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Promotion of successful hand hygiene practices in the intensive care units of a tertiary care hospital
Juhi Taneja, Bibhabati Mishra
July-September 2015, 3(3):130-133
Control of nosocomial infections is a major health concern in a hospital setting and hand hygiene is considered as the most important tool in nosocomial infection control.
This prospective study about the practice of hand washing by 106 HCWs (Health Care Workers) working in Intensive Care Unit (ICU) before and after patient contact in a tertiary care hospital was conducted to find out the hand washing compliance rate in ICU of GB Pant Institute of Postgraduate Medical Education and Research and the factors associated with noncompliance and to find out the impact of a task-orientated hand hygiene education and intervention program.
462 opportunities of hand hygiene were observed in the ICUs over 30 h. Adherence was found to be 52%. A positive intention to comply with hand hygiene was found among 94% of the respondents. Most respondents (78.2%) believed that they could improve compliance with hand hygiene on their own. Intervention included education on hand hygiene indications and technique, hand hygiene performance feedback, and discussion of the previous assessment of HCWs' beliefs toward hand hygiene. After intensive promotion of hand hygiene, observation sessions were performed on 98 nursing staff, which provided 425 opportunities of hand hygiene, and hand hygiene adherence was increased to 63% as an impact of measures taken.
The study revealed that hand hygiene compliance can be effectively increased among HCWs by regular reminders and surveys. Training programs on hand hygiene should be systematically planned, regularly conducted, and evaluated for staff nurses so as to keep them motivated.
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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
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
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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Microbial epidemiology and antimicrobial susceptibility profile of wound infections in out-patients at a level 1 trauma centre
Amit Kumar Gupta, Priyam Batra, Purva Mathur, Alphina Karoung, BT Thanbuana, Shiny Thomas, M Balamurugan, Jacinta Gunjiyal, Mahesh C Misra
July-September 2015, 3(3):126-129
Wound is a disruption of normal anatomic structure and function of the skin, and any infection in this constitutes wound infection. Wound infection delays wound healing, and it causes wound breakdown, leading to increased hospital stay, morbidity and mortality. Most of the published data available focus on surgical site infections. In the developing countries, however, wound infection is an important cause of hospital mortality and morbidity. No data are available on the microbial profile of the wounds presenting at our hospital.
This study was thus designed to describe the microbial epidemiology and the antimicrobial resistance profile of the wounds of the patients presenting to the OPD.
Methodology and results:
Retrospective review of records of all wound samples sent over 3 years from OPD was done. OPD sent 827 wound samples of 571 patients. Most common organism isolated was
[132 (35%)], followed by
[54 (14%)] and
[49 (13%)]. Of the 145 S. aureus strains, 43 (30%) strains were Methicillin Resistant Staphylococcus aureus, and none were resistant to vancomycin/line- zolid/teicoplanin. Gram-negative organisms were resistant to most antibiotics tested.
Wound healing is halted in the presence of prolonged inflammation such as due to infection. Presence of bacteria delays wound healing, but the presence of low number of microbes is required for wound healing. Absence of appropriate signs to guide treatment becomes a reason for prolonged indiscriminate use of antibiotics which leads to rapid emergence of resistant organisms. Data generated by our study would help in the formulation of antibiotic policy for OPDs and also help in checking inadvertent antibiotic usage.
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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
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).
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%,
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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Air travel in COVID-19 pandemic
Narendra Saini, Vandana Saini
January-April 2020, 8(1):29-32
To limit the spread of coronavirus, most of the countries had applied lockdown, restricting movement of people, ban on public transport and air travel. The World Health Organization (WHO) advises against the application of travel or trade restrictions in countries experiencing COVID-19 outbreaks for a longer period of time. These lockdowns should be short in duration and be regularly reviewed as the situation evolves. After lockdown, most of the countries have started airline services again, but society in general is sceptical about safety of air travel and the spread of disease in the present COVID time. Aircraft appears to be airtight chamber with passengers sitting very close to each other, so people get worried about getting infection from fellow travellers. Unfortunately, most of the regulations are on chemical contaminants in the flight cabin but are silent on bacteriological, viral and other microbial contamination of air in the cabin. Still, it has been observed that the risk of infection in flight is comparable to train and car and might be much lesser. To maintain air quality, airplanes have High-Efficiency Particulate Air filters which can capture 99.9% of particles (bacteria, fungi and larger viruses or virus clumps) of 0.1–0.3 μm in diameter. Low concentrations of bacteria and fungi have been found in air cabin at levels that are not thought to pose any health risk. Air is replaced with fresh air every 2–4 min in the aircraft. Besides that, ventilation systems on planes are set up in zones; air is shared between a small group of people only. Although the risk of catching something, airborne on a plane is lower than in many other confined spaces because of the filters and air exchange ratio but risk of infection through contact is still possible, so if a person fly observe contact precautions, for example, hand hygiene and use face cover.
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