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   Table of Contents - Current issue
Coverpage
January-April 2019
Volume 7 | Issue 1
Page Nos. 1-30

Online since Tuesday, August 13, 2019

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ORIGINAL ARTICLES  

Economics of preventing healthcare-associated infections p. 1
Roopa Bhandary, Amitha Marla, KB Anita
DOI:10.4103/jpsic.jpsic_1_19  
Introduction: Healthcare-associated infections (HCAIs) contribute to significant morbidity, mortality and economic costs. There are many different ways of preventing hospital infections. An effective infection control programme (ICP) should be a cost-effective medical intervention. Hence, the current study was undertaken to determine the cost-effectiveness of the ICP for the years 2015–2016 and 2014–2015 in comparison to 2013–2014. Methodology: This study was conducted in a 400-bedded super speciality hospital. The infection control budget for the years 2013–2014, 2014–2015 and 2015–2016 was calculated. Incremental cost-effectiveness ratio (ICER) was calculated as the difference in cost between two interventions divided by the difference in health benefit obtained. Results: The total expense incurred on the ICP in the year 2013–2014 was Rs. 1,640,162. In the years 2014–2015 and 2015–2016, the ICP was upgraded with an incremental budget of Rs. 816,208 and Rs. 1,025,730, respectively. There was a significant reduction in HCAI rates in the years 2014–2015 and 2015–2016. The ICER for the years 2014–2015 and 2015–2016 was 68,017.33 and 60,337.05, respectively. Based on the analysis, the ICP for the year 2015–2016 was more cost-effective. Conclusion: The incremental budgeting for the new ICP for the year 2015–2016 proved to be a more efficient and cost-beneficial intervention for infection control.
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Hand hygiene compliance among healthcare workers in a superspeciality tertiary care hospital p. 5
Neeta Patwardhan, Satish Patwardhan
DOI:10.4103/jpsic.jpsic_4_19  
Introduction: Hand hygiene (HH) is an important tool in the prevention of transmission of infections in hospitals; however, it is often an aspect which is neglected by healthcare workers (HCWs). Therefore, ongoing training and education, introduction of hand rubs at every bedside, displaying posters of the indications of HH as well as the six important steps of HH are some of the important measures to increase compliance. Assessment of compliance and feedback is again important so as to take measures to improve further the compliance and thus the infection rates in the hospital. Methodology: We studied the compliance rate in the year 2018. We had different categories of HCWs. The total number of HCWs was 594, out of which a representative percentage was taken from each category. The study was conducted according to the WHO guidelines. Results: We found the compliance rate to be low in months when there was a turnover of staff, that is, some old staff members left and new staff were recruited. Hence, we found the compliance to be good in housekeepers, technicians, doctors/consultants and nurses, but low in resident medical officers and attendants, with the probable reason being they were most of the times not available for training sessions and sometimes negligence. Conclusion: Ongoing training sessions, education of the HCWs, posters of HH in all wards and intensive care units and motivation are absolutely essential to maintain an effective compliance. Efforts taken by our infection control nurse and administrators did help us in improving our compliance rate this year.
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Evaluation of two culture-based methods for the early detection of methicillin-resistant Staphylococcus aureus nasal carriage in pre-operative neurosurgical patients p. 11
Isabella Princess, Siddhartha Ghosh, S Elizabeth
DOI:10.4103/jpsic.jpsic_3_19  
Background: Pre-operative screening for nasal carriage of methicillin-resistant Staphylococcus aureus(MRSA) is practiced to reduce the risk of post-operative MRSA infections. Although controversies prevail on the necessity for screening, we perform MRSA screening in all pre-operative neurosurgical patients due to the benefits incurred. Aim: The aim of this study was to evaluate two different culture-based methods for rapid screening of MRSA nasal carriage among pre-operative neurosurgical patients. Methods: This cross-sectional, single-centre study was conducted in a tertiary healthcare facility in South India. All pre-operative neurosurgery patients were screened for nasal carriage of MRSA using two culture-based methods. Advantage of the newer screening method using chromogenic media over the conventional method was evaluated. A positive screening test was considered an indication for decolonisation using mupirocin and chlorhexidine prior to surgery. A repeat negative screening was ensured before the surgical procedure. Results: MRSA colonisation rate among pre-operative neurosurgical patients in our study was 2.7%. Good correlation was observed between the two screening methods evaluated. Newer method using chromogenic media on comparison with conventional culture showed better turnaround time and shorter pre-operative stay of patients. Because the turnaround time is reduced, earlier contact isolation practice and treatment initiation was achieved for better care of MRSA carriers. Conclusion: Chromogenic media usage for screening the nasal carriage of MRSA is beneficial to patients, surgeons and laboratory personnel. Decrease in turnaround time and processing time and early initiation of isolation along with major reduction in reagent usage are the benefits achieved.
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Clinical profile of patients with heteroresistant vancomycin- intermediate Staphylococcus aureus bacteraemia compared to those with methicillin-resistant Staphylococcus aureus bacteraemia at a level-1 trauma centre of India p. 16
Priyam Batra, Purva Mathur, Ritick Paul, Pramod Gupta, Rajesh Malhotra
DOI:10.4103/jpsic.jpsic_9_19  
Introduction: Staphylococcus aureus is the common cause of bacteraemia, skin/soft-tissue infections and pneumonia in both developed and developing countries, with many of them being caused by methicillin-resistant S. aureus (MRSA) strains. Vancomycin has been a reliable therapeutic option for MRSA infections. Vancomycin-resistant S. aureus and heterogeneous vancomycin-intermediate S. aureus (hVISA) strains have been reported to be associated with vancomycin treatment failure. The present study was performed to determine the percentage of infections due to hVISA and also to compare the clinical characteristics of patients with hVISA infections. Methods: The study was conducted at the department of microbiology of a 1600-bedded level 1 trauma centre of India. Vancomycin minimum inhibitory concentration (MIC) using Etest was performed for MRSA strains isolated from inpatients over 3 years, 2013 to 2015. Heteroresistance determination was done for strains with vancomycin MIC ≥1 μg/ml using Macro Etest method. Clinical data of all patients with MRSA and hVISA infection were compared. Results: A total of 837 S. aureus strains were collected. Of these, 371 (44.3%) were MRSA; 108 (12.9%) had vancomycin MIC ≥1 μg/ml and 32 (3.8%) strains had hVISA. Presence of hVISA infection was found to be significantly associated with the presence of prosthetic implants and surgical-site infections. These patients had prolonged duration of hospital stay and were also associated with vancomycin treatment failure. Discussion: Percentage of hVISA strains reported at our institution was 3.8%, which may be a reflection of community scenario. Mortality rate associated with hVISA bacteraemia was more than that observed with MRSA bacteraemia though not statistically significant. hVISA isolation was greater in high-bacterial–load infections such as blood and respiratory tract infections. Presence of high-bacterial-load MRSA infections for prolonged period despite adequate vancomycin treatment is an indirect clinical marker of hVISA infection.
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Targeted infection control practices lower the incidence of surgical site infections following total hip and knee arthroplasty in an Indian tertiary hospital p. 20
Guda Vaishnavi, AV Gurava Reddy, Dinaker Manjunath, Ganesh Oruganti, Ramesh Reddy Allam
DOI:10.4103/jpsic.jpsic_6_19  
Introduction: Deep surgical site infection (SSI) following total knee arthroplasty (TKA) or total hip arthroplasty (THA) is a devastating complication that occurs in approximately 2% of surgical procedures and accounts for 20% of healthcare-associated infections. Despite improvements in prevention, SSI remains a significant clinical problem. Prevention bundles are central to prevent SSI. Methods: SSIs following TKA/THA are defined by centres for disease control and prevention (CDC) as infections occurring within 1 year post-surgery. Targeted surveillance using prevention bundles for SSIs was instituted among cohort of patients with primary hip and knee arthroplasties from January 2014 to September 2016. Secondary data analysis of the follow-up was done during the physiotherapy appointment and surgical site review visits by the infection control professionals. Infection control team instituted policies and capacity building of known risk factors, such as admitting patients only on day of surgery, pre-operative chlorhexidine bath, hair clipping, timing of antibiotic prophylaxis, glycaemic control, use of High-efficiency particulate air (HEPA) filters and reducing operation theatre traffic. We calculated the incidence, trend and post-operative follow-up of SSIs after universal implementation of bundles. Results: Among 9666 patients with TKA or THA over 4 years, 8967 were successfully followed up for 1 year. Of the 8967 arthroplasties, 49 cases had SSIs (0.52%). TKA and THA contributed to 89% (42 of 47) and 11% (5 of 47) of the SSIs, respectively. The characteristics of SSIs were 83%, 15% and 2% superficial, deep and organ, respectively. Over the 4 years, the combined SSIs of TKA and THA decreased from 0.79% to 0.34% and the proportion of lost to follow-up decreased from 11.09% to 3.72%. Cases of SSI had co-morbidities such as hypertension, diabetes and others. Conclusion: Targeted surveillance with adherence to infection control practices significantly reduces the incidence of SSI. Stringent documentation and follow-up of the patients post-surgery will ensure that the SSIs are monitored and attended to.
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Infection control practices at facilities providing monetary incentives for facility births: An assessment at selected labour and delivery rooms in two states of India p. 25
Vikas Manchanda, Deepa Prasad, Bharat Randive, Addison Gearhart, W Charles Huskins, Nalini Singh
DOI:10.4103/jpsic.jpsic_5_19  
Introduction: We report findings from an assessment of infection prevention and control (IPC) practices using a standardised assessment tool at five facilities in high maternal mortality areas of India. Methods: This study was conducted in five public facilities in the two high-focus states ‒ Odisha and Rajasthan. Both the states registered a high uptake of the Janani Suraksha Yojana programme. We surveyed facilities using the infection control assessment tool. The overall quality of those practices assessed in each section was as follows: A – excellent practices in this area (75%–100% of the possible total score); B – good practices in this area (from 50% to 75% of the possible total score) and C – poor practices needing immediate attention (<50% of the possible total score). Results: The mean score for the hospital facility was 36% (27%–46%) in the C category. General ward facilities mean score was 83% (between 50% and 100%) in the A category. Biomedical waste management scored between 10% and 47% both in the C category. Adherence to policies regarding waste management scored 25%–50% in the C category. All the sites had dedicated labour rooms, and for all the modules, the mean score was <50% (22%–47%) in the C category. On general issues, staff education and labour and delivery service design, across the sites, the mean score was 30% (25%–50%) in the category C. Prophylactic antibiotics were used with a mean score of 67% (33% at one site 100% at four sites) for normal delivery and that was inappropriate. Post-partum care received mean score of 23% (20%–25%). The mean length of stay was 1–2 days following uncomplicated delivery and 5–7 days' post-C section delivery. Conclusions: Our study reveals that basic core components of IPC practices were not being fully implemented for safe delivery of babies. Antibiotics were being used inappropriately for normal delivery. A robust IPC programme and antimicrobial stewardship programme should be implemented in labour and delivery rooms.
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