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   Table of Contents - Current issue
January-April 2018
Volume 6 | Issue 1
Page Nos. 1-31

Online since Monday, August 6, 2018

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A review of prevention of surgical site infections in Indian hospitals based on global guidelines for the prevention of surgical site infection, 2016 p. 1
A Arora, P Bharadwaj, H Chaturvedi, P Chowbey, S Gupta, D Leaper, GK Mani, SK S Marya, R Premnath, K Quadros, A Srivastava, A Tendolkar
While the global estimates of surgical site infection (SSI) have varied from 0.5% to 15%, studies in India have consistently shown higher rates ranging from 23% to 38%. The incidence of SSI may be influenced by factors such as pre-operative care, the theatre environment, post-operative care and the type of surgery. Many other factors influence surgical wound healing and determine the potential for, and the incidence of, infection. Therefore, the prevention of these infections is complex and requires the integration of a range of preventive measures before, during and after surgery. No standardised guidelines backed by evidence are currently established in India for the prevention of SSI. Hence, there is a need for an adaptable, executable National Guideline for low- and middle-income countries which includes India. An effort to draw out most doable and must doable action points to prevent SSI was undertaken by the panelists involved in this paper on the basis of recent global guidelines for the prevention of SSI.
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Adherence to surgical antibiotic prophylaxis guidelines in an Indian tertiary care hospital p. 13
Namita Jaggi, Pushpa Nirwan, Meenakshi Chakraborty
Introduction: The surgical antibiotic prophylaxis guidelines are developed to provide surgeons with a standardised approach to the rational, safe and effective use of antimicrobial agents for the prevention of surgical-site infections based on international, national and local recommendations. However, despite the availability of these guidelines, the adherence to the set protocols is a challenge. This study was carried out to evaluate the adherence to presurgical antibiotic prophylaxis in a tertiary care hospital. Materials and Methods: The antibiotic audit was prospectively carried out for 29 months January 2014—May 2016 for randomly selected clean and clean-contaminated surgeries. Measurable parameters for each selected case were choice of antibiotic, timing of administration and duration. The results were statistically analysed (Minitab 17.0 software). Results: A total of 1549 surgeries were audited. Out of this, 1501 (96.9%) surgeries fulfilled the inclusion criteria and 76.8% were clean. Mean age of the patients was 42.9 ± 18 years with the majority being females 52.5%. The most commonly used antibiotics were amikacin 32.5%, cefuroxime 29.5% and cefazolin 22.9%. The three parameters tested for adherence showed individual compliance of 87.3% for appropriate selection of antibiotic, 85.3% for appropriate administration and 34.9% for appropriate duration of antibiotic, respectively. Overall adherence to presurgical antibiotic prophylaxis guidelines by the surgeons showed significant results (69.2%, P < 0.05). Conclusion: The present study highlights the adherence and challenges faced in transforming hospital-specific guidelines into practice. The adherence to SAP protocols by surgeons was found comparable with that of the developed countries. This is due to their involvement in the formulation of antibiotic guidelines.
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Effectiveness of isopropyl alcohol and ultraviolet-based sanitiser on decontamination of mobile phones used by dental personnel p. 19
Srikanthan Sriram, Parangimalai Diwakar Madan Kumar, Ramanathan Swaminathan, Rajendran Venkatesh, Vasudevan Menaka
Introduction: Mobile phones have become an inevitable mode of communication. Dental office and the dental operators along with their mobile phones are exposed to numerous pathogens as a part of their profession, leading to nosocomial infection. This study aimed at assessing the effectiveness of isopropyl alcohol and a customised ultraviolet-based (UV) sanitiser in decontamination of mobile phones. Methods: A cross-sectional study was carried out on 30 touch screen mobile phones belonging to dental professionals in a college setting. Swabs were collected along the screen, camera lens and on/off buttons of mobile phones. Swabs were streaked onto nutrient agar and incubated at 37°C for 24 h for the assessment of microbial load before and after the disinfection procedures. The disinfection process was performed using 70% isopropyl alcohol and an UV-based sanitiser. Mann—Whitney U-test was used to compare the values between the two groups. Wilcoxon signed-ranks test was used to compare values within each group Results: There was a statistically significant reduction in the mean number of colonies (P = 0.001) after decontamination by the two groups (isopropyl alcohol and UV-based sanitiser) indicating that both agents were effective in disinfection. Conclusion: The study concluded that the percentage reduction in microbial load of the mobile phones was better with isopropyl alcohol compared to UV-based sanitiser. It is recommended that mobile phones in the dental setup be regularly decontaminated and dentists must adhere to strict infection control protocols specifically in relation to hand hygiene.
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Culture of cultures: Antimicrobial prescription practices in hospitalised patients at level 1 trauma centre p. 23
Vijeta Bajpai, Deepak Gupta, Ashish Bindra, Rajesh Malhotra, Purva Mathur
Introduction: Antibiotic stewardship practices require that antimicrobial treatment should be tailored according to microbiological culture. Therefore, the aim of this study was to describe the antibiotic prescription pattern and to assess how frequently the surgeons request for a specimen culture during the patient's stay. Materials and Methods: This was an observational study; conducted in level-1 trauma center for 10 months and all consecutive neurosurgery patients, admitted in the hospital were included in the study. Detail of microbiology culture and anti-microbial-sensitivity results were recorded. Antibiotic prescriptions were recorded in each patient during their hospital stay. Results: A total of 1216 consecutive patients admitted to the neurosurgery unit were included in the study. The mean age (± standard deviation) of patients was 33.29 (±16.27) years, predominantly male patients; 1038 (85.4%). Overall, culture-confirmed infections were present in 216 (19.4%) patients. Prevalence of Gram-negative bacteria; 195 (90.2%) was more than Gram-positive bacteria; 21 (4.7%) (P < 0.001). The most frequently used antibiotic was cephalosporin; 1030 (84.7%), followed by aminoglycoside; 952 (78.3%), fluoroquinolone; 422 (34.7%), penicillin; 311 (25.6%) and metronidazole 277 (22.8%). A total of 400 (13.15%) antibiotics were prescribed appropriately in patients with culture-confirmed infection while 2640 (86.8%), antibiotics were given inappropriately in rest of the patient in whom there was no matching culture-confirmed infection (P < 0.001). Conclusion: A very small number of antimicrobial prescriptions were based on culture reports. Hospitals in developing countries including India need to institute surgical antibiotic policies soon since most hospitals are facing a severe problem of antimicrobial resistance.
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An epidemiological study of ventilator-associated pneumonia in Intensive Care Unit and antibiotics sensitivity pattern of organism causing ventilator-associated pneumonia (2012—2016) at Al Qassim Region of Saudi Arabia p. 27
Sanjay Kumar Gupta, Fahd Khaleefah Al Khaleefah, Ibrahim Saifi Al Harbi, Marilou A Torre, Sinimol Jabar, Sunitha Lorin Mathias, Omar Al Romaih
Background: Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs after 48—72 h following endotracheal intubation, characterised by the presence of a new or progressive infiltrate showing in X-ray, signs and symptom of systemic infection such as fever, change in white blood cell count, changes in sputum characteristics and the detection of a causative agent in the sample. Aim: This study aims to find out the epidemiological pattern of the VAP in Intensive Care Unit and their sensitivity pattern. Materials and Methods: This was retrospective observational study. Results: In the past 5 years, 69 (20.24%) cases of VAP were reported out of total healthcare-associated infections (n = 331). The male cases 54 (78%) were nearly four times higher than that of female cases 15 (22%), and difference is statistically significant (χ2 = 15.2, P = 0.01). Most of the cases observed were above 60 years of age (n = 24) whereas, least cases observed in cases below 15 years of age (n = 4). In the present study, VAP was observed in increasing trend (2012—2015) 16% to 27%. Mean hospital-wide infection rate was higher in 2015 (4.34; standard deviation [SD] =3.33) than 2016 (2.14; SD = 2.25). The most common organism isolated from VAP was Acinetobacter baumannii followed by Pseudomonas aeruginosa. Conclusion: The VAP cases reported four times higher among males than females and common above 60 years of age, most common causative organism isolated from VAP patients was A. baumannii. Majority of the isolates of A. baumannii and P. aeruginosa were resistant to commonly used antibiotics.
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