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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Background: 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. Methods: 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. Results: 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. Conclusions: 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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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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Background: 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. Objective: 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 Staphylococcus aureus [132 (35%)], followed by Escherichia coli [54 (14%)] and Pseudomonas aeruginosa [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. Conclusion: 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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Background: Healthcare-associated infections among health-care workers (HCWs) commonly follow occupational exposures to pathogens through sharp, cuts and splashes contaminated with infected blood or body fluids of patients. The objective of this study was to determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. Materials and Methods: An observational prospective study was done in the HCWs of a tertiary care centre of North India from January 2015 to December 2016. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) serum markers. Follow-up status before and after needle-stick injuries (NSIs) was done. Results: NSIs were reduced from 18 (70.37%) in 2015 to 8 (29.62%) in 2016 with P < 0.05. The maximum numbers of NSIs were found in staff nurses (68.64%), mostly with hollow bore needle (68.75%), during insertion of intravenous cannula (29.66%). Maximum type of injury was superficial percutaneous (62.82%). 35.89% of the HCWs who had NSI were not immunised with HBV vaccines. Post-exposure prophylaxis for HIV was started within 2 h of exposures in whom it was warranted. Conclusions: The study indicates that supervised training, especially during initial stressful years, is needed not only to reduce the incidence of NSIs but also to improve work performance.

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Introduction: Surgical antimicrobial prophylaxis (SAP) is considered vital for reducing surgical site infection, however, if inappropriate, it prolongs the hospital stay of patients, increases morbidity, promotes antimicrobial resistance and puts an economic burden on the health system. This study was carried out to assess the knowledge and compliance of SAP among surgeons in a hospital. Methods: A quantitative, non-interventional study was done among surgeons from a tertiary teaching hospital. First, we evaluated participant knowledge from different surgical specialities by the pre-designed questionnaire, and second, we audited surgeries during the study period of 3 months for a compliance rate of SAP. The score of responses and compliance to SAP variables during surgeries was studied. Results: We assessed a total of 184 participants for knowledge and 271 surgeries were audited. Among the variables of surgical prophylaxis, majority of the participants answered correctly about the route and timing of administration of SAP in 179 (97.3%) and 145 (78.8%) respectively. Only 66 (35.9%) knew about the correct choice of SAP while 78 (42.4%) responded correctly about the duration within which it should be stopped. However, two-third 138 (75%) were aware of the assessment of beta-lactam allergy before administration. Among the surgeries audited, 83.7% compliance was noted for the timing of administration of antibiotics, however, in only 42 (26.7%) cases SAP was stopped within 24 h of surgery and in only 38 (24.2%) cases cefazolin/cefuroxime was given as prophylaxis. Conclusion: This study highlighted the importance of knowledge and awareness of SAP guidelines among surgeons. There is a need to train surgeons regarding this important issue.

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Objective: Healthcare associated infections cause significant morbidity, mortality and escalation of cost of care. It is the responsibility of all concerned to work towards reducing this potentially preventable increase in morbidity, mortality and cost caused by healthcare associated infections. Such data in Indian subcontinent has been studied sparingly. The objective of this study was to understand the degree of the cost escalation, morbidity and mortality associated with healthcare associated infections. Design: This prospective case controlled observational study was carried out from the year 2007 onwards. All the infections that occurred unto 2014 were included. Cost, morbidity and mortality of two similar matched controls for each infected case were chosen. Setting: Tertiary referral hospital. Participants: All patients with healthcare associated infections and twice that number as control. Interventions: None. Main outcome measure: Escalation of cost, morbidity and mortality due to healthcare. Results: There were five hundred fifteen infections during the study period. The escalation of cost due to infection was $ 4611. The mean mortality in the infected group was 8.75% in contrast to 2.5 in the non infected group. The mortality due to central line associated blood stream infection and ventilator associated pneumonia was more than 30% each. The length of stay in the intensive care unit was 8 days in the infected group in contrast to 2.27 days in the non infected group. Length of stay in the hospital was 33.5 days in the infected patients in contrast to 10.3 days in the non infected group. Conclusions: Healthcare associated infections caused escalation of cost, length of stay in the intensive care unit and hospital. Mortality in the infected cohort was more in contrast to the controls.

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Introduction: Hand hygiene (HH) is an important tool in the prevention of transmission of infections in hospitals; however, it is often an aspect which is neglected by healthcare workers (HCWs). Therefore, ongoing training and education, introduction of hand rubs at every bedside, displaying posters of the indications of HH as well as the six important steps of HH are some of the important measures to increase compliance. Assessment of compliance and feedback is again important so as to take measures to improve further the compliance and thus the infection rates in the hospital. Methodology: We studied the compliance rate in the year 2018. We had different categories of HCWs. The total number of HCWs was 594, out of which a representative percentage was taken from each category. The study was conducted according to the WHO guidelines. Results: We found the compliance rate to be low in months when there was a turnover of staff, that is, some old staff members left and new staff were recruited. Hence, we found the compliance to be good in housekeepers, technicians, doctors/consultants and nurses, but low in resident medical officers and attendants, with the probable reason being they were most of the times not available for training sessions and sometimes negligence. Conclusion: Ongoing training sessions, education of the HCWs, posters of HH in all wards and intensive care units and motivation are absolutely essential to maintain an effective compliance. Efforts taken by our infection control nurse and administrators did help us in improving our compliance rate this year.

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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.

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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.

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The coronavirus disease 2019, the first case of India surfaced in Kerala. Hence, an exploration of knowledge of medical professionals regarding transmission and steps adopted for prevention and spread of disease was assessed via a cross-sectional study, designed and disseminated through media. The study revealed no significant difference in knowledge score based on district, age and medical discipline. However, majority of the participants lacked basic knowledge and opted social media to update knowledge, which pinpoints towards the need for online training courses in newer disaeses.

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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.

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Introduction: Antibiotic stewardship practices require that antimicrobial treatment should be tailored according to microbiological culture. Therefore, the aim of this study was to describe the antibiotic prescription pattern and to assess how frequently the surgeons request for a specimen culture during the patient's stay. Materials and Methods: This was an observational study; conducted in level-1 trauma center for 10 months and all consecutive neurosurgery patients, admitted in the hospital were included in the study. Detail of microbiology culture and anti-microbial-sensitivity results were recorded. Antibiotic prescriptions were recorded in each patient during their hospital stay. Results: A total of 1216 consecutive patients admitted to the neurosurgery unit were included in the study. The mean age (± standard deviation) of patients was 33.29 (±16.27) years, predominantly male patients; 1038 (85.4%). Overall, culture-confirmed infections were present in 216 (19.4%) patients. Prevalence of Gram-negative bacteria; 195 (90.2%) was more than Gram-positive bacteria; 21 (4.7%) (P < 0.001). The most frequently used antibiotic was cephalosporin; 1030 (84.7%), followed by aminoglycoside; 952 (78.3%), fluoroquinolone; 422 (34.7%), penicillin; 311 (25.6%) and metronidazole 277 (22.8%). A total of 400 (13.15%) antibiotics were prescribed appropriately in patients with culture-confirmed infection while 2640 (86.8%), antibiotics were given inappropriately in rest of the patient in whom there was no matching culture-confirmed infection (P < 0.001). Conclusion: A very small number of antimicrobial prescriptions were based on culture reports. Hospitals in developing countries including India need to institute surgical antibiotic policies soon since most hospitals are facing a severe problem of antimicrobial resistance.

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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.

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Introduction: Health personnel in high-burden countries are at a greater risk of tuberculosis (TB) infection, due to continuous exposure to diagnosed and undiagnosed pulmonary TB cases. A scoping review is done to ascertain the prevalence and risk factors for latent TB infection (LTBI) among India's healthcare personnel. Materials and Methods: A review of literature was done from Medline, CINAHL, Global Health and PubMed. Full-text review of 30 articles was done, and three were found to be eligible for final analysis. Results: The prevalence of LTBI was found to range from a quarter to one-third of the study participants. Available evidence has revealed the role of increased time being spent in the healthcare profession as an essential risk factor for the development of LTBI. The study participants were of younger age in all studies. There was a lack of representation of different categories of health workers. Discussion: Higher prevalence in younger participants poses significant threats to the well-being of healthcare professionals. The absence of proper guidelines for treating LTBI in high-prevalent settings and the lack of awareness among healthcare professionals regarding LTBI are significant challenges for preventing TB infection among healthcare professionals.

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