Background: Central line associated blood stream infections (CLA-BSIs) are a leading cause of health care associated infections. There is paucity of data on the actual magnitude of CLA-BSIs in most hospitals of developing countries due to lack of surveillance. This study reports the impact of an intensive surveillance, training and feedback on the rates of CLA- BSIs at an Indian trauma center. Methods: The study was conducted at a level 1 trauma center from June 2010 to January 2013. The clinical details of all patients and microbiology culture reports who were admitted for more than 48 h were recorded in a pre-designed pro forma. These details were further entered in an automated software based upon CDC NHSN's definitions of device associated infections. The CLA-BSI rates in a previous pilot study in 2010 were found to be very high. Intensive surveillance, education and training drive was initiated along with better hand hygiene and device care as a part of hospital infection control measures. Results: During the study period, a total of 2969 patients were followed up for CLA-BSIs. These patients amounted to a total of 27,394 ICU days and 15,443 CVC days. A total of 93 episodes of CLA-BSI occurred during the study, amounting to a CLA-BSI rate of 6.02/1000 CVC days. Staphylococcus aureus (27; 27.5%) was the most common isolate. A total of 101 episodes of secondary BSIs were also observed during the study. Of these, 70 (69%) were secondary to VAP, 18 (18%) were secondary to wound infections and 13 (13%) were sec- ondary to UTI. Of the 92 patients who accounted for the 93 episodes of CLA-BSIs, a total of 20 (21.7%) had a fatal outcome. Conclusions: Thus, with the help of the intensive surveillance, using this software, we have been able to monitor the impact of training, surveillance and interventions on the rates of CLA-BSI, which have reduced from 27.6 to 6/1000 CVC days within a span of 2 years at our institute. Although these measures require a dedicated team effort, they are easy and cost effective to implement and can reduce device associated infections across all types of health care facilities.

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Background/objectives: The aim of this study is to determine the incidence of occupational exposures, the immunization status and the rate of injuries being reported among health care workers (HCWs) and students at the dental school. Methods: A questionnaire was applied to all academic staff, dental students and nurses. The questionnaire included the sections about frequency of sharp injuries, type of instrument that caused the injury, and whether or not the injury was reported. Data from the ques- tionnaires was analyzed using SPSS; 17.0 statistical software and assessed in each group. Results: The number of persons reporting one or more percutaneous injury was 415 (74.6%). 448 (80.5%) respondents reported saliva/blood splashes into skin and eyes. The majority of the respondents failed to report the exposure incidents. Common reasons for not reporting included lack of information about reporting and not to worry about the injury. The most common injuries were reported as needlesticks and dental probe injuries. 86% of re- spondents followed post-exposure protocol after the injury and 96% of them reported the regular usage of masks to prevent risk of infection. The immunization status of students, academic staff and nurses were 89.5%, 78.6% and 72%, respectively. Conclusion: The high incidence of occupational injuries among health care workers reveals a necessity to raise awareness and to provide periodical training in infection prevention.

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Context: Hospital acquired infections being significant hazards in all health care settings are considered an important indicator of quality of health care. Nurses especially novices, the largest workforce in health care, are at highest risk of acquiring and transmitting diseases. Hand hygiene is one of the simplest measures to prevent infections. Aims: This study is to assess the knowledge of Hand hygiene and self reported hand hy- giene practices during the clinical experience at the hospital. Settings and design: This exploratory study was carried out among 200 nursing students of different courses of study selected using disproportionate stratified sampling technique. Methods and material: Knowledge questionnaire and self reported practice checklist were utilized to collect data. Results: Knowledge was 'good' about hand washing (75.5%). On an average higher number of students reported to have washed their hands after the specific procedures (90.97%) as compared to before performing it (72.58%). Conclusions: There is a need for improving hand hygiene related knowledge and practices of nursing students.

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Background: It has been suggested that the use of stethoscopes may transmit infection between patients and yet stethoscope cleaning protocols lack consistency of guidance as to where, when and how stethoscopes should be cleaned. We have assessed the difference in microbiological colonisation between non-dedicated and patient dedicated stethoscopes and between the stethoscope diaphragm and neck. Methods: An observational study over an 8-day period at a secondary care hospital. We analysed 104 samples comprising matched diaphragm and neck data for each of 26 non- dedicated and 26 patient dedicated stethoscopes. The diaphragm and neck of each stethoscope were swabbed and processed using standard microbiology techniques. Results: 98% of stethoscopes were colonised. There was a lack of evidence for a true difference in colonisation levels between the stethoscope diaphragm and neck (n Ό 104, p Ό 0.752(OR1.000 95%CL (0.230e4.345)) Cohen's effect size index Ό 0.000) or between dedicated and non-dedicated stethoscopes (n Ό 104, p Ό 1.000(OR3.118 95%CL (0.121 e80.190))). Conclusions: Importance in maintaining the hygiene of stethoscopes is underplayed. An effective patient safety culture will not merely respond to recognised risk but will identify and mitigate potential risk. These data suggest the entirety of the stethoscope will become colonised regardless of its environment. A good patient safety intervention will make doing the right thing the easy thing. Here we argue for cleansing the entirety of the stethoscope before and after patient contact.

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Airborne infection control at health care settings remains a low priority especially in public health settings in India. Recent events of upsurge in cases of tuberculosis (TB), Drug resistant Tuberculosis (DRTB) and reported occurrence of health care workers (HCW) diagnosed with TB and DRTB in Maharashtra have highlighted the need to implement airborne infection control practices. Airborne infection control (AIC) guidelines in India recommend administrative control, environmental control, and personal respiratory protection measures. Public and private tertiary care institutes face many challenges to implement the airborne infection control measures in their settings. Practical solutions are needed to address these challenges. An innovative approach was implemented in tertiary care facility in Nagpur, Maharashtra. The approach included use of "Sunrise model" tool for implementing AIC activities with practical innovative approach of decompression & segregation of crowd in waiting areas using coloured coupons and re-organisation of spaces to reduce the risk of transmission in the hospital setting. Initial risk assessment of the facility was conducted by state airborne infec- tion control committee members using a checklist as per the National Airborne infection guidelines and six month follow-up on recommendations of committee was done. Practices of airborne infection control were improved with the use of 'Sun rise model 'as a tool and innovative approaches used for decompression of waiting area are feasible having potential for scale-up in other resource poor health care settings.

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