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REVIEW ARTICLE
A review of prevention of surgical site infections in Indian hospitals based on global guidelines for the prevention of surgical site infection, 2016
A Arora, P Bharadwaj, H Chaturvedi, P Chowbey, S Gupta, D Leaper, GK Mani, SK S Marya, R Premnath, K Quadros, A Srivastava, A Tendolkar
January-April 2018, 6(1):1-12
DOI:10.4103/jpsic.jpsic_29_17  
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.
  16,989 53 9
ORIGINAL ARTICLES
Air sampling procedures to evaluate microbial contamination: A comparison between active and passive methods at high-risk areas in a Tertiary Care Hospital of Delhi
Rumpa Saha, Shrreya Agarawal, Amir Maroof Khan
January-April 2017, 5(1):18-23
DOI:10.4103/jpsic.jpsic_12_17  
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.
  11,577 29 -
Clinical experience of using chlorhexidine gluconate-impregnated dressings in reducing the central line-associated bloodstream infection rate at a Level 1 trauma centre
Priyam Batra, S Thomas, Jacinta Gunjyal, Purva Mathur, Babita Gupta, Chhavi Swahnney, Deepak Agarwal, Ashish Bindra, Keshav Goyal, Richa Aggarwal, Kapil Soni, Rajesh Malhotra
May-August 2018, 6(2):59-62
DOI:10.4103/jpsic.jpsic_15_18  
Introduction: Central venous catheters are vital in critical care which can be associated with infectious and non-infectious adverse events. Materials and Methods: This case–control study was conducted over 1 year in trauma centre of India. All patients admitted in intensive care units (ICUs) having central line inserted during the study period (November 2013–October 2014) were included as cases. Historical controls with non-antibiotic-impregnated dressings were used as controls (November 2012–October 2013). Standard central line insertion and maintenance checklist was followed. Results: A total of 2034 patients were admitted in ICUs during study period, and the central line-associated bloodstream infection (CLABSI) rate was 2.89/1000 catheter days. During the year 2012–2013, 2100 patients were admitted and CLABSI rate was 3.04/1000 catheter days. The mean central line insertion bundle compliance rate was 76.8% in 2012–2013 and 78.37% in 2013–2014. The compliance with scrubbing the access port was minimum 34% while that with change in dressing was the maximum 79%. Discussion: Since CLABSI rate reduction was not statistically significant, the use of biopatch in our setting could not be justified and its use was not found to be cost-effective. In maintenance bundle, compliance with scrubbing the hub was least only 35%. Thus, the use of effective maintenance bundle parameters could easily reduce CLABSI rate.
  8,790 32 -
Catheter-associated urinary tract infection in a Tertiary Care Hospital
Areena Hoda Siddiqui, Vipul Kumar Srivastava, PP Aneeshamol, Carolyn Prakash
January-April 2017, 5(1):7-11
DOI:10.4103/jpsic.jpsic_2_16  
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.
  7,715 25 -
Effectiveness of isopropyl alcohol and ultraviolet-based sanitiser on decontamination of mobile phones used by dental personnel
Srikanthan Sriram, Parangimalai Diwakar Madan Kumar, Ramanathan Swaminathan, Rajendran Venkatesh, Vasudevan Menaka
January-April 2018, 6(1):19-22
DOI:10.4103/jpsic.jpsic_4_18  
Introduction: Mobile phones have become an inevitable mode of communication. Dental office and the dental operators along with their mobile phones are exposed to numerous pathogens as a part of their profession, leading to nosocomial infection. This study aimed at assessing the effectiveness of isopropyl alcohol and a customised ultraviolet-based (UV) sanitiser in decontamination of mobile phones. Methods: A cross-sectional study was carried out on 30 touch screen mobile phones belonging to dental professionals in a college setting. Swabs were collected along the screen, camera lens and on/off buttons of mobile phones. Swabs were streaked onto nutrient agar and incubated at 37°C for 24 h for the assessment of microbial load before and after the disinfection procedures. The disinfection process was performed using 70% isopropyl alcohol and an UV-based sanitiser. Mann—Whitney U-test was used to compare the values between the two groups. Wilcoxon signed-ranks test was used to compare values within each group Results: There was a statistically significant reduction in the mean number of colonies (P = 0.001) after decontamination by the two groups (isopropyl alcohol and UV-based sanitiser) indicating that both agents were effective in disinfection. Conclusion: The study concluded that the percentage reduction in microbial load of the mobile phones was better with isopropyl alcohol compared to UV-based sanitiser. It is recommended that mobile phones in the dental setup be regularly decontaminated and dentists must adhere to strict infection control protocols specifically in relation to hand hygiene.
  7,611 31 -
Objective assessment of hand hygiene: When we see it, we believe it!
Shikha Ranjan, Dhivya Venkatesan, Ramya Devi
September-December 2018, 6(3):67-72
DOI:10.4103/jpsic.jpsic_10_18  
Background: Hand hygiene is the fundamental and leading measure to prevent the spread of antimicrobial resistance and to reduce hospital-acquired infections. Several strategies are recommended to increase the compliance for hand hygiene practice; however, health-care worker (HCW) compliance with optimal practices remains low in most settings. Aim: This study aims to assess the efficacy of hand hygiene practice in HCWs at our hospital, and to demonstrate objective result of their practices, followed by a questionnaire-based study to assess their attitude towards hand hygiene, and effect of workshop on their hand hygiene practice pattern. Materials and Methods: Participants were asked to disinfect their hands using a hand rub solution mixed with the fluorescent dye. Photos were taken under an ultraviolet lamp. A self-designed questionnaire was given to all the participants. Results: A total of 94 HCWs participated in the hand hygiene workshop. Only 11.11% nurses (6/54) and 17.5% doctors (7/40) were able to use disinfectant solution with complete coverage of hand areas. Incomplete coverage of dorsum of hand was more common than that of palms. About 84.21% doctors (32/38) and 80% nurses (36/45) wanted to participate in such hand hygiene workshop in future with majority of them opting for frequent workshop. All the participants admitted that such workshop changed their attitude towards their practice pattern. Conclusion: It is important to carry out hand hygiene training programmes regularly to achieve increased compliance with hand hygiene practices. This study also emphasises that an objective technique of demonstration has a greater effect in changing professional's attitude towards hand hygiene.
  7,478 16 -
Patient safety and infection control in operation theatre: A prospective observational study in a tertiary care hospital of India
Deepti Sahran, Vijaydeep Siddharth, Sidhartha Satpathy
May-August 2018, 6(2):38-44
DOI:10.4103/jpsic.jpsic_14_18  
Introduction: This study aimed to observe the various patient care processes pertaining to patient safety including infection control. Materials and Methods: A descriptive, prospective, observational, qualitative study was conducted in operation theatre (OT) complex of a tertiary care teaching hospital of North India from January to December 2016. Eleven operating rooms utilised for performing routine surgeries were included in the study. Non-participant observations were made by the single trained observer, and in-depth unstructured discussions were also held with the key stakeholders. One OT each for a full day per week was observed. Simple random sampling without replacement using chit system was used for selecting the OT and day of the week for data collection. Results: There are documented infection control guidelines which are being utilised for infection control. There is no patient safety committee, no guidelines on patient safety and no mechanism has been established for reporting of the patient safety incidents. Implementation of surgical safety checklist was inadequate and only nursing personnel filled it. There is a comprehensive training programme available for infection control among nursing staff only but not on patient safety. Only one adverse event was observed during the study period, in addition to four near misses. Conclusion: Culture of patient safety needs to be established, especially in critical areas such as OT. Mechanism needs to be developed for capturing data pertaining to patient safety and patient safety practices, especially implementation of surgical safety checklist need intense and sustained efforts.
  7,430 16 -
Surveillance of microbial contamination of mobile phones, reported behaviour and hand hygiene practices of healthcare personnel related to mobile phone use: A prospective observational study
Sunil Kumar Poonia, Poonam Joshi, Rakesh Lodha, Arti Kapil, M Srinivas
January-April 2017, 5(1):40-44
DOI:10.4103/jpsic.jpsic_6_17  
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.
  7,269 20 -
Adherence to surgical antibiotic prophylaxis guidelines in an Indian tertiary care hospital
Namita Jaggi, Pushpa Nirwan, Meenakshi Chakraborty
January-April 2018, 6(1):13-18
DOI:10.4103/jpsic.jpsic_28_17  
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.
  7,140 21 1
Impact of novel blood culture collection bundle to reduce blood culture contamination rates: An important continuous quality improvement indicator of laboratory medicine
Kinjal P Patel, Trupti N Carval, Aruna Poojary, Reshma Poojary
September-December 2019, 7(3):65-71
DOI:10.4103/jpsic.jpsic_25_19  
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.
  6,763 16 1
NATIONAL OR SOCIETY GUIDELINES
Preventing infection from indwelling intravascular devices: Hospital infection society India consensus group recommendations for Indian healthcare
Raman Sardana, Amit Kumar Mandal, Deepthi Nair, Leena Mendiratta, Hena Butta, TS Jain, Arti Kapil, Chand Wattal, Charoo Hans, RK Mani, Gaurav Sagar, Namita Jaggi, Praveen Khilnani, Purva Mathur, Sanjiv Jasuja, Sudha Kansal, Vikas Manchanda, Vivek Nangia, Anita Sharma, Fatima Khan, Geeta Mehta, Gita Nataraj, Rohini Kelkar, Subhash Todi, Sujata Baveja, V Balaji, Aarti Gupta, Anita Arora, Anu Gupta, Azra Hasan, Lakshmy A Raman, Madhu Choudhry, Mahvash Haider, Manju Mani, Neha Rathor, Nitika Aggarwal, Purabi Barman, Ravneet Kaur, Shalini Malhotra, Sonia Khatter Malik, Suresh Kumar, TD Chugh, VL Malhotra, Vrushali Patwardhan, Angela Stephens, Reena Ligin, Sapna Kumari, Shilpi Singh
May-August 2019, 7(2):31-47
DOI:10.4103/jpsic.jpsic_17_19  
  6,187 29 -
ORIGINAL ARTICLES
A study to assess the degree of adherence of prescription to WHO and MCI guidelines at a tertiary health care teaching hospital in North India
Richa Mishra, Rajesh Harsvardhan, Ritika Rai, Hem Chandra
May-August 2019, 7(2):48-52
DOI:10.4103/jpsic.jpsic_12_19  
Background: Prescription errors are one of the most common preventable medication errors. The occurrence of medication errors can compromise the patient confidence in the healthcare system and also increase healthcare costs. The aim of this study was to randomly audit medical prescriptions and associated factors at the outpatient department of a tertiary care teaching institute in Lucknow. Methodology: A total of 420 prescriptions were randomly selected and reviewed. Data on the prescribed drugs were collected from prescription papers using a structured format and analysed using SPSS software. Data on patient demographics, indication for each medication, dosage, dosage form, regimen and concurrent medications were collected. Data on duration of medication were not evaluated. Results: Out of 420 prescriptions included for review, date of prescription was documented in only 59% of cases. Signature of doctor was present in 94.2% prescriptions although the name of the prescriber was mentioned in only 27% prescriptions. The average number of drugs per prescription was 3.89%. Errors related to dosing were documented in 44% cases. Injectable drugs were prescribed in 26.6% prescriptions, whereas antibiotics were written in 13.8%. The percentage of drugs prescribed by generic name was only 7.61%. The understanding of patients regarding prescription of medication given to them, especially with regards to legibility of dose and timing was 55.7%. Conclusion: The results of our study prove that prescribing errors are a major cause of preventable iatrogenic injury to patients. They may be rectified by educational intervention as well as standardised prescription charts.
  6,092 18 -
To know the hindrance or obstacles in hand hygiene practice among healthcare workers of Qassim province of Saudi Arabia
Sanjay Kumar Gupta, Sunitha Lorin Mathias, Ibrahim Saifi Al Harbi
May-August 2017, 5(2):52-56
DOI:10.4103/jpsic.jpsic_16_17  
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.
  5,964 19 -
Efficacy studies on peracetic acid against pathogenic microorganisms
Gunjan Katara, Nanda Hemvani, Sheetal Chitnis, Vikrant Chitnis, Dhananjay Sadashiv Chitnis
January-December 2016, 4(1):17-21
DOI:10.4103/2214-207X.203545  
Background: The peracetic acid (PAA) has antimicrobial activity against bacteria and fungi including spores and is envirosafe. Despite its widespread use in food industry and effluent treatment, it is not widely used in hospitals. The present work was aimed to find out its efficacy against hospital pathogens, bacterial and fungal spores and mycobacteria. Methods: Multidrug-resistant, wild hospital isolates of Gram-positive, Gram-negative bacteria, tough organisms such as Mycobacterium fortuitum, Mycobacterium tuberculosis and Candida albicans and spores of Bacillus subtilis, Clostridium perfringens and Aspergillus niger were checked by modified Kelsey-Sykes suspension test. For vegetative bacteria, exposure time was 1 min. For bacterial and fungal spores, Candida and Mycobacteria, exposure time varied from 10 to 30 min. Results: More than 5-log reduction was seen for vegetative bacteria just after 1 min exposure to PAA. Ten minute exposure to PAA could inactivate 99.5% bacterial and fungal spores. Mycobacteria were inactivated within 10 min of exposure to PAA. PAA rapidly inactivates pathogenic bacteria within 1 min and inactivates mycobacteria and fungi within 10 min and sterilises spores within 30 min and remains active in the presence of proteins. Conclusions: It is economic, eco-friendly and deserves major share in hospital disinfection.
  5,915 67 -
SHORT REPORT
Hand hygiene: From semmelweis to present!
Areena Hoda Siddiqui, Vipul Kumar Srivastava, PP Aneeshamol, Carolyn Prakash
January-December 2016, 4(1):22-24
DOI:10.4103/2214-207X.203537  
Background: In the era of multidrug-resistant organisms and dearth of new antimicrobials, hand hygiene has become an important tool in reducing the burden of healthcare associated infections (HAIs). The content of this article is based on awareness and practice of hand hygiene among healthcare workers (HCWs). Objectives: Hand hygiene has emerged as one of the most important strategies to prevent HAIs. Hand hygiene practice has led to the decrease in infections. The present study was undertaken to assess the compliance among HCWs. Materials and Methods: Hand hygiene compliance and number of opportunities were evaluated for 2 years (2013 and 2014), and the data were compared. The study was carried out in the emergency department and critical care areas of our hospital. Results: It was found that the number of events monitored and compliance increased considerably in the subsequent year. The compliance rate on an average increased from 57.6% to 61.6%. Conclusions: The present results emphasise on the regular training and education of hand hygiene among HCWs. They should be made aware of the HAIs and that hand wash and hand rub help in decreasing the rate of HAIs.
  5,107 20 -
PERSPECTIVE
Needle-stick injury: A perspective
Padma Srikanth, Yazhini Ravi, Shyamala Mani
September-December 2018, 6(3):90-92
DOI:10.4103/jpsic.jpsic_16_18  
  4,931 31 -
ORIGINAL ARTICLES
Prevalence of needle-stick injuries among health-care workers in a tertiary care centre in North India
Sana Islahi, Vineeta Mittal, Manodeep Sen
May-August 2018, 6(2):45-50
DOI:10.4103/jpsic.jpsic_13_18  
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.
  4,885 16 1
Presence of Qnr genes related to resistance to quinolones, first-, second- and third-generation in diarrhoeagenic Escherichia coli
Abbas Mokhtari-Farsani, Abbas Doosti, Zahra Mohammadalipour
January-December 2016, 4(1):5-9
DOI:10.4103/2214-207X.203541  
Background: Resistance genes transferred by plasmids are important factors that can contribute to the occurrence of quinolone resistance, specifically in Escherichia coli strains. Methods: A total number of 117 diarrhoeagenic E. coli strains were tested for the resistance to nalidixic acid, ofloxacin, ciprofloxacin and levofloxacin and for the presence of qnrA, qnrB and qnrS genes determinants by polymerase chain reaction. Antibiotic susceptibility test was performed using the Clinical and Laboratory Standard Institute standard method. Results: The highest resistance belonged to the nalidixic acid (52.14%) and the least resistance to levofloxacin (37.61%). In this study, among a total of 117 samples, 23 (19.66%) strains were susceptible to all the studied antibiotics. Among the remainder, 94 (80.34%) samples resistant to at least one quinolone, three genes including qnrA, qnrB and qnrS were present in 19.15%, 88.30% and 78.72% isolates, respectively. Furthermore, 51.06% of strains had A, B+ and S+ pattern that seems to have a significant association (P < 0.001) with resistance to quinolones. Conclusions: The results of present study show the presence of a high frequency of qnr genes in E. coli strains resistant to quinolones in clinical samples from southwest of Iran. In addition, this study approved that plasmid-mediated quinolone resistance is a possible mechanism among the quinolones-resistant E. coli isolated from patients with diarrhoea in the study, and also qnrB and qnrS genes seem to be more important in resistance to quinolones.
  4,564 45 -
An analysis of health economics related to hospital-associated infections: A prospective case–control analysis of 7-year data from a tertiary referral corporate hospital in India
Murali Chakravarthy, Raj Gore, Navin Yellappa, Antony George, Sukanya Rangaswamy, Rajathadri Hosur, Sumant Pargaonkar, Chidananda Harivelam, Priyadarshini Senthilkumar, Tejaswini Saravanan, Suganya Arul Rose
September-December 2018, 6(3):73-77
DOI:10.4103/jpsic.jpsic_20_18  
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.
  4,537 20 1
There is more to hand hygiene than routine training of health workers and display of promotional materials
Ashmitaa Srianand, Marina Thomas
January-December 2016, 4(1):1-4
DOI:10.4103/2214-207X.203539  
Background/Objective: Hand hygiene (HH) non-compliance is a major cause of hospital-acquired infections, and a gap between knowledge and practice is observed widely. Health researchers are now using a new approach called 'Positive Deviance' (PD) to tackle such behavioural/cultural/social problems leading to adverse health issues. Therefore, can PD approach be used to improve knowledge and compliance of HH practices also? This study is designed to find what are the reasons for PD among nursing staff of our hospital and whether these behavioural changes can be imbibed by others if motivated and trained appropriately. Materials and Methods: The level of compliance to HH and PD among 25 Intensive Care Unit nurses was noted. This was followed by a second and a third interface consisting of focus group discussions and one-to-one interviews to motivate them based on the PD noted and to detect the possible betterment of compliance to HH. Results: The practice of HH was followed by 20% of the nurses, and they were identified as positive deviants and when reasons which made them to be compliant were reinforced and impressed on the rest of the nurses, a further 32% became compliant. Awareness of the fact that HH prevents colonisation with potential pathogens was shown by 100% after the intervention. Conclusions: A PD strategy yielded an improvement in HH compliance. An improvement in knowledge and practice of HH was noted. Multimodal interventions are needed to induce sustained HH practice improvements and this will reduce the gap between knowledge and practice of HH in hospitals and thereby reduce hospital-acquired infections.
  4,454 29 -
An epidemiological study of ventilator-associated pneumonia in Intensive Care Unit and antibiotics sensitivity pattern of organism causing ventilator-associated pneumonia (2012—2016) at Al Qassim Region of Saudi Arabia
Sanjay Kumar Gupta, Fahd Khaleefah Al Khaleefah, Ibrahim Saifi Al Harbi, Marilou A Torre, Sinimol Jabar, Sunitha Lorin Mathias, Omar Al Romaih
January-April 2018, 6(1):27-31
DOI:10.4103/jpsic.jpsic_27_17  
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.
  4,430 18 1
Hand hygiene compliance among healthcare workers in a superspeciality tertiary care hospital
Neeta Patwardhan, Satish Patwardhan
January-April 2019, 7(1):5-10
DOI:10.4103/jpsic.jpsic_4_19  
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.
  4,390 16 1
Magnitude and profile of occupational exposures to blood and body fluids among health-care workers: A study from a tertiary care teaching hospital
Chithra Valsan, Jane Paul, Praveenlal Kuttichira, Resmi Varghese, Sophiya Joseph
May-August 2017, 5(2):47-51
DOI:10.4103/jpsic.jpsic_18_17  
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.
  4,237 20 -
Blood culture contamination rates in two district general hospitals in the Southeast of England
Nadeem Sajjad Raja, Bill O'Neill
May-August 2017, 5(2):57-61
DOI:10.4103/jpsic.jpsic_17_17  
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.
  3,982 32 -
A cross-sectional pilot survey of sharp injuries among dental students in a tertiary care dental hospital in Lucknow, India
Rhythm Bains, Vivek K Bains, Reema Kumari
September-December 2018, 6(3):78-82
DOI:10.4103/jpsic.jpsic_22_18  
Aim: This study aims to estimate the frequency of sharp injuries among the post-graduate and undergraduate dental students and evaluate their knowledge regarding the needle-stick/sharp injuries, proper handling and disposal of sharp waste. Methodology: A written questionnaire containing questions regarding frequency of sharps injury, source of injury, status of immunisation and knowledge regarding handling and disposal of sharps waste was personally distributed to the participants and collected on the same day. Informed consent was obtained from the participants, and the purpose of the study was explained to them. The data obtained was statistically analysed. Percentage distribution of responses for Bachelor of Dental Surgery (BDS) and Master of Dental Surgery (MDS) students was recorded. Furthermore, the comparison of responses for BDS and MDS was analysed using the t-test. Chi-square test was used to find the significance difference between responses by BDS and MDS students. Results: The results of the present questionnaire study revealed that 38.5% (10/26) post-graduate students and 37.2% (16/42) undergraduate respondents had a history of sharps injury (P = 0.917). Most common reason for the injury among post-graduates was recapping of needles 84.6% (22/26) followed by endodontic instruments 11.5% (3/26) and use of probes/explorer 3% (1/26). Among the undergraduates, the most common source of injury was again recapping of needles 97.7% (42/43), followed by endodontic instruments 2.3% (1/43). Conclusion: Both undergraduates and post-graduates reported with history of sharps injury, though the difference among them was not significant. Needle-stick or sharps injury can prove to be fatal, and as dental students have an early clinical exposure, they should be trained early in their curriculum regarding correct disposal and handling of sharps.
  3,973 24 -