Background: Surveillance of health-care-associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. Objectives: To study the benefits and limitations of an innovative, two-stage surveillance method of HAIs and effectiveness of infection control measures. Design: It is a retrospective 5-year study of electronic surveillance system to capture HAI cases with high index of suspicion and confirmation with the manual methods of HAI tracking. Methods: The tertiary care hospital, New Delhi, India, adopted an electronic two-stage HAI surveillance system in April 2015. This system automatically detects all microbiology culture-positive cases for patients on central line, ventilator or urinary catheter for more than 48 h in the hospital along with relevant clinical information, which was further validated by infection control team. These all are suspected HAI cases. Hence, the system is screening the cases which can be potential HAI further. Daily clinical assessment to look for initial warning signs related to HAI was done in every individual case irrespective of culture results. Results: HAI incidence rates in pre-period (before implementation of electronic detection system April 2013 to March 2015) of CLABSI, CAUTI, VAP and SSI were 1.36%, 1.41%, 2.65% and 0.16% and post-period (after implementation of electronic detection system April 2015 to March 2018) were 1.25%, 1.30%, 1.16% and 0.09%, respectively. The pre- and post-analysis depicted that rates of CLABSI, CAUTI and VAP declined significantly; however, SSI rate in post-implementation declined but not significantly. Conclusion: The electronic tracking system acts as an early warning system for identification of suspected HAI cases and triggers an early preventive response by both clinician and hospital infection control team. Moreover, the use of electronic monitoring system also led to implementation of many additional infection control measures.

Introduction: Blood cultures play a very important role in the diagnostic algorithm for managing patients with sepsis. Contamination of blood cultures complicate patient care resulting in unnecessary antibiotic use, prolonged hospital stays and more financial burden on the patient. Hence, microbiology laboratories strive to keep contamination rates within <3% as per international standards. Aim: To monitor blood culture contamination rate and reduce contamination using a novel blood culture collection (BCC) bundle. Materials and Methods: A prospective interventional study carried out in a newly set up Microbiology laboratory of a 200 bed tertiary care hospital in North Mumbai. Blood cultures from various clinical areas of the hospital were processed using the BacT/Alert system (BioMereiux, Marcy l'etiole, France). All positive blood cultures were co-related clinically and assigned as pathogens or contaminants. Blood culture contamination rates were actively monitored and BCC bundle was introduced to reduce contamination, which comprised six steps to follow while performing BCC. Active surveillance, audits of the collection process and root cause analysis (RCA) of blood culture contamination were done simultaneously. This was followed by feedback to phlebotomists, nurses and doctors. Periodic and need-based onsite training of health-care workers was also done. Results: Different types of Health Care Workers were performing the procedure. The most common contaminant grown were Gram-positive cocci 159 (25.5%), followed by Gram-negative bacilli 58 (9.32%), and Bacillus spp. 37 (5.95%). It was observed that skin disinfection and incorrect order of draw were two main reasons for the contamination. Over a period of 18 months, BCC bundle implementation reduced the contamination from 17% to 4%. Conclusion: RCA, training, surveillance and audits are essential to improve the quality of blood culture results. Implementation of the BCC bundle benefits both the microbiology laboratory and the clinical teams by decreasing the growth of contaminants and improving the utility of blood culture for better management of patients in sepsis bringing in favorable outcomes.

Background: Diagnostic ophthalmic drugs are very essential in every eye care setting. Contamination of these drugs has a deleterious effect on the eye as they can trigger or worsen a pre-existing ocular disease. Purpose: The aim of this study was to evaluate how ocular diagnostic drugs are cared for and maintained by eye care practitioners. Methods: A total of 140 eye care practitioners across the ten regions of Ghana responded and returned the questionnaires. It contained questions on how frequently they checked date of expiry, first date of opening the diagnostic drug bottle, how long the opened diagnostic drug bottles were kept in use before discarding them, adherence to hand hygiene practices prior to instillation of drops among others. Some 20 of the 60 eye care facilities (from which the participants were drawn) were purposively selected and observed for their adherence to care and maintenance practices with regarding the use of diagnostic agents in a blinded fashion (the practitioners did not know they were they were being observed). Results: It was realised that most of the practitioners did not adhere strictly to basic care and maintenance (as indicated in the drug insert and the British Pharmaceutical Codex) practices necessary to ensure optimal safety of patients. Conclusion: Care and maintenance practices were not always adhered to by most of the eye care practitioners despite its implication for patients' safety.

Background: Medical students and residents are at higher risk of sharps injuries (SIs) as a result of various factors, including the lack of experience, skills, technical expertise and risk perception. SIs place these individuals at higher risk of exposure to blood-borne pathogens such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus. There is a wealth of research regarding SIs among health-care workers who are professionals/employees, but not as much among medical students and residents. Aim: The aim of this retrospective analysis was to analyse the various factors and relationships between sharps injuries and medical students/residents at a University in the United States. Methods: The sharps injuries exposure logs of medical students and residents at the University, from 2006 January to September 2018, were analysed using SPSS software. Results: Residents had a higher rate of SIs versus medical students. The prevalence percentage of SIs among residents was 10.99%, whereas 2.22% in medical students. SIs increased with the number of training years among medical students and residents, especially among residents in and after their 5^th year. July and September had the highest frequency of SIs. Suture and hollow-bore needles were the most common medical device associated with SIs among medical students and residents, whereas, among the residents, scalpel blades and surgical instruments were also frequently encountered. Conclusion: Medical schools and training hospitals could use this information to formulate plans and policies in the training of medical students and residents to reduce the risk of SIs among these groups.

Aim: Ralstonia mannitolilytica species, an opportunistic pathogen prevalent in moist environmental conditions has been known to cause outbreaks in health care associated institutes. It has been linked to contaminated equipment, antiseptics and other medications. This article deals with an outbreak in Day care ward which caters primarily to oncology patients. Methodology: Blood cultures of febrile patients who had received chemotherapy were evaluated. Environmental surveillance cultures were undertaken to investigate the outbreak. Results: Six patients who presented with fever grew R. mannitolilytica in their blood cultures exhibiting the differential time to positivity. The chemo ports were removed and appropriate antibiotics based on the sensitivity profile were administered. The patients responded to these measures. Environmental surveillance cultures were negative. Conclusion: Accurate identification of nonfermenters in blood cultures is essential for appropriate management of patients. The isolation of organisms such as Ralstonia species could indicate a breach in sterility calling forth appropriate investigations. Infection control training needs to be reinforced regularly to prevent the occurrence of healthcare associated infections.