples were culture positive, which included 80 (71.43%) from ICUs and 32 (28.57%) from ward. These 112 samples yielded 122 isolates. Gram-negative bacilli predominated (99.18%). The most common isolate was Acinetobacter species(62.29%), followed by Pseudomonas aeruginosa (16.39%) and Klebsiella pneumoniae (15.57%). Overall, 80.99% (98/121) of Gram-negative bacilli were extensively drug resistant (XDR) and 11.57% were MDR. Maximum XDR was seen amongst Acinetobacter spp. (97.36%). However, all Acinetobacter spp. were susceptible to colistin. Carbapenem susceptibility was only 23.97% (29/121), and rest of the 76.03% (92/121) isolates were resistant to either one or more carbapenems.

Conclusion: There is increasing incidence of XDR Acinetobacter spp. in intubated ICU patients. History and clinical condition as well as quantitative culture of ET secretions would help to differentiate infections from colonisation, and only the former should be treated. Besides this, antibiotic cycling, stringent asepsis and appropriate management of patients on ventilators are crucial to prevent the development of respiratory infections.


  CP-2 Rg No: 141: Prevalence of Methicillin-Resistant Staphylococcus Aureus As a Causative Agent of Neonatal Septicaemia and Its Sensitivity Pattern in a Tertiary Care Hospital in North-East India (Assam) Top


Bhaskar Jyoti Neog, Monsoomi Mahanta, Angshurekha Das

Department of Microbiology, Jorhat Medical College and Hospital, Jorhat, Assam, India

Background: Neonatal septicaemia is one of the important causes of mortality and morbidity in neonates. Emergence of multidrug-resistant bacterial strains is a major problem in the management of neonatal sepsis. Amongst all the resistant strains, methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of neonatal sepsis. MRSA is of serious concern not only because of its sole resistance to methicillin but also due to resistance to many other antimicrobials that are indicated on a regular basis in hospitals.

Aims and Objectives: The aim and objective of the study was to study the prevalence of MRSA as a major cause of neonatal sepsis in a tertiary care hospital in Assam.

Materials and Methods: This is a retrospective study conducted from December 2015 to December 2016 in the Microbiology Department of Jorhat Medical College and Hospital. A total of 480 blood samples were collected using sterile precautions and processed following standard laboratory protocols. Identification of isolates was done as per standard methods. Antibiotic susceptibility test was done by Kirby–Bauer disc diffusion method and according to Clinical and Laboratory Standards Institute guidelines.

Results: Out of the total 332 blood culture-positive samples, of which 76 (22.8%) cases are found to be S. aureus strains. Amongst these, 45 (59.2%) cases were MRSA and 31 (40.7%) were methicillin-sensitive S. aureus. Vancomycin and linezolid were 100% sensitive to MRSA and penicillin was 100% resistant followed by other cephalosporin's group of drugs.

Conclusion: The emergence of drug resistance in MRSA is worrisome in the present therapeutic scenario. A regular surveillance of hospital-associated infection including monitoring antibiotic sensitivity pattern of MRSA should be mandatory to control the spread of this disease in the Neonatal Intensive Care Units (NICUs). In our centre, a significant number of MRSA were found to be the major cause neonatal septicaemia followed by other Gram-negative bacteria. This study stresses the need for the continuous screening and surveillance for antibiotic resistance in NICU for preventing neonatal septicaemia.


  CP-3 Rg No: 208: Klebsiella Pneumoniae in Neonatal Septicaemia With Special Reference to Multiple Drug Resistance in a Tertiary Care Hospital Top


David Barman, Ritapa Ghosh1, Pallabi Sargiary, Reema Nath

Department of Microbiology, Jorhat Medical College, Jorhat, Assam, India

Background: Multidrug-resistant (MDR) Klebsiella pneumoniae has emerged as an important cause of neonatal sepsis in developing countries. Prompt treatment with appropriate antibiotics is necessary to reduce mortality and complications. The current study was done with a view to study the incidence and antimicrobial susceptibility pattern of K. pneumoniae septicaemia during a period of 6 months in a Neonatal Intensive Care Unit of a tertiary care centre and to assess the burden of multiple drug resistance. K. pneumoniae has played an important role as a cause of infection in the neonatal high-risk units globally. The widespread use of broad-spectrum antibacterial agents has led to an increase in the emergence of resistance to broad-spectrum cephalosporins and carbapenem.

Methods: A total of 162 blood samples from cases of neonatal septicaemia included in the study were processed in BacT/ALERT 3D system (bioMeérieux, France). Subculture on MacConkey's agar and blood agar plates was done and identified using standard microbiological techniques. Antimicrobial susceptibility was determined by Kirby–Bauer's disc diffusion method according to Clinical and Laboratory Standards Institute guidelines using  Escherichia More Details coli ATCC 25922 as the control strain.

Results: Amongst 162 clinically suspected cases of neonatal sepsis, 102 (62.9%) cases had a positive blood culture, of which 49 (48.03%) cases were due to K. pneumoniae. All K. pneumoniae isolates were sensitive to meropenem (100%) followed by ofloxacin (87.7%). The isolates were MDR showing 0% sensitivity towards cephalosporins, aminoglycosides and piperacillin-tazobactam.

Conclusion: This is a preliminary report showing a high incidence of MDR K. pneumoniae isolates with similar antibiogram pattern in a tertiary care hospital of Assam. High prevalence of MDR isolates was probably attributable to the widespread use of broad-spectrum antibiotics. Further molecular study will reveal the strain relatedness of the isolates with environmental isolates to exclude hospital-acquired infection.


  CP-4 Rg No: 062: Methicillin-Resistant Staphylococcus Aureus: a Threat to Healthcare Top


N. Chatterjee, L. Dash, G. Gole, A. De, J. S. Shastri

Department of Microbiology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a major problem within healthcare organisations. It is an important nosocomial pathogen worldwide, accounting for 20%–80% of all hospital-acquired infections. The incidence of MRSA has been reported as 25% from Western India and 50% from Southern India, with an ever-increasing trend. Infection due to MRSA imposes a huge burden on healthcare resources, and once MRSA becomes endemic in a setting, it is difficult to eradicate. Hence, it is necessary to define the problem of MRSA in every hospital to evolve an effective infection control strategy and antimicrobial stewardship programme.

Aims and Objectives: The aims and objectives of the study were to study the prevalence of MRSA strains in clinical samples over 1 year and to determine their antimicrobial susceptibility pattern (AMST) and the presence of inducible clindamycin resistance (ICR).

Materials and Methods: A prospective study was carried out on all S. aureus isolates recovered between January and December 2016, from pus, wound swab, ear/nasal swab and tissue samples received in Bacteriology Section of Microbiology Laboratory in a tertiary care hospital. The isolates were identified by standard biochemical tests. AMST was performed by Kirby–Bauer disc diffusion method as per Clinical and Laboratory Standards Institute guidelines (2015). Methicillin resistance was detearmined using cefoxitin as a surrogate marker. ICR was detected by D-test. History and clinical details of all MRSA-infected patients were noted in a standard format.

Results: Out of total 364 S. aureus isolates, 114 (31.3%) isolates were found to be methicillin resistant and 250 (68.7%) isolates were methicillin sensitive. Amongst all 114 MRSA isolates, 67 were from pus samples and 32 were from wound swabs. Majority of the isolates were recovered from general surgery and orthopaedics patients with a large proportion from post-operative infections which were probably hospital acquired. A total of 54.4% (62/114) of MRSA isolates demonstrated ICR. AMST revealed 100% isolates sensitive to vancomycin, teicoplanin and linezolid, with 90.4% sensitive to gentamicin and 73.7% to co-trimoxazole.

Conclusion: Continuous laboratory monitoring, alertness and stringent handwashing protocol along with the judicious use of antimicrobial will facilitate effective management and containment of spread of MRSA.


  Pseudo-Outbreak of Adenovirus Inpatient in Respiratory Critical Care Unit Top


Category: Outbreak Management

Tsering Dolma, Smita Sarma1

Departments of Infection Control and 1Infection Control and Clinical Microbiology, Medanta - The Medicity Hospital, Gurgaon, Haryana, India

Background: Pseudo-outbreak is the recovery of the same microorganism from the sample of multiple patents who are not infected with the organism.

Outbreaks and pseudo-outbreaks associated with bronchoscopy continue to occur because of poor adherence to current disinfection guidelines, especially the failure of healthcare facilities to have policies and procedures consistent with the current guidelines. It may be resulted from contaminated equipment, including rinsing tanks, tubing, antibacterial filters on water lines, cleaning brushes, and biofilms in the reprocessor.

In this report, we will describe a Pseudo-outbreak with adenovirus in an intensive care unit of tertiary hospitals from 27/08/2016 to 7/09/2016.

Method: An outbreak investigation was carried out in a medical ICU in which there was an unusual rise in adenovirus detection in BAL sample by PCR between August –September 2016.

Result: During investigation 2 bronchoscopes were identified which were used during BAL sample collection. One of the bronchoscopes was used for all the 12 positive patient.

Conclusion: On completion of investigation, we found that cleaning & disinfection of scopes were inappropriate. Training and periodic assessment of competency of persons performing cleaning and disinfection were done.


  CP-6 Rg No: 014: Fast and Safe – Confidence With Autoreader Top


Sourav Maiti

Chief Consultant Microbiologist and In-Charge, Department of Infection Prevention and Control, Institute of Neurosciences Kolkata

Background: Sterilization failure in implant surgery, particularly for neurosurgery, is disastrous for the patient, surgeon and the hospital. Microbiological assurance of safety takes minimum 48 hours, posing practical difficulty in time and load management. Relying on physical and chemical indicators only may cause medicolegal hazards if biological indicator fails. Therefore a faster and safe answer is the unmet need of the hour. Autoreader technology shows promise in this regard.

Methods: Implant items were autoclaved with biological indicator 1292E with proper cycle monitoring at CSSD. Readings were recorded by autoreader (“ATTEST”) needing 3 hours of incubation and compared with 48 hours and 7 days incubation. CSSD indicators were reviewed.

Results: 100% conformance noted between results at 3 hours, 48 hours and 7 days. Issue time for implants decreased from 72 hours to 5 hours. Final safety answer for implants was obtained with no recall. Early detection of cycle failure saved recall hazard and ensured patient safety and 3 days production.

Conclusion: Time is both the money as well as safety in case of autoreader. Autoreader bridges the gap between manpower shortage and ever-increasing workload with effective CSSD business gain in a scientifically valid way.


Acinetobacter baumannii Scientific Name Search uro-Trauma Unit">  CP-7 Rg No: 177: Occurrence of Acinetobacter Baumannii in Neuro-Trauma Unit Top


Category: Outbreak Management

Jomy Joseph

Department of Infection Control, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India

Background: In a tertiary care hospital in Pune city, there was a sudden outbreak of Acinetobacter baumannii in neuro-trauma unit amongst many patients; therefore, to identify the cause of outbreak and to prevent further transmission, this study was conducted.

Methods: A total of 20 patients with A. baumannii infection identified between September and December 2015 have been included in the study. The nosocomial infections were established according to the Centers for Disease Control and Prevention criteria. Tool used was audit.

Results: Out of 20 patients affected with A. Baumannii, 75% of patients were intubated from outside hospital and 25% of patients were intubated inside the hospital.

Conclusion: In this study, Acinetobacter found in patients with ETT. Success in infection control has been attained by educating the staff about the importance of handwashing, proper feed preparation and proper disinfection.


  CP-8 Rg No: 143: Prevalence of Carbapenem Resistance Amongst Klebsiella Species in a Tertiary Care Hospital in Assam Top


Pirbox Rafiqul Hussain, David Barman, Angshurekha Das

Department of Microbiology, Jorhat Medical College and Hospital, Jorhat, Assam, India

Background: Carbapenem-resistant Gram-negative pathogens are an increasing threat to the management of hospital-acquired infections. Although the isolation of carbapenem-resistant Enterobacteriaceae was unusual, the frequency of carbapenemase-producing Klebsiella pneumoniae had increased in different geographic regions. Therefore, this retrospective study was done in a tertiary care hospital to look for the prevalence of carbapenem-resistant Klebsiella species in routine clinical specimens.

Materials and Methods: The study was carried out in the Microbiology Department of Jorhat Medical College, Assam, over a period of 6 months. The samples tested were different clinical samples from hospitalised and outpatient department (OPD) patients sent to the department for microbiological testing. Specimens were processed using standard microbiological techniques. Cultures yielding only Klebsiella species were included in the study. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disc diffusion method recommended by Clinical and Laboratory Standards Institute guidelines.

Results: Out of total 479 Klebsiella species isolated, 397 (82.88%) isolates were K. pneumoniae and 82 (17.12%) were Klebsiella oxytoca. A total of 119 (24.84%) isolates were found to be carbapenem resistant. The prevalence of carbapenem-resistant K. pneumoniae and K. oxytoca was found to be 105 (26.45%) and 14 (17.07%), respectively. The predominant age group is adult (57 [47.9%]) followed by paediatric and adolescent age group (43 [36.13%]). Highest incidence of carbapenem resistance was found in wards (55 [46.22%]), followed by OPDs (46 [38.66%]) and then Intensive Care Units (18 [15.13%]). Most of the cases were from departments of Medicine and Paediatrics (31.09% each) followed by department of Tuberculosis and Chest (13.45%). Majority of the isolates were detected from urine samples (40.34%), followed by sputum (34.45%) and pus (15.97%).

Conclusion: Carbapenems have long been considered the antibiotic class of last resort in the treatment of infections caused by multidrug-resistant (MDR) Gram-negative organisms. Although most isolates were obtained from ward patients, a significant number of isolates were also isolated from OPD patients' samples. This suggests that several isolates in the study may have been community acquired. The need of the hour would be to have a strong antimicrobial policy, with further emphasis on better cost-effective, logical infection control measures to prevent the dissemination of such MDR bacteria.


  CP-9: Green Harbingers of Safety for Patient and Healthcare Worker Top


Mendiratta Leena, Kumari Sapna, Gupta Viyom, Philip Gracy, Sardana Raman

Indraprastha Apollo Hospitals, New Delhi, India

Background: Disinfection of urinal and bedpan is generally carried out manually using disinfectants or with automated washers, both requiring strict adherence to infection prevention protocols. Technical problems may be encountered such as failure of the automated washer to reach appropriate disinfection temperature. Review of literature has revealed studies wherein outbreaks have been implicated on bedpan practices. After our earlier study on clinico-microbiological evaluation which depicted decreased urinary tract infection, we performed a second pilot study on the use of disposable bedpans and urinals along with macerators, aiming at a technique that is environment-friendly and simultaneously safe for both patient and healthcare workers.

Methods: This technology replaces traditional reusable bedpans, and washers with disposable bedpans and urinals processed from moulded paper pulp products which are environment-friendly. These containers are disposed in macerators (disposal machines). The liquidised waste, after disintegration, is then discharged into the wastewater drainage system. This technology does not involve the use of any chemicals or disinfectants which are alternatively required. Furthermore, it bypasses the strict protocols essential for maintenance of the right concentration and preparation of the disinfectants.

Results: This project has reaped three major benefits:

  1. Reduced risks of infection to both patient and healthcare workers through bypassing of direct handling of reusable bedpans and urinals. No growth in urine has increased from 52.85% to 73.83%, post-project
  2. Efficient work organisation by optimum time and workforce utilisation: Alternate methods involve workforce deployment. The time saved by housekeeping (9986 housekeeping person-hours per year in five locations, which when extrapolated to 45 locations, shall translate to 89,874 h) can be utilised in rendering better patient care
  3. Environment-friendly and cost-efficient: Use of containers which disintegrate into pulp. No use of disinfectants (100% savings) which is damaging to the environment.


Conclusion: Adopting this practice not only reduces the risk of healthcare-associated infections at a reduced cost but also presents safety as a priority for both patient and healthcare workers and is community-beneficial as well as environment-friendly.


  CP-10: Increasing Hand Hygiene Compliance: the Bundled Approach Top


Sardana Raman, Mendiratta Leena, Kansal Sudha, John Reena, Tso Lhamo, Dawar Reetika

Indraprastha Apollo Hospitals, New Delhi, India

Background: Hand hygiene forms the priority for our annual action plan as per our risk-based matrix. Over the past few years, our hand hygiene dashboard depicted fluctuating peaks and led us to look into causative factors for not attaining our 100% compliance target. Analysis revealed that key issues could be addressed in a 'bundle' of behaviour-driven strategies coupled with self-motivation.

Methods: A project was conceptualised on the basis of the human behavioural approach based on multiple behaviour change theories. Valuable inputs from our clinical psychologist, already a part of our multidisciplinary Infection Control Committee, were also incorporated. This interactive behavioural toolkit focused on 'motivational' aspects. The strategies revolved around personalised themes such as multidisciplinary 'request rounds' and one-to-one counselling, especially of the defaulters. The catchy individualised colourful awareness standees and multilingual intercom addresses served as persistent reminders. The competitive spirit fostered by the interdepartmental rolling trophy aided towards boosting the compliance.

Results: The compliance increased to an average of 74%, 88%, 78% and 80% by the doctors, nursing, paramedical staff and housekeeping, respectively. Frequent campaigns focused on our 5R bundle – Request Rounds, Rolling Trophy, Reminders (audiovisual), Re-auditing and Re-education helped to sustain our compliance. The secret of our bundles lays in their execution and personalised approach.

Conclusions: Our increasing hand hygiene compliance has led us towards incorporation of this bundled approach as an integral component of our hand hygiene programme.






 

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  In this article
CP-1 Rg No: 065:...
CP-2 Rg No: 141:...
CP-3 Rg No: 208:...
CP-4 Rg No: 062:...
Pseudo-Outbreak ...
CP-6 Rg No: 014:...
CP-7 Rg No: 177:...
CP-8 Rg No: 143:...
CP-9: Green Harb...
CP-10: Increasin...

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