Patient Safety and Infection Control

Clinical spectrum and resistance pattern of community-acquired invasive Staphylococcus aureus infection in children Mohd Kashif, Yusuf Imran Ansari, Tarique Ekram, Fatima Khan, Tabassum Nawab, Shaad Abqari Journal of Patient Safety and Infection Control 2018 6(2):33-37 Introduction: The incidence of Staphylococcal infections has been increasing over the last 20 years and MRSA infection is becoming an important cause of hospital infection among children. Aims and Objectives: The study aimed to delineate the clinical spectrum of Staphylococcus aureus infection in children, their complications, antimicrobial resistance patterns and response to treatment. Materials and Methods: Children with suspected community acquired invasive S. aureus infections were retrospectively identified. Fifty patients with proven S.aureus infection on culture from clinically relevant sites were included. Their symptoms, course of disease, complications, antimicrobial resistance pattern and response to treatment is described. Results and Conclusions: Out of a total of 50 cases, S.aureus isolates from 31 (62%) cases were sensitive to oxacillin while resistance to this antibiotic was reported in 19 (38%) cases. Most common site for localisation of infection was present in lungs (40%) followed by CNS (16%), skin (8%) and bone (4%) The focality of infection and pattern of resistance were not significantly associated with outcomes.

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 Journal of Patient Safety and Infection Control 2018 6(2):38-44 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.

Prevalence of needle-stick injuries among health-care workers in a tertiary care centre in North India Sana Islahi, Vineeta Mittal, Manodeep Sen Journal of Patient Safety and Infection Control 2018 6(2):45-50 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.

Profile of fatal geriatric trauma at a Level 1 trauma centre of India Sanjeev Lalwani, Purva Mathur, Mahesh Kumar, Chhavi Sawhney, Deepak Agrawal, Omika Katoch Journal of Patient Safety and Infection Control 2018 6(2):51-53 Background: Trauma in old age is a serious health issue and associated with high fatality. This study details the profile of fatal geriatric trauma at a Level 1 Indian trauma centre. Methods: This is a retrospective study. A total of 779 geriatric patients were admitted to the Jai Prakash Narayan Apex Trauma Centre during 2-year period from January 2014 to December 2015. A retrospective analysis was done of all 194 fatal geriatric trauma patients who underwent autopsy at our centre during this 2-year period. The study has been taken ethical clearance from the institutional review board. Setting: This study was conducted in a 165-bedded Level 1 trauma centre of India. Participants: Hundred and ninety-four fatal geriatric trauma patients were included in the study. Interventions: There were no interventions in this study. Measurements: Data were represented in median (range: minimum–maximum) and frequency (%). Results: The duration of admission of these 194 patients ranged from <1 to 91 days (median 3 days). The causes of trauma were road traffic accidents in 78 (40%), fall from height in 75 (39%), assault in 12 (6%), railway accident in 10 (5%) and unconsciousness in 10 (5%). The autopsy-proven primary cause of death was severe head injury in 89 (46%), septicaemia in 30 (15%), polytrauma in 11 (6%), orthotrauma in 12 (6%), haemorrhagic shock in 9 (5%), spinal injury in 8 (4%), musculoskeletal injury in 3 (2%) and fat embolism in 3 (2%). Conclusion: In our study, while most of the early deaths were due to severe head injuries, late deaths were predominantly due to infections.

Phenotypic and molecular characterization of extended spectrum beta lactamase and AmpC beta lactamases in Escherichia coli from a tertiary care centre in India Aishwarya Govindaswamy, Vijeta Bajpai, Priyam Batra, Rajesh Malhotra, Purva Mathur Journal of Patient Safety and Infection Control 2018 6(2):54-58 Background: Antibiotic resistance mediated by extended spectrum beta lactamase (ESBL) and AmpC enzymes in Escherichia coli continue to be a major threat in a health care setting. This study was undertaken to calculate the prevalence and to characterize ESBL and AmpC enzymes produced by E. coli by various phenotypic and molecular methods (polymerase chain reaction [PCR]). Materials and Methods: A total of 196 clinical isolates of E. coli were screened for ESBL production using cephalosporin disk diffusion method, minimum inhibitory concentration (MIC) determination by E-test and Vitek-2 system. Phenotypic confirmation for ESBL production was done using cephalosporin/clavulanate combination disc test method and E-test for ESBLs. For the detection of AmpC enzymes, cefoxitin disk diffusion and cefoxitin MIC testing was used and further phenotypically confirmed by three dimensional extract test, AmpC disk test, boronic acid disk test method and disk approximation method. The genotypic detection of ESBL genes and AmpC genes were done by PCR. Statistical Analysis: The data was analyzed using SPSS software (Version 21.0). Chi-square test was used for statistical analysis of the data. Results: The prevalence of ESBL and AmpC enzymes among E. coli isolates was found 93.12% and 28.68%. Among the various phenotypic screening methods evaluated, ceftazidime (CZD) disk diffusion test had the highest sensitivity of 90.67% and positive predict value of 92.86% followed by cefotaxime and CZD in comparison with polymerase chain reaction (PCR). For AmpC β-lactamases, the cefoxitin disk used for screening of AmpC β-lactamases had sensitivity of 91.67%, specificity of 59.14%, positive predict value of 46.48%, and negative predict value of 94.83% when compared with PCR. Conclusion: The high prevalence of ESBL and AmpC in our study emphasises on the judicious use of antibiotics in controlling antimicrobial resistance in the hospital.

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 Journal of Patient Safety and Infection Control 2018 6(2):59-62 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.

Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and their implication in occupational health Areena Hoda Siddiqui, Vipul Kumar Srivastava Journal of Patient Safety and Infection Control 2018 6(2):63-65 ORIGINAL ARTICLES   Clinical spectrum and resistance pattern of community-acquired invasive Staphylococcus aureus infection in children p. 33 Mohd Kashif, Yusuf Imran Ansari, Tarique Ekram, Fatima Khan, Tabassum Nawab, Shaad Abqari DOI:10.4103/jpsic.jpsic_12_18   Introduction: The incidence of Staphylococcal infections has been increasing over the last 20 years and MRSA infection is becoming an important cause of hospital infection among children. Aims and Objectives: The study aimed to delineate the clinical spectrum of Staphylococcus aureus infection in children, their complications, antimicrobial resistance patterns and response to treatment. Materials and Methods: Children with suspected community acquired invasive S. aureus infections were retrospectively identified. Fifty patients with proven S.aureus infection on culture from clinically relevant sites were included. Their symptoms, course of disease, complications, antimicrobial resistance pattern and response to treatment is described. Results and Conclusions: Out of a total of 50 cases, S.aureus isolates from 31 (62%) cases were sensitive to oxacillin while resistance to this antibiotic was reported in 19 (38%) cases. Most common site for localisation of infection was present in lungs (40%) followed by CNS (16%), skin (8%) and bone (4%) The focality of infection and pattern of resistance were not significantly associated with outcomes. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Patient safety and infection control in operation theatre: A prospective observational study in a tertiary care hospital of India p. 38 Deepti Sahran, Vijaydeep Siddharth, Sidhartha Satpathy 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. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Prevalence of needle-stick injuries among health-care workers in a tertiary care centre in North India p. 45 Sana Islahi, Vineeta Mittal, Manodeep Sen 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. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Profile of fatal geriatric trauma at a Level 1 trauma centre of India p. 51 Sanjeev Lalwani, Purva Mathur, Mahesh Kumar, Chhavi Sawhney, Deepak Agrawal, Omika Katoch DOI:10.4103/jpsic.jpsic_8_18   Background: Trauma in old age is a serious health issue and associated with high fatality. This study details the profile of fatal geriatric trauma at a Level 1 Indian trauma centre. Methods: This is a retrospective study. A total of 779 geriatric patients were admitted to the Jai Prakash Narayan Apex Trauma Centre during 2-year period from January 2014 to December 2015. A retrospective analysis was done of all 194 fatal geriatric trauma patients who underwent autopsy at our centre during this 2-year period. The study has been taken ethical clearance from the institutional review board. Setting: This study was conducted in a 165-bedded Level 1 trauma centre of India. Participants: Hundred and ninety-four fatal geriatric trauma patients were included in the study. Interventions: There were no interventions in this study. Measurements: Data were represented in median (range: minimum–maximum) and frequency (%). Results: The duration of admission of these 194 patients ranged from <1 to 91 days (median 3 days). The causes of trauma were road traffic accidents in 78 (40%), fall from height in 75 (39%), assault in 12 (6%), railway accident in 10 (5%) and unconsciousness in 10 (5%). The autopsy-proven primary cause of death was severe head injury in 89 (46%), septicaemia in 30 (15%), polytrauma in 11 (6%), orthotrauma in 12 (6%), haemorrhagic shock in 9 (5%), spinal injury in 8 (4%), musculoskeletal injury in 3 (2%) and fat embolism in 3 (2%). Conclusion: In our study, while most of the early deaths were due to severe head injuries, late deaths were predominantly due to infections. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Phenotypic and molecular characterization of extended spectrum beta lactamase and AmpC beta lactamases in Escherichia coli from a tertiary care centre in India p. 54 Aishwarya Govindaswamy, Vijeta Bajpai, Priyam Batra, Rajesh Malhotra, Purva Mathur DOI:10.4103/jpsic.jpsic_11_18   Background: Antibiotic resistance mediated by extended spectrum beta lactamase (ESBL) and AmpC enzymes in Escherichia coli continue to be a major threat in a health care setting. This study was undertaken to calculate the prevalence and to characterize ESBL and AmpC enzymes produced by E. coli by various phenotypic and molecular methods (polymerase chain reaction [PCR]). Materials and Methods: A total of 196 clinical isolates of E. coli were screened for ESBL production using cephalosporin disk diffusion method, minimum inhibitory concentration (MIC) determination by E-test and Vitek-2 system. Phenotypic confirmation for ESBL production was done using cephalosporin/clavulanate combination disc test method and E-test for ESBLs. For the detection of AmpC enzymes, cefoxitin disk diffusion and cefoxitin MIC testing was used and further phenotypically confirmed by three dimensional extract test, AmpC disk test, boronic acid disk test method and disk approximation method. The genotypic detection of ESBL genes and AmpC genes were done by PCR. Statistical Analysis: The data was analyzed using SPSS software (Version 21.0). Chi-square test was used for statistical analysis of the data. Results: The prevalence of ESBL and AmpC enzymes among E. coli isolates was found 93.12% and 28.68%. Among the various phenotypic screening methods evaluated, ceftazidime (CZD) disk diffusion test had the highest sensitivity of 90.67% and positive predict value of 92.86% followed by cefotaxime and CZD in comparison with polymerase chain reaction (PCR). For AmpC β-lactamases, the cefoxitin disk used for screening of AmpC β-lactamases had sensitivity of 91.67%, specificity of 59.14%, positive predict value of 46.48%, and negative predict value of 94.83% when compared with PCR. Conclusion: The high prevalence of ESBL and AmpC in our study emphasises on the judicious use of antibiotics in controlling antimicrobial resistance in the hospital. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Clinical experience of using chlorhexidine gluconate-impregnated dressings in reducing the central line-associated bloodstream infection rate at a Level 1 trauma centre p. 59 Priyam Batra, S Thomas, Jacinta Gunjyal, Purva Mathur, Babita Gupta, Chhavi Swahnney, Deepak Agarwal, Ashish Bindra, Keshav Goyal, Richa Aggarwal, Kapil Soni, Rajesh Malhotra 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. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PERSPECTIVE Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and their implication in occupational health p. 63 Areena Hoda Siddiqui, Vipul Kumar Srivastava DOI:10.4103/jpsic.jpsic_1_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta