Background/Objective: Hand hygiene (HH) non-compliance is a major cause of hospital-acquired infections, and a gap between knowledge and practice is observed widely. Health researchers are now using a new approach called 'Positive Deviance' (PD) to tackle such behavioural/cultural/social problems leading to adverse health issues. Therefore, can PD approach be used to improve knowledge and compliance of HH practices also? This study is designed to find what are the reasons for PD among nursing staff of our hospital and whether these behavioural changes can be imbibed by others if motivated and trained appropriately. Materials and Methods: The level of compliance to HH and PD among 25 Intensive Care Unit nurses was noted. This was followed by a second and a third interface consisting of focus group discussions and one-to-one interviews to motivate them based on the PD noted and to detect the possible betterment of compliance to HH. Results: The practice of HH was followed by 20% of the nurses, and they were identified as positive deviants and when reasons which made them to be compliant were reinforced and impressed on the rest of the nurses, a further 32% became compliant. Awareness of the fact that HH prevents colonisation with potential pathogens was shown by 100% after the intervention. Conclusions: A PD strategy yielded an improvement in HH compliance. An improvement in knowledge and practice of HH was noted. Multimodal interventions are needed to induce sustained HH practice improvements and this will reduce the gap between knowledge and practice of HH in hospitals and thereby reduce hospital-acquired infections.

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Background: The peracetic acid (PAA) has antimicrobial activity against bacteria and fungi including spores and is envirosafe. Despite its widespread use in food industry and effluent treatment, it is not widely used in hospitals. The present work was aimed to find out its efficacy against hospital pathogens, bacterial and fungal spores and mycobacteria. Methods: Multidrug-resistant, wild hospital isolates of Gram-positive, Gram-negative bacteria, tough organisms such as Mycobacterium fortuitum, Mycobacterium tuberculosis and Candida albicans and spores of Bacillus subtilis, Clostridium perfringens and Aspergillus niger were checked by modified Kelsey-Sykes suspension test. For vegetative bacteria, exposure time was 1 min. For bacterial and fungal spores, Candida and Mycobacteria, exposure time varied from 10 to 30 min. Results: More than 5-log reduction was seen for vegetative bacteria just after 1 min exposure to PAA. Ten minute exposure to PAA could inactivate 99.5% bacterial and fungal spores. Mycobacteria were inactivated within 10 min of exposure to PAA. PAA rapidly inactivates pathogenic bacteria within 1 min and inactivates mycobacteria and fungi within 10 min and sterilises spores within 30 min and remains active in the presence of proteins. Conclusions: It is economic, eco-friendly and deserves major share in hospital disinfection.

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Background: Resistance genes transferred by plasmids are important factors that can contribute to the occurrence of quinolone resistance, specifically in Escherichia coli strains. Methods: A total number of 117 diarrhoeagenic E. coli strains were tested for the resistance to nalidixic acid, ofloxacin, ciprofloxacin and levofloxacin and for the presence of qnrA, qnrB and qnrS genes determinants by polymerase chain reaction. Antibiotic susceptibility test was performed using the Clinical and Laboratory Standard Institute standard method. Results: The highest resistance belonged to the nalidixic acid (52.14%) and the least resistance to levofloxacin (37.61%). In this study, among a total of 117 samples, 23 (19.66%) strains were susceptible to all the studied antibiotics. Among the remainder, 94 (80.34%) samples resistant to at least one quinolone, three genes including qnrA, qnrB and qnrS were present in 19.15%, 88.30% and 78.72% isolates, respectively. Furthermore, 51.06% of strains had A⁻, B⁺ and S⁺ pattern that seems to have a significant association (P < 0.001) with resistance to quinolones. Conclusions: The results of present study show the presence of a high frequency of qnr genes in E. coli strains resistant to quinolones in clinical samples from southwest of Iran. In addition, this study approved that plasmid-mediated quinolone resistance is a possible mechanism among the quinolones-resistant E. coli isolated from patients with diarrhoea in the study, and also qnrB and qnrS genes seem to be more important in resistance to quinolones.

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Background: In the era of multidrug-resistant organisms and dearth of new antimicrobials, hand hygiene has become an important tool in reducing the burden of healthcare associated infections (HAIs). The content of this article is based on awareness and practice of hand hygiene among healthcare workers (HCWs). Objectives: Hand hygiene has emerged as one of the most important strategies to prevent HAIs. Hand hygiene practice has led to the decrease in infections. The present study was undertaken to assess the compliance among HCWs. Materials and Methods: Hand hygiene compliance and number of opportunities were evaluated for 2 years (2013 and 2014), and the data were compared. The study was carried out in the emergency department and critical care areas of our hospital. Results: It was found that the number of events monitored and compliance increased considerably in the subsequent year. The compliance rate on an average increased from 57.6% to 61.6%. Conclusions: The present results emphasise on the regular training and education of hand hygiene among HCWs. They should be made aware of the HAIs and that hand wash and hand rub help in decreasing the rate of HAIs.

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Background: Surgical site infections (SSIs) still continue to be a major cause of morbidity and mortality despite the improvement in methods for infection control as well as surgical practices. The aim of this work is the presentation and analysis of SSI control practices in selected surgical wards in Poland as compared to other European countries. Methodology: The presented data were obtained using a standardised questionnaire within a European project devoted to describing and analysing the surveillance of nosocomial infections in individual European countries. Results: In all studied wards, written procedures of SSI prevention were present, as well as obligatory training of ward personnel concerning infection control. Alcohol-based hand rub dispensers were available in over 75% points of care in most wards, as opposed to belt/pocket bottles, which were available for a small number of ward personnel. Alcohol solutions were most often used for skin preparation. Shaving immediately before operations was the most common way of hair removal. A WHO checklist was used in 20% of the studied wards. Conclusions: Based on the results of the study, the organisation of surveillance infections in Polish surgical wards appears to be satisfactory. However, practical implementation of SSI prophylaxis calls for significant alterations, both in terms of executing training and implementing practices in the wards or the operating room. On the one hand, due to a lack of multicentre studies on the epidemiology of SSI in Polish surgical wards, actual exposure to SSI cannot be assessed.

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Background/objectives: The aim of this study is to determine the incidence of occupational exposures, the immunization status and the rate of injuries being reported among health care workers (HCWs) and students at the dental school. Methods: A questionnaire was applied to all academic staff, dental students and nurses. The questionnaire included the sections about frequency of sharp injuries, type of instrument that caused the injury, and whether or not the injury was reported. Data from the ques- tionnaires was analyzed using SPSS; 17.0 statistical software and assessed in each group. Results: The number of persons reporting one or more percutaneous injury was 415 (74.6%). 448 (80.5%) respondents reported saliva/blood splashes into skin and eyes. The majority of the respondents failed to report the exposure incidents. Common reasons for not reporting included lack of information about reporting and not to worry about the injury. The most common injuries were reported as needlesticks and dental probe injuries. 86% of re- spondents followed post-exposure protocol after the injury and 96% of them reported the regular usage of masks to prevent risk of infection. The immunization status of students, academic staff and nurses were 89.5%, 78.6% and 72%, respectively. Conclusion: The high incidence of occupational injuries among health care workers reveals a necessity to raise awareness and to provide periodical training in infection prevention.

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The draft of National Health Policy 2015 is under discussion and process of finalization. Issues of healthcare quality, maternal and neonatal health, communicable diseases, infor- mation technology, affordable and accessible healthcare, health as a fundamental right and justiciable healthcare are some of the key focus areas in the draft. Most of the focus areas of the draft will have a direct bearing on the patient safety. Numerous discussions on the National Health Policy Draft 2015 are available but none relate to the issue of patient safety specifically. This paper analyses the Policy Draft with a focus on patient safety regulatory needs in India.

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Background: Methicillin resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. A strong correlation between the invasive and the nasal carriage strains in the patients has been well established indicating the need to eliminate the carriage of MRSA to prevent the transmission. The objectives of this study are to assess the prevalence of MRSA colonisation in patients from ICUs and high risk wards for a period of 33 months, (2011-2013) by routine active surveillance culture, and also to evaluate the role of extra-nasal sites in the screening. Methods: The nasal and extra-nasal specimens were obtained from patients using sterile cotton swab. Staphylococci were identified based on colony morphology on blood agar, Gram's staining and coagulase test. The Staphylococcus aureus (S. aureus) isolates were screened for methicillin resistance by Kirby-Bauer disc diffusion method using oxacillin (1 mg) and cefoxitin (30 mg) discs and reported according to CLSI guidelines. Results: Out of the 5372 nasal samples tested, S. aureus was identified in 14.1% patients. The rate of methicillin resistance was 31.7% of the total S. aureus isolates. The overall prevalence of MRSA was 4.5%. Out of 219 extra-nasal samples tested, 4.1% of the patients carried MRSA in sites like axilla and groin without nasal carriage. Conclusion: Our results encourage us to continue with the screening program so as to prevent the high risk patients contracting endogenous infections thus controlling the transmission and spread and also the addition of extra-nasal site; either axilla or groin might increase the screening efficiency in non nasal colonisers.

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