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Introduction Healthcare associated infections (HAIs) are prevalent and difficult to treat worldwide. Most HAIs can be prevented by effective implementation of Infection Prevention and Control (IPC) measures. A survey was conducted to assess the existing IPC practices across a network of Indian Hospitals using the World Health Organization designed self-assessment IPC Assessment Framework (IPCAF) tool. Methods This was a cross sectional observation study. Thirty-two tertiary care public and private facilities, part of the existing Indian HAI surveillance network was included. Data collected was analysed by a central team at All India Institute of Medical Sciences (AIIMS), New Delhi, a tertiary care hospital of India. The WHO questionnaire tool was used to understand the capacity and efforts to implement IPC practices across the network. Results The overall median score of IPCAF across the network was 620. Based on the final IPCAF score of the facilities; 13% hospitals had basic IPC practices, 28% hospitals had intermediate and 59% hospitals had advanced IPC practices. The component multimodal strategies (CC5) had the broadest range of score while the component IPC guidelines had the narrowest one. Conclusion Quality improvement training for IPC nurses and healthcare professionals are needed to be provided to health facilities.

Background Healthcare-associated infections (HAIs) can impact the outcome following traumatic brain injury (TBI) in children. We undertook a retrospective observational study to see the incidence, risk factors, and microbiological profile for HAIs in pediatric TBI. We also studied the impact of baseline patient characteristics, HAIs on patient outcome, and antibiotic resistance of different types of bacteria. Materials and methods Data on pediatric TBI patients of age up to 12 years were collected via a computerized patient record system (CPRS) from January 2012 to December 2018. Descriptive Chi-square test and Wilcoxon signed rank test were used to characterize baseline parameters. General linear regression models were run to find an unadjusted and adjusted odds ratio (OR). Results HAIs were found in 144 (34%) out of 423 patients. The most commonly seen infections were of the respiratory tract in 73 (17.26%) subjects. The most predominant microorganism isolated was Acinetobacter baumannii in 188 (41%) samples. A. baumannii was sensitive to colistin in 91 (48.4%) patients. Male gender (OR 0.630; p-value 0.035), fall from height (OR 0.374; p-value 0.008), and higher injury severity scale (ISS) (OR 1.040; p-value 0.002) were independent risk factors for development of HAIs. Severe TBI, higher ISS and Marshall grade, and HAIs were significantly associated with poor patient outcome. Conclusion Severe TBI poses a significant risk of HAIs. The most common site was the respiratory tract, predominately infected with A. baumannii. HAIs in pediatric TBI patients resulted in poor patient outcome. How to cite this article Prasad C, Bindra A, Singh P, Singh GP, Singh PK, Mathur P. Healthcare-associated Infections in Pediatric Patients in Neurotrauma Intensive Care Unit: A Retrospective Analysis. Indian J Crit Care Med 2021;25(11):1308–1313.

Healthcare-associated infections contribute to morbidity, mortality, and increased cost in intensive care unit patients. Understanding evidence-based prevention strategies can help to optimize patient outcomes.

Staphylococci species are known to cause healthcare-associated infections in neonatal intensive care (NICU) unit patients. Little is known about Staphylococcal contamination of NICU environments. Swabs from 25 of 46 (54%) surfaces sampled in a NICU had viable Staphylococcal contamination, with 11% contaminated by methicillin resistant Staphylococcus aureus [MRSA]. Floors by sinks and return air ducts in the NICU were the most contaminated (67% positive), possibly serving as reservoirs for Staphylococci.

Introduction: Hand hygiene is the first line of defense and a cost-effective method for reducing healthcare-associated infections (HCAIs) and antibiotic resistance. It is essential for healthcare professionals to have adequate knowledge regarding hand hygiene. Ensuring proper education of trainees is required as they are the healthcare providers of the future. Aim: To assess the impediments that both medical and dental trainees face in performing effective hand hygiene. Materials and Methods: The study questionnaire based on WHO’s concepts of "Five Moments for Hand Hygiene" and “Six Steps of Hand Hygiene” was sent to 225 participants from 2nd & 3rd MBBS and BDS courses. Associations between variables of interest were tested using the chi-square (χ2) test. Statistical analysis was carried out using the Statistical Package for the Social Sciences version 17. The p-value

4—5 congenital heart defect cases per 1000 newborns are diagnosed worldwide. Some malformations require surgical methods of correction. Various risk factors contribute to the development of healthcare associated infections (HAIs). The HAIs are one of the leading causes of the prolongation of hospitalization length both in intensive care unit and in the inpatient departments, and they also play a significant role in increasing the number of lethal outcomes. A number of risk factors play an important role in the development of HAIs: the duration of post-operative mechanical ventilation, neonatal age, low birth weight, co-morbidities, including malformations of other body systems.

Background: Healthcare-Associated Infections (HAIs) are significant causes of illness and mortality, and nurses are healthcare professionals with the most consistent contact with patients, therefore nurses need to possess adequate knowledge, and awareness. Aim: this study aim to analyze factors impacting nurses' awareness of the prevention of HAIs, such as their knowledge, attitude, and practice compliance. Methods: A systematic review was conducted from the sources of data collection, namely Proquest, Science Direct, Pubmed, and Google Scholar from 2011-2020, with English guidelines used to review the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Data were obtained through a questionnaire survey, direct observation, and self-report from 4329 nurses with a total of 12 inclusion criteria. The result showed that a significant number of nurses do not possess an acceptable level of knowledge and practice, although nurses have a positive attitude. Hand hygiene and the other protective personal equipment need to be used by nurses and other health personal to prevent Urinary Tract Infection, respiratory, and Surgical Site Infection in the hospital. Conclusion: nurses need to possess the right knowledge, attitude, and guidelines. Standard precaution is important for patient safety management, nurses need to be adequately trained to increase awareness.

Summary Background The use of single rooms for patient isolation often forms part of a wider bundle to prevent certain healthcare-associated infections (HAIs) in hospitals. Demand for single rooms often exceeds what is available and the use of temporary isolation rooms may help resolve this. Changes to infection prevention practice should be supported by evidence showing that cost-effectiveness is plausible and likely. Aim To perform a cost-effectiveness evaluation of adopting temporary single rooms into UK National Health Service (NHS) hospitals. Methods The cost-effectiveness of a decision to adopt a temporary, single-patient, isolation room to the current infection prevention efforts of an NHS hospital was modelled. Primary outcomes are the expected change to total costs and life-years from an NHS perspective. Findings The mean expected incremental cost per life-year gained (LYG) is £5,829. The probability that adoption is cost-effective against a £20,000 threshold per additional LYG is 93%, and for a £13,000 threshold the probability is 87%. The conclusions are robust to scenarios for key model parameters. If a temporary single-patient isolation room reduces risks of HAI by 16.5% then an adoption decision is more likely to be cost-effective than not. Our estimate of the effectiveness reflects guidelines and reasonable assumptions and the theoretical rationale is strong. Conclusion Despite uncertainties about the effectiveness of temporary isolation rooms for reducing risks of HAI, there is some evidence that an adoption decision is likely to be cost-effective for the NHS setting. Prospective studies will be useful to reduce this source of uncertainty.

BACKGROUND: The real-world impact of breathing zone air purification and coronavirus disease 2019 (COVID-19) mitigation measures on healthcare-associated infections is not well documented. Engineering solutions to treat airborne transmission of disease may yield results in controlled test chambers or single rooms, but have not been reported on hospital-wide applications, and the impact of COVID-19 mitigation measures on healthcare-associated infection rates is unknown. AIM: To determine the impact of hospital-wide bioaerosol treatment and COVID-19 mitigation measures on clinical outcomes. METHODS: The impact of the step-wise addition of air disinfection technology and COVID-19 mitigation measures to standard multi-modal infection control on particle counts, viral and bacterial bioburden, and healthcare-associated infection rates was investigated in a 124-bed hospital (>100,000 patient-days over 30 months). FINDINGS AND CONCLUSION: The addition of air disinfection technology and COVID-19 mitigation measures reduced airborne ultrafine particles, altered hospital bioburden, and reduced healthcare-associated infections from 11.9 to 6.6 (per 1000 patient-days) and from 6.6 to 1.0 (per 1000 patient-days), respectively (P

Objectives:To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019.Methods:Central–line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed.Results:Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020.Conclusions:This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.

Introduction: Healthcare-associated infections are the most common problem in intensive care unit world- wide. Children with congenital heart diseases have many complications such as developmental problems, respiratory tract infections, endocarditis, pneumonia and after long-term hospital and intensive care stays and surgeries patients become vulnerable to healthcare-associated infections. Patients and Methods: The study presents the frequency of infection, microorganisms in patients hospital- ized at Kartal Koşuyolu High Specialization Training and Research Hospital Pediatric Cardiovascular Surgery Intensive Care Unit between 2016-2020. Results: One hundred-eight healthcare-associated infections episodes were seen in 83 of 1920 patients hos- pitalized in Pediatric Cardiovascular Surgery Intensive Care Unit between 2016-2020. Healthcare-associated infections rates varied between 4.8% and 7.77% over the years. In the 5-year period, a total of 118 micro- organisms were detected. Among all microorganisms, Candida species (n= 43, 36.4%) ranked first. Central line-associated bloodstream infections 53 (49%), ventilator-associated pneumonia 40 (37%), surgical site in- fection 8 (6.5%), catheter-associated urinary tract infection 7 (6%). Conclusion: Healthcare-associated infections requires special attention in pediatric cardiovascular intensive care units. In order to prevent, innovations such as bundle applications should be implemented as well as personnel training.

Summary A survey was undertaken to evaluate the level of computerization in intensive care units (ICUs) within a French network dedicated to the surveillance of healthcare-associated infections, antimicrobial use (AMU) and antimicrobial resistance (AMR) in ICUs (REA-REZO). Ninety-eight ICUs responded, and patient records were computerized in 57%, antimicrobial prescriptions were computerized in 59% and AMR epidemiology was computerized in 72%. AMU and AMR feedback was provided to the ICU itself for 77% and 65% of ICUs, respectively, and feedback was provided to the national surveillance for 79% and 65% of ICUs, respectively. This study suggests that the level of computerization in ICUs requires further improvement.

Aim:Healthcare-associated infections are important conditions, as they may increase morbidity and mortality, prolong hospital stay and increase costs. A higher incidence of healthcare-associated infections has been reported in developing countries, but data on its epidemiology in pediatric patients are limited. The aim of this study was to determine the rate and distribution of health care-associated infections and antimicrobial susceptibility patterns in a pediatric intensive care unit.Materials and Methods:Demographic and clinical details, microbiological findings, antibiotic susceptibility results and the outcomes of all hospitalized pediatric intensive care unit patients were collected for one year (September 2017 to September 2018). Results:The health care-associated infections rate was 5.6 per 100 admissions and the incidence density was 7.2 per 1,000 patient-days. Bloodstream infections (50%) were the most common type and Klebsiella species (40.9%) was the most common cause of health careassociated infections. All of the Klebsiella spp. were resistant strains producing extended-spectrum beta-lactamases (77.7%) and the remaining were resistant to carbapenem. Acinetobacter species and colistin resistance was not detected in any isolates.Conclusion:This study demonstrated a low prevalence of health care-associated infections but a high rate of antibiotic resistance in Klebsiella species in a pediatric intensive care unit. In addition to improved surveillance, consultation with infectious disease specialists will allow the development of interventions to reduce healthcare-associated infections, in order to regulate both empirical treatment and ongoing management, and also to provide appropriate targeted therapy.

Diagnostic stewardship means ordering the right tests for the right patient at the right time to inform optimal clinical care. Diagnostic stewardship is an integral part of antibiotic stewardship efforts to optimize antibiotic use and improve patient outcomes, including reductions in antibiotic resistance and treatment of sepsis. The Centers for Disease Control and Prevention’s Division of Healthcare Quality Promotion hosted a meeting on improving patient safety through diagnostic stewardship with a focus on use of the laboratory. At the meeting, emerging issues in the field of diagnostic stewardship were identified, awareness of these issues among stakeholders was raised, and strategies and interventions to address the issues were discussed—all with an emphasis on improved outcomes and patient safety. Here, we summarize the key takeaways of the meeting including needs for diagnostic stewardship implementation, promising future avenues for diagnostic stewardship implementation, and areas of needed research.

Non-tuberculous mycobacteria (NTM) are opportunistic pathogens commonly colonizing hospital water systems, and may be responsible for healthcare-associated infections (HAI). Investigation of HAI and outbreaks caused by NTM necessitates water analyses. However, NTM are slow-growing bacteria within the mesophilic community present in water, and are difficult to detect. Prior to culture on specific media, their recovery usually requires decontamination and concentration steps. We assessed the effectiveness of filtration as regards the recovery of 7 NTM species in hospital water samples. We also compared the use of cetylpyridinium chloride (CPC) at different concentrations and Sodium Hydroxide (NaOH) 4% in decontamination of water samples with mesophilic bacteria. Our laboratory protocol showed that membrane filtration was suitable for concentration and recovery of NTM from water. Sample decontamination with CPC was more NTM-preservative than NaOH. A combination of CPC at 0.005% and filtration allowed detection of NTM at low concentrations, ranging from 3 to 98 CFU/100mL according to the NTM species.

The relationship between nursing staffing levels and healthcare-associated infections (HAIs) has been explored previously with conflicting results. This study uses daily shift records from 2 intensive care units (ICUs) to evaluate whether nuanced changes in nursing team composition impacts subsequent risk for device associated HAIs. Staffing deficiencies may be associated with periods of risk prior to central line-associated bloodstream infection in the ICU.

Injection safety is essential to reduce the risk of healthcare-associated infections (HAIs) when accessing vascular catheters. This general review evaluates the contamination of vascular catheter access ports and associated HAIs in acute care settings, focusing on open lumen stopcocks (OLSs) and disinfectable needleless closed connectors (DNCCs). PubMed was searched from January 2000 to February 2021. OLS intraluminal surfaces are frequently contaminated during patient care, increasing the risk of HAIs, and neither an isopropyl alcohol (IPA) pad nor a port-scrub device can reduce contamination effectively. In contrast, DNCCs can be disinfected, with most studies indicating less intraluminal contamination than OLSs and some studies showing decreased HAIs. While the optimal DNCC design to reduce HAIs needs to be determined, DNCCs alone or stopcocks with a DNCC bonded to the injection port should replace routine use of OLSs, with OLSs restricted to use in sterile fields. Compliance with disinfection is essential immediately before use of a DNCC as use of a non-disinfected DNCC can have equivalent or greater risk of HAIs compared with use of an OLS. The recommendations for access port disinfection in selected national and international guidelines vary. When comparing in-vitro studies, clinical studies and published guidelines, consensus is lacking; therefore, additional studies are needed, including large randomized controlled trials. IPA caps disinfect DNCCs passively, eliminate scrubbing and provide a contamination barrier; however, their use in neonates has been questioned. Further study is needed to determine whether IPA caps are more efficacious than scrubbing with disinfectant to decrease HAIs related to use of central venous, peripheral venous and arterial catheters.

Over the past decade, the healthcare system of the Russian Federation has undergone progressive changes in the system of maternity care, which relate to the development of infrastructure and the introduction of new organizational models. In particular, a three-level system of providing medical care to mothers and children has been created, including a network of perinatal centers for patients at high perinatal and obstetric risk. Field events of specialists of National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation to the medical organizations of maternity care in various regions of Russia revealed hot spots that require primary attention: acute shortage of staff for the implementation of diagnostic and therapeutic measures at the modern methodological level, as well as for ensuring epidemiological safety in the medical organizations (medical microbiologists (bacteriologists), clinical pharmacologists and epidemiologists); the lack of registration of healthcare-associated infections, which is associated with the prevailing in the country mainly punitive methods of combating hospital infections. In modern conditions of nursing preterm babies, newborns with various severe somatic and surgical pathologies, it is necessary to know the real indicators of morbidity in order to reasonably and promptly carry out therapeutic and preventive measures; the need to organize modern microbiological laboratories in the perinatal centers with the availability of fast methods (proteomic and molecular-genetic) diagnostics, allowing for microbiological monitoring in specialized departments of newborns and promptly respond to the changes in the epidemiological situation in the hospital, to prevent the development of clinically pronounced cases of healthcare-associated infections.

Reporting and learning from preventable adverse events is crucial to improve patient safety. Although physicians should file and analyse adverse events by law in The Netherlands, it is unknown if these reporting systems are sufficiently used in clinical practice. This study is a substudy of the multicenter RICAT trial, a successful quality improvement project to reduce inappropriate use of intravenous and urinary catheters in medical wards in seven hospitals, in which we screened 5696 patients and documented 803 catheter-related complications. We also checked the adverse events reporting systems of these patients and found that only 13 (1.6%) of 803 catheter-related complications were registered. Of the infectious complications only five (10.9%) of 46 catheter-associated bloodstream infections and urinary tract infections were registered. We conclude that the reported complications were a major underestimation of the real complication practice in medical wards in The Netherlands. The RICAT trial is registered at Netherlands Trial Register, trial NL5438.

An electrocardiogram (ECG), the recording of the electrical activity in the heart, is the most commonly performed cardiac test. It is carried out in a variety of clinical settings in hospitals and primary care, and its use is standard practice among high-risk, critically ill patients, and those who have undergone cardiac surgery. ECG recording is classified into two main categories: monitoring and diagnostic. 12-lead ECGs, which require electrodes to be placed on the chest and each limb, are used for diagnostic purposes, whereas 3- or 5-lead ECGs are used for rhythm monitoring. Cross-infection can arise from reusing ECG cables, even if they have been cleaned. Surgical site infection is a particular risk in patients who have undergone coronary artery bypass grafting, because ECG wires are placed on the chest close to the incision site. Single-use ECG leads, such as the Kendall DL™ ECG cable and lead wire system, reduce the risk of cross-contamination between patients and free nursing time for patient care because they are discarded after use and do not have to be cleaned and disinfected for use with another patient.

We found 15-day mortality rates were higher for patients with severe infections than for those with mild infections or colonization., Klebsiella pneumoniae carbapenemase–producing K. pneumoniae (KPC-Kp) has been endemic in Italy since 2013. In a multicenter cohort study, we investigated various aspects of KPC-Kp among patients, including 15-day mortality rates and delays in adequate therapy. Most (77%) KPC-Kp strains were sequence type (ST) ST512 or ST307. During 2017, KPC-Kp prevalence was 3.26 cases/1,000 hospitalized patients. Cumulative incidence of KPC-Kp acquired >48 hours after hospital admission was 0.68% but varied widely between centers. Among patients with mild infections and noninfected colonized patients, 15-day mortality rates were comparable, but rates were much higher among patients with severe infections. Delays of >4 days in receiving adequate therapy more frequently occurred among patients with mild infections than those with severe infections, and delays were less common for patients with known previous KPC-Kp colonization. Italy urgently needs a concerted surveillance system to control the spread of KPC-Kp.

Aim To evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit. Background Burn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them. Methods An interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice. Results During the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013. Conclusion The implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.

One of the most detrimental consequences of surface colonization by bacteria is healthcare-associated infections (HAIs), which contribute to increased patient mortality and morbidity. Medical devic...

Resume Position du probleme Les infections associees aux soins sont source de morbi-mortalite importante en neonatologie. L’objectif etait de decrire l’epidemiologie des infections associees aux soins en neonatologie en termes de frequence, de facteurs associes et de pronostic. Methodes La recherche a ete realisee sur les bases de donnees PubMed, Scopus et Web of Science. Ont ete incluses les etudes observationnelles chez les nouveau-nes qui ont developpe des infections survenues au-dela de 48 h apres l’hospitalisation, portant sur la prevalence ou l’incidence ou la mortalite. La mesure des effets globaux a ete calculee via le modele a effet aleatoire. Les biais de publication ont ete analyses par les funnel plot et le test d’Egger. Le logiciel de meta-analyse R Studio V1.2 a ete utilise pour l’analyse statistique. Resultats Parmi 137 articles retrouves, dix articles ont ete inclus. Ils concernaient surtout le Maroc, la Tunisie et l’Algerie. L’incidence globale etait de 10 % (IC95 % [4 %-18 %]) et la mortalite globale de 49 % (IC95 % [33 %-66 %]). L’heterogeneite etait significativement elevee entre les etudes avec des taux respectifs de 98 % et 90 %. Conclusion Il apparait necessaire de mener des etudes multicentriques ainsi que des etudes sur le systeme de surveillance, les attitudes et pratiques des agents de santes impliques dans les soins pour apprehender plus les realites de l’infection associee aux soins dans les services de la neonatologie au grand Maghreb.

Highlights • The impact of a multimodal infection control strategy originally designed for containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs) was evaluated over a 7-month period across the largest healthcare system in Singapore. • During the COVID-19 pandemic, methicillin-resistant Staphylococcus aureus acquisition rates declined significantly, together with central-line-associated-bloodstream infection rates; likely due to increased compliance with standard precautions. • Enhanced infection control measures resulted in the unintended positive consequences of containing health care-associated respiratory viral infections, with a significant and sustained decline for both enveloped and nonenveloped respiratory viruses. • The ongoing COVID-19 pandemic provided the impetus to demonstrate the potential benefit of heightened infection control measures in controlling HAIs and acquisition of multidrug-resistant-organisms., Background In the current COVID-19 pandemic, aggressive Infection Prevention and Control (IPC) measures have been adopted to prevent health care-associated transmission of COVID-19. We evaluated the impact of a multimodal IPC strategy originally designed for the containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs). Methodology From February-August 2020, a multimodal IPC strategy was implemented across a large health care campus in Singapore, comprising improved segregation of patients with respiratory symptoms, universal masking and heightened adherence to Standard Precautions. The following rates of HAI were compared pre- and postpandemic: health care-associated respiratory-viral-infection (HA-RVI), methicillin-resistant Staphylococcus aureus, and CP-CRE acquisition rates, health care-facility-associated C difficile infections and device-associated HAIs. Results Enhanced IPC measures introduced to contain COVID-19 had the unintended positive consequence of containing HA-RVI. The cumulative incidence of HA-RVI decreased from 9.69 cases per 10,000 patient-days to 0.83 cases per 10,000 patient-days (incidence-rate-ratio = 0.08; 95% confidence interval [CI] = 0.05-0.13, P< .05). Hospital-wide MRSA acquisition rates declined significantly during the pandemic (incidence-rate-ratio = 0.54, 95% CI = 0.46-0.64, P< .05), together with central-line-associated-bloodstream infection rates (incidence-rate-ratio = 0.24, 95% CI = 0.07-0.57, P< .05); likely due to increased compliance with Standard Precautions. Despite the disruption caused by the pandemic, there was no increase in CP-CRE acquisition, and rates of other HAIs remained stable. Conclusions Multimodal IPC strategies can be implemented at scale to successfully mitigate health care-associated transmission of RVIs. Good adherence to personal-protective-equipment and hand hygiene kept other HAI rates stable even during an ongoing pandemic where respiratory infections were prioritized for interventions.

Purpose Hospital floors are underappreciated reservoir for microbes; therefore, floor cleaning should warrant reduction of microbial load for decreasing risk of infection transmission and has to be aesthetically acceptable. It was aimed to study the impact of mechanized laundering of floor mops in reducing microbial load compared to manual washing. Methods An interventional study was conducted from January to July 2019 in various inpatient areas of All India Institute of Medical Sciences, New Delhi. Culture of floor mops were taken after manual washing (pre-intervention) and mechanized laundering(intervention). During intervention, mops were equally divided into two piles, with one pile soaked in sodium hypochlorite for 15–20 min before mechanized laundering and other were put directly for mechanized laundering. Bacterial load in floor mops was observed in each group. Results Significant difference (P Value 0.001) in bacterial load was observed in manually washed (502 cfu/plate) and mechanized laundering (278 cfu/plate) of floor mops. Presoaking of floor mops with sodium hypochlorite (262 cfu/plate) did not show any significant difference (P-value 0.59) in reduction of bacterial load compared to mops which were cleaned using mechanized laundering (294 cfu/plate). The bacterial load of floor mops which were manually washed showed increase in mean value of microbial load from 609 cfu/plate from day one to 4015 cfu/plate on day five. Conclusion Mechanized laundering of floor mops standardizes the mop cleaning process and brings down the microbial load significantly compared to manual washing. Disinfection of floor mops before mechanized laundering using sodium hypochlorite did not have significant impact on reduction of microbial load.

Objective: To determine the frequency of Ventilator associated Pneumonia (VAP), Central Line Associated Blood Stream Infection (CLABSI) and Catheter Associated Urinary Tract infection (CAUTI) by using standardized criteria established by Center of disease control and prevention. Study Design: Cross-sectional study. Setting: PICU of Aga Khan University Hospital (AKUH). Period: (August 2015 to January 2016). Material & Methods: Data was collected on a pre-coded proforma. Data was entered and analyzed through SPSS. Results: 156 patients were enrolled. 102 (65.4%) were male. Mean age was 57.59 months. Mean length of stay was 5.6 days. Patient and Device days were 546 and 958 respectively. Device utilization ratio was 0.56. Four Device associated infections (DAI) were identified during study period with a DAI Rate of 4.17 per 1000 device days. All DAI were CLABSIs. Enterococcus was the most frequent bacterial isolate. Conclusion: DAI are highly prevalent in low resource countries, especially in intensive care areas including PICUs. In our setup, CLABSI are increasing while VAP and CAUTI are decreasing.

Bioinformatics and Computational Biology analyses were supported by the University of St Andrews Bioinformatics Unit which is funded by a Wellcome Trust ISSF award [grant 097831/Z/11/Z]. The SHAIPI consortium is funded by the Chief Scientist Office through the Scottish Infection Research Network (SIRN10). Outbreaks pose a significant patient safety risk as well as being costly and time consuming to investigate. The implementation of targeted infection prevention and control (IPC) measures relies on infection prevention and control teams (IPCTs) having access to rapid results that accurately detect resistance, and typing results that give clinically useful information on the relatedness of isolates. At present, determining whether transmission has occurred can be a major challenge. Conventional typing results do not always have sufficient granularity or robustness to unequivocally define strains, and sufficient epidemiological data to establish links between patients and the environment is not always available. Whole genome sequencing (WGS) has emerged as the ultimate genotyping tool, but has not yet fully crossed the divide between research method and routine clinical diagnostic microbiology technique. A clinical WGS service was officially established in 2014 as part of the Scottish Healthcare Associated Infection Prevention Institute (SHAIPI) to confirm or refute outbreaks in hospital settings from across Scotland. In this personal view we describe our experiences that we believe provide new insights into the practical application of the use of WGS to investigate healthcare and public health outbreaks. We also propose solutions to overcome barriers to implementation of this technology in a clinical environment. Publisher PDF

Background Nosocomial infections are the foremost reasons for morbidity and mortality among hospitalized patients. Rampant use of antibiotics in infections has led to the emergence of multiresistant bacteria worldwide. Periodical review of sensitivity profiles is of utmost importance for optimal patient benefit. Aims and objectives To explore the spectrum of organisms responsible for intensive care unit (ICU) and inpatient hospital-acquired sepsis and evaluate the pattern of antibiotic sensitivity of the organisms. Materials and methods Samples were collected from all consecutive patients getting fever and satisfying the criteria for a nosocomial infection indoor as well as ICU, irrespective of etiology. They included sputum, blood, urine, and wound swabs. All samples were sent for a routine examination as well as a culture and sensitivity test. Descriptive statistical methods were used with the help of SPSS version 21. Results The most frequent organisms for nosocomial infections in the ICU were Enterobacteriaceae (45%), Acinetobacter (13.7%), and Staphylococcus aureus (12.3%). In the general wards, the most common isolates were Enterobacteriaceae (59.9%), S. aureus (14.5%), Enterococcus (9.8%), and Pseudomonas (9.3%). There was a high percentage of extended-spectrum beta-lactamase among the Enterobacteriacae, methicillin-resistant S. aureus, and borderline oxacillin-resistant S. aureus among S. aureus and metallo-ß-lactamase among the Acinetobacter and Pseudomonas. These indicate resistance to most beta-lactams, cephalosporins, and at times to carbapenems. There was also coresistance to fluoroquinolones and aminoglycosides. Conclusion An antibiotic policy should be improvised for each healthcare facility on the basis of that point of time. How to cite this article Ghosh S, Mukhopadhyay M, Namhata A, et al. A Spectrum of Causative Organisms of Healthcare-Associated Infections in a Tertiary Care Hospital of West Bengal: An Observational Study. Bengal Physician Journal 2020;7(1):2–7.

Background: Prevention of healthcare associated infections is still an actual issue. Decontamination is one of the most basic activities of general nurses in the provision of health services. An important role in the decontamination process is also the training of general nurses about the observance of principles related to the chemical disinfection.Aim: To find out the current state of training of general nurses in the issue of decontamination of repeatedly used medical devices and surfaces in clinical practice.Methods: The research was realized by a quantitative method using a questionnaire technique. The research was carried out in a selected regional hospital. The research group consisted of general nurses working in standard departments.Results: The research found out that respondents were trained in the last 2 years most often in the use of personal protective equipment (88.0 % of respondents), the use of cleaning and disinfecting agents (81.5 % of respondents). Furthermore, it was found out that 77.8 % of respondents always emphasize the disinfection of reusable medical devices and surfaces.Discussion: The results of the research brought interesting findings and correspond to some realized researches. Based on the results, it can be recommended to increase the effectiveness of training and implement new aspects of decontamination and prevention of infection transmission, for example, using simulation training for provision of effective feedback.Conclusion: Training of general nurses about sanitary-epidemiological measures is an important part of preventing the transmission of healthcare associated infections.

Background: Healthcare associated infections (HAIs) have been recognized as a critical challenge affecting the quality of healthcare services provided. A significant proportion of these infections result from cross-contamination of microorganisms which are often acquired and spread by direct contact with patients or contaminated adjacent environmental surfaces through the hands of healthcare workers (HCWs). The objectives of this study are to profile bacterial pathogens commonly found on the hands of health care workers while routinely attending to patients in thehealthcare facility and to determine their antibiotic susceptibility pattern.Methodology: The fingers of the dominant hand of 300 HCWs at the Barau Dikko Teaching Hospital (BDTH), Kaduna, Nigeria, were imprinted on 5% Sheep blood, MacConkey, and Mannitol salt agar plates and incubated at 37°C for 24 hours. Bacteria isolates were identified by Gram staining and conventional biochemical tests. The susceptibility of isolated bacteria to selected antibiotics was determined by the modified Kirby–Bauer disk diffusion method and interpreted using the 2012 guidelines of the Clinical and Laboratory Standards Institute.Results: Bacteria were isolated from the hands of all 300 HCWs, with coagulase negative staphylococci (CONS) being the most frequent (67.0%, 201/300). Other bacteria identified were Staphylococcus aureus (23.7%, MRSA of 3%), Streptococcus pyogenes (2.7%), and Enterobacteriaceae (6%). The isolates were highly sensitive to ofloxacin 96.7% (290/300), augmentin 87.7% (263/300) and ceftriaxone 87.3% (262/300).Conclusion: This study demonstrates a high rate of contamination of hands of HCWs with potentially pathogenic bacteria, some of which were multidrug resistant. Concerted efforts should be made to implement programs dedicated to improve hand hygiene practices in the tertiary health care facility. Keywords: Hand hygiene, bacterial, pathogen, healthcare workers, healthcare associated infection French title: Profil d'agents pathogènes bactériens contaminant les mains des travailleurs de la santé lors des soins quotidiens de routine auxpatients d'un hôpital tertiaire dans le nord du Nigéria Contexte: Les infections associées aux soins de santé (IHA) ont été reconnues comme un défi critique affectant la qualité des services de santé fournis. Une proportion importante de ces infections résulte de la contamination croisée de micro-organismes qui sont souvent acquis et propagés par contact direct avec des patients ou des surfaces environnementales adjacentes contaminées par les mains des travailleurs de la santé (TS). Les objectifs de cette étude sont de dresser le profil des agents pathogènes bactériens que l'on trouve couramment dans les mains des travailleurs de la santé tout en s'occupant régulièrement des patients dans l'établissement de santé et de déterminer leur profil de sensibilité aux antibiotiques.Méthodologie: Les doigts de la main dominante de 300 travailleurs de la santé au Barau Dikko Teaching Hospital (BDTH), Kaduna, Nigéria, ont été imprimés sur des plaques de gélose au sang de mouton à 5%, MacConkey et Mannitol et incubés à 37°C pendant 24 heures. Les isolats de bactéries ont été identifiés par coloration de Gram et tests biochimiques conventionnels. La sensibilité des bactéries isolées aux antibiotiques sélectionnés a été déterminée par la méthode de diffusion sur disque modifiée de Kirby-Bauer et interprétée en utilisant les lignes directrices de 2012 du Clinical and Laboratory Standards Institute.Résultats: les bactéries ont été isolées des mains des 300 TS, les staphylocoques à coagulase négative (CONS) étant les plus fréquents (67,0%, 201/300). Les autres bactéries identifiées étaient Staphylococcus aureus (23,7%, SARM de 3%), Streptococcus pyogenes (2,7%) et Enterobacteriaceae (6%). Les isolats étaient très sensibles à l'ofloxacine 96,7% (290/300), à l'augmentationin 87,7% (263/300) et à la ceftriaxone 87,3% (262/300).Conclusion: Cette étude démontre un taux élevé de contamination des mains des travailleurs de la santé par des bactéries potentiellement pathogènes, dont certaines étaient multirésistantes. Des efforts concertés devraient être faits pour mettre en œuvre des programmes visant à améliorer les pratiques d'hygiène des mains dans les établissements de soins de santé tertiaires. Mots-clés: hygiène des mains, bactérienne, pathogène, personnel de santé, infection associée aux soins de santé

In multidisciplinary hospitals, there are conditions conducive to the emergence of healthcare-associated infections: high concentration of people with reduced immunity in a limited area, the presence of a significant number of sources of contagion (patients and carriers), a change in the biocenosis of the mucous membranes and skin of patients and medical personnel under the influence of widespread use of antibiotics and cytostatics. The aim of the research was in the intercomparison of the standardized bacteriological algorithms and the MALDI Biotyper system in the microbiological diagnosis of pathogens as illustrated by the healthcare-associated diseases. Materials and methods . Seventy-eight patients of a multidisciplinary hospital of a regional level (Irkutsk) in 2018–2019 were examined. The age of patients ranged from 1 to 15 years. The material for the study was blood, sputum, swabs from the tracheobronchial tree, throat, nose, wound, abdominal fluid, cerebrospinal fluid, and swabs from environmental objects. Identification of the isolated cultures (78 bacterial strains) was carried out using generally accepted bacteriological methods, as well as using the MALDI Biotyper system. Results and discussions. In the structure of healthcare-associated infections, Pseudomonas aeruginosa occupied a leading position. Not all isolates of microorganisms were identified by standardized bacteriological methods. The identification of strains with characteristic manifestations of physiological and biochemical characteristics was more reliable. Identification difficulties arose in the presence of atypical properties of microorganisms when the use of MALDI Biotyper would be crucial. Conclusion . It is necessary to apply an integrated approach to conduct reliable diagnostics of pathogens. It includes standardized bacteriological methods and methods for identifying microorganisms using mass spectrometry in the subsequent stages.

Healthcare-associated infections (HAI) represent infections that happened during after hospitalization, the symptoms starting at least 48 hours after admission, being present during hospitalization or after discharge. A common category of HAI are surgical infections that have a major clinical and financial impact. The aim of this study is the analysis of cases of healthcare-associated infections in the surgery departments in Constanţa County during 2014-2018. The authors note the progressive increase in the number of cases reported annually, thanks to the rigorous application of the provisions of Order of the Ministry of Health 1101/2016, which regulates the activity of monitoring and controling of HAI. The change of the profile of the infections, with the predominance of the digestive ones compared to those of the surgical wound, denotes on the one hand the improvement of the technical conditions of asepsis, but also an administration of excessive antibiotic therapy, which requires the establishment of effective measures of antimicrobial stewardship.

The healthcare associated infections are the infections in the newborn confirmed by bacteriological cultures (blood culture, culture of cerebrospinal fluid, urine); positive anamnestic-clinical data after 72 hours of life, associated with ICU hospitalization and invasive procedures (intubation, mechanical ventilation, umbilical and peripheral vein catheterization, central artery catheterization, administration of solutions from a single vial to several children). The present study highlights the fact that neonatology departments have a high risk of healthcare associated infections due to the vulnerability of young patients to various germs in hospitals, as evidenced by many cases of sepsis and respiratory infections. In this study, we found a significant increase in the healthcare associated infections reporting in the middle of the study period, followed by a decrease in half the number of reported cases, this fact probably due to awareness of the phenomenon by health units management, the correct implementation of guidelines and protocols, protocols regarding the healthcare associated infections prevention or, why not, due to an underreporting.

Introduction: Catheter-associated urinary tract infections (CAUTIs) are one of the most common infections encountered in healthcare settings. Candida spp. were excluded as the causative agents of CAUTIs as per Centres for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) definitions in 2015. Aim: To determine the impact of the 2015 definition change on the CAUTI rate of patients admitted to medical and surgical intensive care units (ICUs) of a tertiary care and teaching hospital in India. Method: CAUTI rates were compared in both the ICUs over a period of two years with inclusion and exclusion of Candida spp. Results: Out of the total 116 CAUTI episodes during the study period, a mean of 9.08 CAUTIs per 1000 catheter days were observed in both the ICUs when Candida spp. were included, but the mean CAUTI rate was reduced to 4.78/1000 catheter days when Candida spp. were excluded. Discussion/Conclusion: The mean CAUTI rate decreased by 46.03% solely by excluding Candida spp. This significant reduction in CAUTI rates may be applicable to institutions having high rates of candiduria in catheterised patients, but may not be applicable in centres where the incidence of candiduria is already low. Disregarding Candida as a causative agent of CAUTI did not impact rates of central line-associated bloodstream infections during the study period.