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ORIGINAL ARTICLES
Surveillance of microbial contamination of mobile phones, reported behaviour and hand hygiene practices of healthcare personnel related to mobile phone use: A prospective observational study
Sunil Kumar Poonia, Poonam Joshi, Rakesh Lodha, Arti Kapil, M Srinivas
January-April 2017, 5(1):40-44
DOI:10.4103/jpsic.jpsic_6_17  
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.
  4,183 2 -
Air sampling procedures to evaluate microbial contamination: A comparison between active and passive methods at high-risk areas in a Tertiary Care Hospital of Delhi
Rumpa Saha, Shrreya Agarawal, Amir Maroof Khan
January-April 2017, 5(1):18-23
DOI:10.4103/jpsic.jpsic_12_17  
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.
  3,058 7 -
REVIEW ARTICLE
A review of prevention of surgical site infections in Indian hospitals based on global guidelines for the prevention of surgical site infection, 2016
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
January-April 2018, 6(1):1-12
DOI:10.4103/jpsic.jpsic_29_17  
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.
  2,479 8 -
ORIGINAL ARTICLES
Efficacy studies on peracetic acid against pathogenic microorganisms
Gunjan Katara, Nanda Hemvani, Sheetal Chitnis, Vikrant Chitnis, Dhananjay Sadashiv Chitnis
January-December 2016, 4(1):17-21
DOI:10.4103/2214-207X.203545  
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.
  1,631 24 -
Adherence to surgical antibiotic prophylaxis guidelines in an Indian tertiary care hospital
Namita Jaggi, Pushpa Nirwan, Meenakshi Chakraborty
January-April 2018, 6(1):13-18
DOI:10.4103/jpsic.jpsic_28_17  
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.
  1,413 2 -
Catheter-associated urinary tract infection in a Tertiary Care Hospital
Areena Hoda Siddiqui, Vipul Kumar Srivastava, PP Aneeshamol, Carolyn Prakash
January-April 2017, 5(1):7-11
DOI:10.4103/jpsic.jpsic_2_16  
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.
  1,356 4 -
Presence of Qnr genes related to resistance to quinolones, first-, second- and third-generation in diarrhoeagenic Escherichia coli
Abbas Mokhtari-Farsani, Abbas Doosti, Zahra Mohammadalipour
January-December 2016, 4(1):5-9
DOI:10.4103/2214-207X.203541  
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.
  1,347 10 -
Magnitude and profile of occupational exposures to blood and body fluids among health-care workers: A study from a tertiary care teaching hospital
Chithra Valsan, Jane Paul, Praveenlal Kuttichira, Resmi Varghese, Sophiya Joseph
May-August 2017, 5(2):47-51
DOI:10.4103/jpsic.jpsic_18_17  
Background: Health-care workers (HCWs) are always at risk of occupational exposures (OEs) to bloodborne pathogens which mostly occur through needlestick injuries (NSIs). Knowledge about the magnitude and profile of such incidents in a hospital can help to plan effective intervention strategies to reduce such mishaps. Objectives: This study was carried out to find out the magnitude and trends in OE that had occurred in the past 2 years to the HCWs of our hospital which is an 1800 bedded centre to plan effective strategies for the prevention of such incidents. Materials and Methods: An observational study was carried out by collecting data on OEs among our HCWs in the past 2 years from the OE register maintained by the Hospital Infection Control Committee. The circumstances at which these incidents occurred also were analysed. Results: A total of 172 incidents were reported of which 161 (93.6%) were NSIs and 11 (6.4%) splashes. Nurses sustained highest number (38.95%) of NSIs, and maximum incidents occurred in the medical wards (34.9%) and the morning shift (51.3%). Majority (43.6%) occurred during recapping of needles. Discussion and Conclusion: NSIs occur in all categories of HCWs. A multilevel approach that includes regular awareness programmes that can bring about changes in attitude, strict waste management policies and innovative needles and syringes can reduce such incidents.
  1,352 3 -
There is more to hand hygiene than routine training of health workers and display of promotional materials
Ashmitaa Srianand, Marina Thomas
January-December 2016, 4(1):1-4
DOI:10.4103/2214-207X.203539  
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.
  1,250 12 -
Blood culture contamination rates in two district general hospitals in the Southeast of England
Nadeem Sajjad Raja, Bill O'Neill
May-August 2017, 5(2):57-61
DOI:10.4103/jpsic.jpsic_17_17  
Introduction: Blood culture is considered an important diagnostic tool to identify the causative agent of bloodstream infection (BSI) as well as to direct the definitive therapy. High contamination rate in any healthcare institution is directly linked with increased cost, use of unnecessary antibiotics and additional testing in the diagnostic laboratories. The audit team determined the blood culture contamination rate and the distribution of microorganisms causing BSIs in patients for the East Sussex Healthcare Trust, United Kingdom. Materials and Methods: This is a retrospective study which analyses the blood culture results over 2 years period (January 2014 to December 2015). Positive blood cultures were grouped into significant, contaminant or unknown significance by reviewing patient clinical data collected at the time of positive blood culture and the microbiology records. Results: A total of 11036 blood cultures were processed in the microbiology laboratory during the study (January 2014 to December 2015). A total of 1641 (14.9%) blood cultures were positive. Of 1641, 1298 (11.8%) and 286 (2.6%) were grouped as significant and contaminant, respectively. Fifty-six positive blood culture sets remained indeterminate due to the lack of the clinical information. The overall contamination rates in both hospitals in 2014 and 2015 were 0.9% and 1.7%, respectively. The average yearly contamination rate is 1.3%. Higher contamination rates were recorded from the paediatric, emergency, orthopaedics and surgical departments. A total of 1753 microorganisms were isolated. The most common isolated organisms include Escherichia coli 482, (27.5%), Coagulase-negative Staphylococcus, 274 (15.6%), Streptococcus species, 183 (10.4%), Staphylococcus aureus, 162 (9.2%), Klebsiella species, 135 (7.7%), Enterococcus species, 109 (6.2%) and Streptococcus pneumonia, 48 (2.7%). Thirty-three Candida species were isolated. The prevalence of methicillin-resistant S. aureus and the extended-spectrum b-lactamase producing Enterobacteriaceae were low. Conclusion: The present data showed lower contamination rate in the Trust than the acceptable rates. It also supports the need for regular training and education of healthcare professional that collect blood culture where the contamination rates are high.
  1,074 15 -
Prevalence of surgical site infections and antimicrobial sensitivity pattern in patients attending a Tertiary Care Hospital in South India: A prospective study
Giridharan Shanmugam, Selvi Rangam, KK Kayalvili, Lakshmi Sundaram
January-April 2017, 5(1):12-17
DOI:10.4103/jpsic.jpsic_8_17  
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.
  966 4 -
To know the hindrance or obstacles in hand hygiene practice among healthcare workers of Qassim province of Saudi Arabia
Sanjay Kumar Gupta, Sunitha Lorin Mathias, Ibrahim Saifi Al Harbi
May-August 2017, 5(2):52-56
DOI:10.4103/jpsic.jpsic_16_17  
Introduction: Hand hygiene (HH) is now considered as one of the most important measure of infection control activities. In the time of the growing burden of health care associated infections (HCAIs), the increasing severity of illness and complexity of management, threatened by multi-drug resistant (MDR) pathogen infections, health care workers (HCWs) are reversing back to the basics of infection preventions by simple measures like hand hygiene. Objectives: To find out the hindrance or obstacles in hand hygiene practice among health care workers. Methodology: Hospital based cross sectional study. Observation's: In the present study we asked about their opinion about hand hygiene (HH) around 21(28%) responded were fully correct, we also access their correct knowledge about WHO five moments/ indication of hand hygiene (HH) 70 (94%) had correct knowledge regarding indication of hand hygiene. We also access according to their day to day difficulties/obstacles in hand hygiene practice majority of them responded often too busy or insufficient time 18 (25%) followed by hands don't look dirty and skin irritation 17 (23%) & 17 (23%) respectively, some peoples also influenced by others behavior because they don't practice so we 13 (17.56%) also responded no difficulties in practicing hand hygiene (HH) in day to day work. We also asked their suggestions for improvement in hand hygiene compliance among health care workers majority of them suggested encourage the staff to do hand hygiene practice every now and then. Conclusion: Most of the respondents in present study were young females, most common obstacle in hand hygiene practice was often too busy and hand don't look dirty. Common suggestion for improvement was head of unit should ask to staffs daily in morning meeting about hand hygiene compliance and those who not follow after all these efforts to be punished.
  961 2 -
SHORT REPORT
Hand hygiene: From semmelweis to present!
Areena Hoda Siddiqui, Vipul Kumar Srivastava, PP Aneeshamol, Carolyn Prakash
January-December 2016, 4(1):22-24
DOI:10.4103/2214-207X.203537  
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.
  959 2 -
ORIGINAL ARTICLES
Risk stratification of surgical site infection in a Tertiary Care Hospital: A prospective case-control study
Murali Chakravarthy, Sukanya Rangaswamy, Antony George, Tejaswini Anand, Priyadarshini Senthilkumar, Suganya Arul Rose
May-August 2017, 5(2):73-77
DOI:10.4103/jpsic.jpsic_24_17  
Introduction: Health care associated infections are preventable cause of morbidity and mortality in healthcare setting. Surgical site infections are no different. It is essential to identify patients who are at high risk of getting SSI and preventive measures instituted even prior to admission for surgery Methods: This study comprising of all the SSIs that we encountered over two years and about 10 to 12 patients (per infected patient ) without infection as 'controls'. These two sets of data was used to identify the weightage of each risk factor using logistic regression. Results: We encountered thirty infections during the years 2015 and 2016, three hundred thirty non infected cases were used as control to arrive the weightage of each factor. Using a backward stepwise multivariate logistic regression model in the whole cohort, body mass index > 30 kg/m2, duration of preoperative stay and use of preoperative antiseptic shower were found to be independent predictors for SSIs. We could predict incidence of SSI with good discrimination (area under ROC curve – 0.855 , 95% confidence intervals 0.81-0.89). Three factors appear to stand out in our study, they are BMI, preoperative stay and preoperative antiseptic shower. These factors appeared to weigh differently in each specialty. Conclusion: The authors are now able assign scores to each of their patients depending on the type of surgery, sex of the patient, body mass index, number of preoperative days in the hospital, and whether chlorhexidine shower was given or not.
  913 3 -
Retrospective analysis of maternal and foetal outcome of H1N1 influenza amongst antenatal mothers at a tertiary care hospital
Manipriya Ravindran, Sivasundari Gowtham, Priyanka Mehta, Palaniappan Narayanan
May-August 2017, 5(2):69-72
DOI:10.4103/jpsic.jpsic_22_17  
Background: Pregnancy is an immunocompromised state where in infections are common. H1N1 (hemagglutinin type 1 and neuraminidase type 1) Influenza is a seasonal epidemic, considered as an alarming infection across the world with high rates of maternal mortality each year. The principal intention of this study was to elicit the clinical profile of antenatal mothers with H1N1 and subsequently to analyse the risk factors, prognosis and the materno-fetal outcome. Extensive review of literature with current guidelines and management protocols has been highlighted. Methodology: This is a retrospective observational study performed in Sri Ramachandra University and Research Institute over the period of one year from January 2016 – March 2017, the clinical course of the patients who were confirmed with H1N1 influenza using throat swab RT-PCR assay was analysed. Statistical analysis was done by SPSS, version 11. Results: A total of 62 antenatal patients with symptoms suggestive of H1N1 influenza were tested for H1N1 out of which 12 were positive, which accounted for 19.35% positivity. The mean age was 24 years with a range of 22-30 years. The epidemic peaked in the month of November to January. Fever with cough was the most common clinical manifestation. Most of the patients were hospitalized and treated with oseltamivir. All the positive patients, were advised home isolation for 5-7 days after discharge. This indexed study had an overall mortality rate of 8.3%. Acute respiratory distress syndrome and multiple organ dysfunction were the most common cause of death. Conclusion: Most of the patients recuperated well with close vigilance, symptomatic and antiviral treatment, went on to deliver healthy baby. Proper prevention steps, personal hygiene and admission to designated swine flu ward can be helpful in preventing the spread in the community. Respiratory failure and sepsis were the cause of mortality among the patients of this study.
  896 2 -
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
Sanjay Kumar Gupta, Fahd Khaleefah Al Khaleefah, Ibrahim Saifi Al Harbi, Marilou A Torre, Sinimol Jabar, Sunitha Lorin Mathias, Omar Al Romaih
January-April 2018, 6(1):27-31
DOI:10.4103/jpsic.jpsic_27_17  
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.
  849 2 -
HISICON 2017
Oral Paper Abstract

September-December 2017, 5(3):102-117
  836 2 -
ORIGINAL ARTICLES
Surgical patients' safety in the polish hospital environment in the context of selected infection control practices in surgical wards
Anna Rozanska, Jadwiga Wojkowska-Mach, Małgorzata Bulanda, Piotr B Heczko
January-December 2016, 4(1):10-16
DOI:10.4103/2214-207X.203542  
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.
  809 10 -
The optimisation of the use of economic resources for hepatitis B vaccination of health care workers
Nivedhana Subburaju, Sulochana Putlibai
January-April 2017, 5(1):1-6
DOI:10.4103/jpsic.jpsic_5_17  
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.
  802 11 -
Post-operative infections at a Tertiary Eye Hospital: A 5-year retrospective study
Namita C Anagol, DS Nisha, Sri Ganesh, Suman Shree
January-April 2017, 5(1):24-29
DOI:10.4103/jpsic.jpsic_4_17  
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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Bacterial spectrum and antimicrobial-resistance pattern of bloodstream infections in neutropenic and non-neutropenic adult cancer patients
Nadeem Sajjad Raja, Sunil Gupta, Bill O'Neill
May-August 2017, 5(2):83-88
DOI:10.4103/jpsic.jpsic_19_17  
Background: Bloodstream infections (BSI) in cancer patients remain associated with significant morbidity and mortality. The choice of an empirical antibiotic regimen is usually based on the local epidemiology of the microorganisms and their antimicrobial susceptibility profile. We present the spectrum and the antimicrobial susceptibility of the causative agents of BSI in adult cancer patients in East Sussex Healthcare Trust (ESHT), UK. Materials and Methods: This retrospective study was conducted at ESHT from January 2006 to December 2015. Demographic and laboratory data were collected from the pathology information system. Results: A total of 640 episodes of BSI occurred in 297 patients (159 male). Of the 297 patients, 239 (80%) had haematology malignancies, whereas 54 (18%) had solid organ tumours. Four patients had both. Majority of BSI (383, 60% episode) occurred in neutropenic patients. A total of 802 organisms (477 [59%] and 325 [41%] organisms from neutropenic and non-neutropenic patients, respectively) were isolated. Of 802, 406 (51%) Gram-positive and 386 (49%) Gram-negative organisms were isolated. Seven Mycobacterium species and three Candida species were isolated. Most common organisms in neutropenic patients were coagulase-negative Staphylococcus (CoNS) (22%), Klebsiella species (14%), Escherichia coli (13%), Streptococcus species (10%) and Pseudomonas species (10%). In non-neutropenic patients, CoNS (29%), E. coli (11%), Pseudomonas species (8%), Streptococcus species (7%) and Klebsiella species (5%) were isolated. Twelve glycopeptide-resistant Enterococci (26% of total 47 Enterococcus species) were isolated. Four methicillin-resistant Staphylococcus aureus (14% of total 28 S. aureus) were isolated. Furthermore, 15 extended-spectrum β-lactamase producing Gram-negative bacilli were isolated. Among Gram-negative organisms, more than 91% isolates were sensitive to piperacillin/tazobactam, ceftazidime and ciprofloxacin and higher sensitivity rates (>95%) were recorded in gentamicin, polymyxin B and meropenem. Conclusion: This study highlights an ongoing trend towards Gram-positive organisms causing BSI in cancer patients. The antimicrobial regimens used in our institution are highly effective against commonly isolated organisms. The identification and the antimicrobial susceptibility of the microorganisms causing BSI in cancer patients remain important to develop antimicrobial treatment strategies including antimicrobial guidelines as well as infection control and to prevent the spread of antimicrobial resistance.
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Molecular characterisation of beta-lactamases-producing Enterobacteriaceae members from critical care patients
Richa Gupta, Abida Malik, Meher Rizvi, Syed Moied Ahmed
May-August 2017, 5(2):62-68
DOI:10.4103/jpsic.jpsic_20_17  
Background: This study was done to assess the prevalence of beta-lactamases and biofilm production in general and blaCTX-M, blaTEM, blaSHV and blaAmpC in particular amongst Enterobacteriaceae members in Intensive Care Unit (ICU) patients. Materials and Methods: Samples were collected aseptically from 210 ICU patients from February 2012 to December 2015. Culture, identification, antimicrobial susceptibility, extended-spectrum beta-lactamases (ESBLs), AmpC, metallo-beta-lactamase (MBL) and biofilm detection were done according to the standard protocol. Polymerase chain reaction analysis for beta-lactamase genes of the family CTX-M, TEM, SHV and AmpC was carried out. Results: Amongst 200 pathogens, most commonly isolated Enterobacteriaceae member was Escherichia coli (2 [26%]), Klebsiella pneumonia (37 [18.5%]), Klebsiella oxytoca (12 [6%]), followed by Citrobacter species (33 [16.5%]) and Serratia species (15 [8%]). E. coli (29 [55.7%]) was most commonly associated with urinary tract infection; however, the frequency of K. pneumoniae (18 [48.6%]), K. oxytoca (5 [41.6%]) and Citrobacter koseri (20 [33%]) was higher in lower respiratory tract, bloodstream and surgical site infections, respectively. Phenotypically, prevalence of ESBL, AmpC and MBL amongst Enterobacteriaceae members was 50.2%, 36.6% and 12.3%, respectively. However, blaCTX-M and blaAmpC genes were detected in 48% and 32.4% of members, respectively. BlaTEM and blaSHV were not detected in any of the isolates. The average hospital stay of ICU patients was 21 days and was associated with 48.5% mortality. Conclusion: There is a great need for informed antibiotic treatment guided by not only routine antimicrobial susceptibility but also by knowledge of ESBL, AmpC and MBL status of the isolate.
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Effectiveness of isopropyl alcohol and ultraviolet-based sanitiser on decontamination of mobile phones used by dental personnel
Srikanthan Sriram, Parangimalai Diwakar Madan Kumar, Ramanathan Swaminathan, Rajendran Venkatesh, Vasudevan Menaka
January-April 2018, 6(1):19-22
DOI:10.4103/jpsic.jpsic_4_18  
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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Central line-associated bloodstream infection: A study on creating awareness about specimen collection
Kavita Raja, Gracyamma Bridget
May-August 2017, 5(2):78-82
DOI:10.4103/jpsic.jpsic_26_17  
Background: Central line associated Blood stream infection(CLA-BSI) is a hospital acquired infection that is often missed. In a patient on a central line, culture of peripheral blood along with a sample of blood taken through the CL or CL tips is imperative, for a better laboratory diagnosis of CLA-BSI. Aim: (1) To compare the number of CLA- BSI detected in 2010 with the number in 2012 after the awareness campaign was conducted in 2011. (2) To compare specimen collection in different units and formulate strategies for improvement. Methods: Using the laboratory information network, the number of cannula tips and blood cultures sent for culture in 2010 was taken. An intensive campaign to detect CLA-BSI, was initiated in 2011 by the Infection Control Team. The total number of CLA-BSI detected in 2010 was then compared with the number in 2012 after this campaign. Results: A total of 158 cannula tips were sent for culture during the year 2010, while in 2012, 276 cannula tips were sampled. In 2010, while incomplete sampling occurred in 39%, this was reduced to 33% in 2012. Number of correctly diagnosed CLA-BSI increased from 13 to 27 cases in 2012. Conclusion: The campaign has led to detection of more correctly defined CLA-BSI and hence, continuing the training in sending samples is essential to collect the correct data of CLA-BSI. The case studies included show the benefits of correctly identifying such infections.
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Specimen collection: The art of laboratory science among the clinicians
Fatima Khan, Hiba Sami, Meher Rizvi, M Salman Shah, Tamkin Khan, Manzoor Ahmad, Asfia Sultan, Indu Shukla
January-April 2017, 5(1):35-39
DOI:10.4103/jpsic.jpsic_9_17  
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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