Journal of Patient Safety and Infection Control

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Background: Surveillance for ventilator-associated pneumonia (VAP) has long been a challenge because of the lack of objective, reliable definitions. Hence, National Healthcare Safety Network (NHSN) has introduced ventilator-associated events (VAEs) as a surveillance definition. While VAE identifies all the possible complications in a mechanically ventilated patient, VAP recognises only the infective complications. There are several retrospective studies reporting no concordance between the occurrence of VAE and VAP. A prospective, observational study in medical intensive care unit (ICU) was conducted over 1 year with the objective of comparing all three tiers of VAE, which are ventilator-associated condition (VAC), infection-related ventilator-associated complication (iVAC) and possible VAP (PVAP), along with VAP in terms of predictive value, characteristics and clinical relevance. Materials and Methods: A prospective cohort study was conducted from July 2018 to June 2019 at PGIMER, Chandigarh, in a 12-bedded medical ICU. All patients with more than 48 h of mechanical ventilation (MV) were included. The demographic data, Acute Physiology and Chronic Health Evaluation-II at 24 h of admission, days of MV, length of ICU stay and outcome of patients were recorded. The patients were screened for both VAP and VAE. Results: Out of a total of 405 patients, 274 patients were included with 3945 patient days and 3330 MV days. The incidence of VAP, VAC, iVAC and PVAP was 6.91, 8.41, 5.41 and 1.50/1000 ventilator days, respectively. Kendall's W-test showed that there was no concordance between VAP and VAE. Conclusion: The study concluded no concordance between cases identified as VAE and VAP.

Introduction: There has been a rise in the use of broad spectrum antibiotics in patients undergoing surgeries in perioperative period including clean surgeries. The use of such antimicrobials is also found to be longer than recommended and is responsible for emregence of multi drug resistant infections. These add to antibiotic related complications and cost as well. Aim: To study the type of antibiotic prescription in patients undergoing clean surgeries and assess compliance with antibiotic policy and frame recommendations for improvements if any. Method: Fifty five patients were prospectively evaluated for perioperative antibiotics prescriptions and followed up till discharge/1 month for any nosocomial infections or other complications. The kind and duration of antibiotics were noted and assessed for extent of compliance to antibiotic policy. Results and Discussions: Compliance to perioperative surgical prophylaxis in time was good (91%) as per the protocol and all patients received prophylaxis. Broad spectrum antibiotics were used in almost 50% cases and duration was prolonged compared to the prescribed protocol. Prescription of oral antibiotics was continued in 72.7% % cases( 40/55 ). There was no increased incidence of health care associated infections(HAI) in these patients. Conclusion: Compliance to Surgical antibiotic prophylaxis practices in clean surgeries is good in the hospital Broad spectrum antibiotics were in use in more than half cases and oral antibiotics were prescribed at discharge in most patients which is not in accordance with the protocol. The incidences of HAIs in these cases were not increased. Regular audit and continued training of all stake holders is necessary to raise awareness and improve practices for antimicrobial stewardship.

Background: Globally, hundreds of millions of people are affected every year by avoidable infections in healthcare (healthcare-associated infections, [HAIs]). Through knowledge, best practices and infection prevention and control (IPC), we can prevent HAI to patients and health workers. Following recent threats caused by widespread epidemics and increasing awareness about the spread of antimicrobial resistance, several countries are paying more attention and investing resources to strengthening IPC infrastructures and improving practices. Objective: The objective was to assess the practices by the healthcare staff regarding the sterilisation process in the central sterilisation service department (CSSD) and to bring about improvements in the practices in the hospital. Materials and Methods: A cross-sectional study was conducted where the healthcare staff were given a set of questionnaires on sterilisation in the CSSD. The staff who participated in the study included doctors, intensive care unit nursing staff, infection control nurses, operation theatre nursing staff, CSSD staff and outpatient department nursing staff. Results: The questionnaire was administered to 120 health staff. All the staff agreed that instruments should be cleaned at the source. The majority of the participants (82%) believed that medical devices should be reprocessed centrally in CSSD; however, very few of them (18%) have felt otherwise. Almost 70% of staff did not know about the indicators used in CSSD and the zones in CSSD. The expiry date of the items once received from CSSD, 60% said it is not mentioned on the pack and 40% of participants agreed that it is mentioned on the pack. Conclusion: The processes of sterilisation and decontamination are complex, require specific infrastructure and equipment and involve several steps that need to be correct, from device collection, receipt by the unit, processing, storage and distribution them throughout the facility. Quality control measures to evaluate the proper functioning of the equipment are of the utmost importance.

Background: Staphylococcus aureus is a common cause of hospital-acquired infections. Medical undergraduates are frequently exposed to hospital-adapted bacterial strains especially S. aureus and therefore are always at risk of colonisation. Materials and Methods: A prospective study was conducted on 150 undergraduate students, of different semesters, to detect S. aureus nasal colonisation. A detailed history regarding attending the hospital ward teaching, hospitalisation, frequency of nose touching and immunocompromised condition was unequivocally obtained from all the participants. Anterior nares were swabbed and inoculated on mannitol salt and blood agar plates. S. aureus isolates were subsequently verified by conventional microbiological techniques. The antibiotic susceptibility testing was done by the modified Kirby–Bauer disc diffusion method. In addition, PCR-based detection of mecA gene and pvl gene was performed. Results: Out of 150 students, we found 18 students (3 of 1^st, 10 of 5^th and 5 of 9^th semester, respectively) to be colonised by S. aureus. Of these 18 isolates, 8 were found to be methicillin-resistant. We observed a significant association (P < 0.05) of hospital exposure, ward teaching/hospitalisation with S. aureus colonisation. These S. aureus isolates exhibited varying susceptibility towards different antibiotics with multiple antibiotic resistance indexes ranging from 0.08 to 0.58. Interestingly, all eight methicillin-resistant S. aureus isolates displayed mecA positivity while all were found to be pvl negative. Conclusion: The results indicate the importance of imparting knowledge about infection control practices during the initial years of undergraduate training in medical schools, which may increase awareness amongst students before getting outpatient or ward postings.

Online since 25^th November, 2016