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.

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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.

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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.

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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.

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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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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.

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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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Aims: Analysis of price variation among parenteral antibiotics available in a tertiary care teaching hospital. Settings and Design: Hospital pharmacy department. Subjects and Methods: Price, strength and brands of parenteral antibiotics included in the study were obtained from a computer database of hospital pharmacy department. The difference between the maximum and minimum prices of various brands manufactured by different companies with the same drug was analysed, and percentage variation and the cost ratio in the prices was estimated. Statistical Analysis Used: Descriptive statistics such as frequency and percentage. Results: Overall, prices of 15 single drug antibiotics available in 24 strengths marketed in 68 brands and 7 fixed-dose combinations available in 15 strength marketed in 49 brands were analysed. The maximum price variation and highest cost ratio between brands of single drug parenteral antibiotics were found to be more in amoxicillin 250 mg (270.43%) with cost ratio (1:3.7) and minimum in ceftazidime 2000 mg (5.26%) with cost ratio (1:1.05). In the case of fixed-dose combinations of parenteral antibiotics, the highest cost ratio (1:4.20) and percentage price variation (320.84) was found to be with cefoperazone 500 mg + sulbactam 500 mg combination, and the lowest cost ratio (1:1.11) and the percentage price variation (11.44) were found to be amoxicillin 600 mg + clavulanate 600 mg combination. The percentage price variability of 12 brands was 0%–25%, and for 26 brands, it was 50%–75%. For 13 brands, percentage price variability was >100%. Conclusions: Pharmacoeconomics aspects should be taken into consideration by healthcare practitioners while prescribing antibiotics to the patients for infectious disease management which will facilitate compliance, minimise antibiotic resistance and treatment failure.

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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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Brucellosis, a zoonoses, is an important yet underdiagnosed and underreported cause of fever of unknown origin (FUO) in India. This may be both due to lack of awareness and lack of simple diagnostic tests for confirmation. The serological and molecular diagnostic tests may pose trouble in interpretation due to lack of standardisation. Culture is the gold standard and needs 6 weeks, which can be minimised with automated blood culture system. We describe four cases of culture-proven childhood brucellosis in the past 1 year. In our case series, fever and lymphadenopathy were seen in 100%, arthralgia in 50% and hepatomegaly in 75%. Use of automated blood culture system and good clinician–microbiologist communication aided in early diagnosis (<5 days) and appropriate treatment. On follow-up, all the cases are doing well.

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