Objectives: To compare the microbial flora on the mobile phones of Health care personnel (HCP) and general public (GP) and to study the reported behaviour and observed hand hygiene practices of the HCP related to mobile phone use in paediatric medical and surgical Intensive Care Units (ICUs). Methodology: Front surface of the mobile phones of enrolled HCP and GP was sampled for culture using sterile swabs. Behaviour of the HCP was assessed using a self-report structured behaviour assessment tool. A total of 360 observations on the hand hygiene practices of the HCP related to mobile phone use in ICUs were carried out over 8 weeks using an observation checklist. Results: Of the 47 HCPs enrolled in the study, 78.7% were nurses and 21.3% were doctors. Majority of the HCPs had smartphones (85%;). Nearly 77% of mobile phones of HCP and GP were contaminated with various pathogenic, commensal and environmental bacteria. Most of HCPs were using mobile phones 1–3 times during working hours for communication, E-mailing and searching information. Two-thirds of the HCP (66) were not cleaning their phones; 38 seldom practiced hand hygiene before using the mobile phones, while better hand hygiene practices were reported after using the mobile phones (60%). More than 50% of the observed hand hygiene practices related to mobile phone usage were inappropriate or wrong. Conclusion: Mobile phones of the HCP and GP were equally contaminated; more pathogenic microorganisms were seen on the mobile surfaces of HCP. Reported behaviour and hand hygiene practices of HCP related to mobile phone use in the ICUs were inappropriate or wrong.

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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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Context: The microbial quality of air in the operation theatres (OTs) is a parameter which appreciably controls the healthcare-associated infections. However, there is currently no international consensus on the most suitable method to be used for air sampling or any set policy on how to achieve the total viable count (TVC) values although the optimum goals have been set. Aims: This study aims to evaluate the microbial air quality in different OTs of our tertiary care hospital at rest and inoperational by comparing active and passive air sampling. Settings and Design: The Department of Microbiology and all the OT rooms of UCMS and GTB Hospital, Delhi. There are 18 OT rooms. This was a cross-sectional, comparative study. Subjects and Methods: Five at rest samples (before the start of operation) and five inoperational samples (during operation) were collected from each of the 18 OTs by both active (using air sampler) and passive (gravity settle plate technique as per the 1/1/1 scheme) methods using five percent sheep blood agar in 9 cm petri plates. The number of personnel present inoperational was recorded, and the number of colony forming units on the petri dish was counted after incubation and compared. Statistical Analysis Used: As the data followed a non-normal distribution, non-parametric tests were applied. Wilcoxon signed rank test, Spearman's correlation coefficient, Simple linear regression and Independent sample t-test. Results: The total bioburden in the OTs exceeded the maximum acceptable limit value during both moments of sampling. There was a significant positive correlation in the TVC values obtained by active and passive sampling methods in the two moments. Conclusions: The present study demonstrates a comparability of results obtained by the two different sampling techniques at two sampling moments. However, authentication of this result necessitates additional studies. In the interim, it is promising to conclude that both methods can be used for universal scrutinising of air biocontamination.

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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: Nosocomial infections account for 1.7 million cases every year costing between $35.7 billion and $45 billion of losses to the system and surgical site infections (SSIs) were responsible for 77' of the death of patients. This study aims to analyse the factors involved and thereby reduce them. Materials and Methods: Ninety-six patients undergoing both emergency and elective procedures in the surgery department during a period of 1 month were selected and followed up pre-operatively, intraoperatively, post-operatively and till 30 days after surgery. Results: The prevalence rate of SSI was 41.6' with women (52') and patients of the age group of 41–60 years (30') being affected more. Alcohol, smoking, tobacco use, diabetes, hypertension, tuberculosis, duration of surgery hospital stay and the American Society of Anesthesiologists classification proved to be important factors in the prevalence rate. Emergency surgeries had twice the rate than electives. Staphylococcus aureus (22') and Escherichia coli (22') followed by Pseudomonas aeruginosa (18') and Proteus mirabilis (17') were the organisms isolated. All S. aureus isolates were methicillin sensitive but erythromycin resistant. E. coli isolates were sensitive to the antibiotics except for cefotaxime and ampicillin (41.6'). Pseudomonas showed resistance to bacitracin (80') and ampicillin (90'), and all were sensitive to ceftazidime. The Proteus species were all resistant to cefotaxime. Conclusion: The high prevalence rate in the study can be reduced by following a systematic approach during pre-operative workup of the patient with proper pre-operative hair removal and smoking cessation at least 1 month before surgery and post-operative monitoring and educating the patient.

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Background: Specimen collection plays an important role in getting timely and accurate results of the investigation required for diagnosis. It is therefore important to develop systems and routine to increase knowledge, attitude and practices (KAP) among health-care workers regarding proper specimen collection, transport and promote cost-effectiveness. This study was conducted to assess and increase the awareness about the importance of proper specimen collection and evaluate the 'KAP' about the compliance with proper specimen collection among post-graduate students of a tertiary care hospital in India. Materials and Methods: A semi-structured questionnaire, pre-tested, self-administered, was used to access the KAP about specimen collection among resident doctors in our institution. The study population comprised resident doctors from different departments including microbiology, medicine, paediatrics, surgery, obstetrics and gynaecology and others. Results: A total of 86 residents took part in the study. Overall knowledge of doctors was found good, but there were gross deficiencies in the KAP of resident doctors in areas of universal precautions, proper collection of specimens, part preparation for specimen collection, safety precaution, disinfection of working area, handling of blood and body fluid, hand washing, disposal of waste, handling and transport of specimens, dealing with sharp injury, dealing with blood spillage and hospital infection control practices. Conclusion: A better understanding of infection control and hand hygiene among medical students and clinicians could play a major role in curbing disease transmission. This will help design an educational intervention programme which will further help identify problem areas in specimen culture.

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Background/Objectives: Hepatitis B virus (HBV) infection and its sequelae is a significant public health problem. Health-care workers (HCWs) are at high risk of occupational exposure to HBV. Centres for Disease Control and Prevention recommends health-care institutions to administer hepatitis B vaccine (0, 1 and 6 months) to HCWs at risk and to check their post-vaccination titre to ensure seroprotectivity. The main aim of this study was to develop a cost-effective protocol for HBV vaccination of HCWs. Materials and Methods: This descriptive observational study was conducted in the Department of Infection control in a tertiary care hospital from January 2014 to June 2015. Three hundred and ninety-one unvaccinated and 10 remotely vaccinated HCWs were immunised with standard 3 doses (0,1 and 6 months) and a challenge dose of hepatitis B vaccine, respectively, and their anti-hepatitis B surface antibody-titre (HBs titres) were checked 2 months later. Results: Based on the anti-HBs titres , the HCWs were classified as non-responders (<10 mIU/ml), hyporesponders (10–100 mIU/ml) and those with good immune response (≥100 mIU/ml). 2 (0.5') were non-responders, 8 (2') were hyporesponders and the rest 391 (97.5') showed good immune response. We categorised the HCWs based on age and gender and analysed the co-morbid conditions of hyporesponders. Conclusions: The seoconversion rate to hepatitis B vaccine was high. The anti-HBs titres of remotely vaccinated HCWs were adequate. Booster doses are not necessary. We emphasise all health-care institutions to follow this cost effective approach rather than pre-vaccination screening for infective hepatitis markers.

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Background: Catheter-associated urinary tract infection (CAUTI) is due to inadvertent use of urinary catheter. This study was done to determine the confirmed CAUTI cases, infection rate, prevalence of organisms, and their sensitivity profile. Materials and Methods: A total of 1874 Foleys catheter cases were followed for 3 months. Cases were confirmed as per the Centers for Disease Control and Prevention guideline. Results: A total of 21 (6.93') CAUTI cases were confirmed from 303 culture positive samples. The most common isolate was Escherichia coli (28.57'). Isolates were found resistant to fluoroquinolones and decreased sensitivity was found to other urinary drugs with the exception being colistin which was 100' sensitive. Average infection rate was 1.78/1000 catheter days. Average of catheter days was 11825. Conclusion: To reduce morbidity and length of hospital stay and costs to the patient, unnecessary catheter insertion should be avoided. If Foley catheter insertion is needed, aseptic precaution during catheter insertion must be practiced and removal of Foleys must be done as soon as possible. Continuous education and training of the health-care workers and surveillance by infection control team play an important role in improving the practice and reducing infection.

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Purpose: The purpose of this study is to evaluate and assess the incidence and outcomes of post-operative infections after eye surgeries. Materials and Methods: A 5-year retrospective study of all the post-operative infections was conducted at our institute with a detailed clinical and microbiological evaluation. All cases were treated with topical, systemic and/or intravitreal antibiotics. In addition to medical management, 7 eyes underwent pars plana vitrectomy, 3 underwent Keraring explantation and 1 underwent a secondary retinal detachment (RD) surgery. Results: Out of 54,359 surgeries done in the past 5 years, 19 cases of post-operative infections were recorded with 14 of them being endophthalmitis and the rest 5 were superficial infections (3 Keraring associated infiltrates, 1 corneal ulcer and 1 orbital cellulitis). Post-operative infection rate and post-operative endophthalmitis rate were found to be 0.0349' and 0.0257', respectively. Four (21') cases were culture positive - 2 cases of Staphylococcus aureus, 1 methicillin-resistant S. aureus and 1 Staphylococcus epidermidis. Twelve cases of endophthalmitis were acute in onset, and 2 were chronic onset endophthalmitis. Final visual outcome recorded at 1 month showed that 15 (79') patients recovered with good vision, whereas 4 (21') had a poor visual outcome. Of the 15 patients with good visual outcome, 6 (31.5') patients had final best-corrected vision >0.3 logMAR while 9 (47.3') had best-corrected vision of 0.3–1 logMAR. Four (21') patients with poor visual outcome had final vision <1 logMAR. Conclusions: A significantly low incidence of post-operative infections can be attributed to adherence of strict pre- and post-operative protocols as per the Hospital Infection Control guidelines. Early and prompt treatment reduced the risk of severe visual morbidity.

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