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: 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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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: 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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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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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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Introduction: The carriage of Staphylococcus aureus is often considered an important issue in terms of infection control. The present study is aimed to determine the carriage rate of S. aureus and methicillin-resistant S. aureus (MRSA) amongst hospitalised patients in comparison to community population and healthcare workers in rural South India. Methods: A cross-sectional prospective study was conducted amongst adult participants from three different groups – healthy community population, healthcare worker (staff nurses) and hospitalised patient. Finger, nose and throat of all study participants were examined for the carriage of S. aureus and MRSA by microbiological culture, identification and susceptibility testing to oxacillin. Results: The carriage rate of S. aureus was 47.2', 55.6' and 77.8', respectively, in the community, hospitalised and healthcare workers; similarly MRSA carriers were 16.6', 47.2' and 22.2', respectively. S. aureus carriage rate was higher amongst healthcare workers, and MRSA carrier rate was higher amongst hospitalised patients. The MRSA carriage rate amongst hospitalised patients was 7-fold higher than the community population and 2-fold higher than the healthcare workers. Conclusion: Hospitalised patients tend to carry the higher rate of MRSA and are at high risk of developing invasive infections. Hence, screening/decolonization for MRSA at the time of hospitalisation and prudent infection control measures is necessary to combat this pathogen.

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