Showing papers in "Journal of Patient Safety and Infection Control in 2017"

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

Abstract: 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.

Analysis of price variation among parenteral antibiotics available in a tertiary care teaching hospital

Abstract: 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.

Bacterial spectrum and antimicrobial-resistance pattern of bloodstream infections in neutropenic and non-neutropenic adult cancer patients

Abstract: 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.

Specimen collection: The art of laboratory science among the clinicians

Abstract: 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.

Retrospective analysis of maternal and foetal outcome of H1N1 influenza amongst antenatal mothers at a tertiary care hospital

Abstract: 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.

To know the hindrance or obstacles in hand hygiene practice among healthcare workers of Qassim province of Saudi Arabia

Abstract: 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.

Risk stratification of surgical site infection in a Tertiary Care Hospital: A prospective case-control study

Abstract: 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.

Higher rate of methicillin-resistant Staphylococcus aureus carriage amongst hospitalised patients in rural South India

Abstract: 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.

Blood culture contamination rates in two district general hospitals in the Southeast of England

Abstract: 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.