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Hand hygiene practices and associated factors in intensive care units (ICUs) in a paediatric tertiary care hospital in India
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journal of patient safety & infection control 3 ( 2 0 1 5 ) 50–69
use of disposable bed-pans/urinals and macerators by comparison of ‘pre’ and ‘post’ urine samples. The ‘Pre’ and ‘Post’ periods were defined as three months prior to (June, July, August’14) and after (September, October, November’14) the installation of the macerator respectively. Urine samples in these defined periods were analyzed towards study of the spectrum of growth in the urine samples, incidence of sterile urine samples and the in-vitro susceptibility pattern of the urinary isolates. Results: No growth was observed in 74 of the pre (n = 140) and in 156 of the ‘post’ (n = 214) samples studied. There was a significant increase of ‘no growth’ samples observed, especially in II Floor ICU (91.17%) followed by Neuro ICU (65.85%). Decrease in isolation rates for Escherichia coli, Klebsiella spp, Enterobacter spp and Citrobacter spp was observed. Carbapenem resistance had decreased during the ‘post’ period, especially in organisms like Escherichia coli and Klebsiella spp to the tune of 25.97% and 38.09%, respectively. Conclusion: Though adherence to practice of disinfection was universal, yet exact protocol was not followed for disinfecting the mouth of the container in 32% of the cases. Although housekeeping is vigorously trained, but due to the high attrition rate, repeated training needs are identified. The cost of consumables can be offset by the yearly expense of disinfectants, the manpower involved as well as the environmental damage that the disinfectants are likely to cause.
pared to the nurses (78.7%) and the technical staff were most compliant with 80.5%. While assessing the five moments of hand hygiene, the compliance was highest before performing an aseptic procedure, 84% in PICU and 85% in NICU and least compliant after contact with the patient and patient surroundings. In NICU, hand rub was conducted 47.6% of times versus hand wash (52.6%). In contrast, in PICU hand rub was preferred 56% of cases as compared to hand wash (44%). Conclusions: The average hand hygiene compliance in both the ICUs is satisfactory at 80%. Innovative methods and more frequent teaching for hand hygiene is required to achieve persistently high compliance rates. Behaviour modification of healthcare workers still remains a challenge to achieve high compliance rate. http://dx.doi.org/10.1016/j.jpsic.2015.10.038
C033 Molecular characterization of ESBL-producing Escherichia coli isolated from urinary tract infections in Sylhet of Bangladesh Belal Mahmood ∗ , Shaheen Mehtar, Ishrat J. Azmi, Donald Gomes Kaisar Talukder Enteric laboratory International Center for Diarrhoeal Diseases and Research, Bangladesh
http://dx.doi.org/10.1016/j.jpsic.2015.10.037
C032 Hand hygiene practices and associated factors in intensive care units (ICUs) in a paediatric tertiary care hospital in India R. Saksena ∗ , C. Nayyar, V. Manchanda, A. Vashisht, J. Mathews, A. Achuthan, Neeta, S. Makkar Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitasalaya, India Introduction: Hand hygiene has been regarded as the cornerstone of infection control efforts since the landmark study conducted by Semmelweis in 1884. Method: A retrospective observational study was conducted from July 2009 to July 2014 by the hospital infection control committee in our 216 bedded hospital with a 20 bedded NICU and a 12 bedded PICU. The infection control nurses (ICNs) observed the ICU staff for hand hygiene compliance and recorded their observations. Monthly feedback was given to the unit in-charges and the concerned staff. The hand hygiene compliance was compared with the rate of hospital associated infections in the ICUs. Result: The average staff on duty in NICU is 12/shift and in PICU is 10/shift. The average compliance in NICU was 80.5% whereas in PICU it was 77.9%. Among the various categories of healthcare workers observed, namely doctors, nurses and technicians, all had a better compliance rate in NICU as compared to PICU. In NICU, doctors had higher compliance rate of 82% vis-ã-vis nurses (80.5%) and technical staff (81%). Doctors in PICU, however, had lower compliance rates (77%) as com-
Background: Patients having urinary tract infections (UTIs) with multidrug resistance bacteria suffer from various complications. This is due to -lactamase-production by certain group of bacteria. This study was undertaken to explore the molecular mechanisms of drug resistance caused by ESBLproducing Escherichia coli isolated from UTI patients in the Sylhet community of Bangladesh. Methods: A total of 100 urine samples from symptomatic UTI patients were used in this study. Twenty three isolates were found to be Klebsiella, which were discarded. Remaining 77 isolates were identified as Escherichia coli by standard methods in the laboratory.25 isolates were further confirmed as ESBLproducing Escherichia coli by double disk-diffusion synergy test and other tests such as antibiotic susceptibility plasmid profile and PCR were also done. Results: The antibiotic susceptibility for ESBL producing group demostrated (n = 20) resistance high percentage, AMC – 80%, CAZ – 55%, CRO – 80%, CIP – 80%. In Non-ESBL group showed (n = 52) lower resistance percentage. All of the isolates (Both for ESBL & non ESBL) were 100% sensitive to the carbepenems. Plasmid profile analysis, of the isolates revealed high molecular wt plasmids of ≤140 MDa both for ESBL and nonESBL isolates. PCR showed three types of ESBLs genes CTXM-1 gene (59%) OXA-1 gene (42%) and TEM-1 gene (45%). Conclusion: The ESBL-producing E. coli strains were responsible for multidrug resistance in the community of Sylhet Town. They also harbour large sized transmissible plasmids and these plasmids are encoded by genes such as TEM-1, OXA-1 and CTXM-1 . It is CTXM-1 that constitutes the highest percentage (60%) in the district of Sylhet in Bangladesh. http://dx.doi.org/10.1016/j.jpsic.2015.10.039
journal of patient safety & infection control 3 ( 2 0 1 5 ) 50–69
use of disposable bed-pans/urinals and macerators by comparison of ‘pre’ and ‘post’ urine samples. The ‘Pre’ and ‘Post’ periods were defined as three months prior to (June, July, August’14) and after (September, October, November’14) the installation of the macerator respectively. Urine samples in these defined periods were analyzed towards study of the spectrum of growth in the urine samples, incidence of sterile urine samples and the in-vitro susceptibility pattern of the urinary isolates. Results: No growth was observed in 74 of the pre (n = 140) and in 156 of the ‘post’ (n = 214) samples studied. There was a significant increase of ‘no growth’ samples observed, especially in II Floor ICU (91.17%) followed by Neuro ICU (65.85%). Decrease in isolation rates for Escherichia coli, Klebsiella spp, Enterobacter spp and Citrobacter spp was observed. Carbapenem resistance had decreased during the ‘post’ period, especially in organisms like Escherichia coli and Klebsiella spp to the tune of 25.97% and 38.09%, respectively. Conclusion: Though adherence to practice of disinfection was universal, yet exact protocol was not followed for disinfecting the mouth of the container in 32% of the cases. Although housekeeping is vigorously trained, but due to the high attrition rate, repeated training needs are identified. The cost of consumables can be offset by the yearly expense of disinfectants, the manpower involved as well as the environmental damage that the disinfectants are likely to cause.
pared to the nurses (78.7%) and the technical staff were most compliant with 80.5%. While assessing the five moments of hand hygiene, the compliance was highest before performing an aseptic procedure, 84% in PICU and 85% in NICU and least compliant after contact with the patient and patient surroundings. In NICU, hand rub was conducted 47.6% of times versus hand wash (52.6%). In contrast, in PICU hand rub was preferred 56% of cases as compared to hand wash (44%). Conclusions: The average hand hygiene compliance in both the ICUs is satisfactory at 80%. Innovative methods and more frequent teaching for hand hygiene is required to achieve persistently high compliance rates. Behaviour modification of healthcare workers still remains a challenge to achieve high compliance rate. http://dx.doi.org/10.1016/j.jpsic.2015.10.038
C033 Molecular characterization of ESBL-producing Escherichia coli isolated from urinary tract infections in Sylhet of Bangladesh Belal Mahmood ∗ , Shaheen Mehtar, Ishrat J. Azmi, Donald Gomes Kaisar Talukder Enteric laboratory International Center for Diarrhoeal Diseases and Research, Bangladesh
http://dx.doi.org/10.1016/j.jpsic.2015.10.037
C032 Hand hygiene practices and associated factors in intensive care units (ICUs) in a paediatric tertiary care hospital in India R. Saksena ∗ , C. Nayyar, V. Manchanda, A. Vashisht, J. Mathews, A. Achuthan, Neeta, S. Makkar Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitasalaya, India Introduction: Hand hygiene has been regarded as the cornerstone of infection control efforts since the landmark study conducted by Semmelweis in 1884. Method: A retrospective observational study was conducted from July 2009 to July 2014 by the hospital infection control committee in our 216 bedded hospital with a 20 bedded NICU and a 12 bedded PICU. The infection control nurses (ICNs) observed the ICU staff for hand hygiene compliance and recorded their observations. Monthly feedback was given to the unit in-charges and the concerned staff. The hand hygiene compliance was compared with the rate of hospital associated infections in the ICUs. Result: The average staff on duty in NICU is 12/shift and in PICU is 10/shift. The average compliance in NICU was 80.5% whereas in PICU it was 77.9%. Among the various categories of healthcare workers observed, namely doctors, nurses and technicians, all had a better compliance rate in NICU as compared to PICU. In NICU, doctors had higher compliance rate of 82% vis-ã-vis nurses (80.5%) and technical staff (81%). Doctors in PICU, however, had lower compliance rates (77%) as com-
Background: Patients having urinary tract infections (UTIs) with multidrug resistance bacteria suffer from various complications. This is due to -lactamase-production by certain group of bacteria. This study was undertaken to explore the molecular mechanisms of drug resistance caused by ESBLproducing Escherichia coli isolated from UTI patients in the Sylhet community of Bangladesh. Methods: A total of 100 urine samples from symptomatic UTI patients were used in this study. Twenty three isolates were found to be Klebsiella, which were discarded. Remaining 77 isolates were identified as Escherichia coli by standard methods in the laboratory.25 isolates were further confirmed as ESBLproducing Escherichia coli by double disk-diffusion synergy test and other tests such as antibiotic susceptibility plasmid profile and PCR were also done. Results: The antibiotic susceptibility for ESBL producing group demostrated (n = 20) resistance high percentage, AMC – 80%, CAZ – 55%, CRO – 80%, CIP – 80%. In Non-ESBL group showed (n = 52) lower resistance percentage. All of the isolates (Both for ESBL & non ESBL) were 100% sensitive to the carbepenems. Plasmid profile analysis, of the isolates revealed high molecular wt plasmids of ≤140 MDa both for ESBL and nonESBL isolates. PCR showed three types of ESBLs genes CTXM-1 gene (59%) OXA-1 gene (42%) and TEM-1 gene (45%). Conclusion: The ESBL-producing E. coli strains were responsible for multidrug resistance in the community of Sylhet Town. They also harbour large sized transmissible plasmids and these plasmids are encoded by genes such as TEM-1, OXA-1 and CTXM-1 . It is CTXM-1 that constitutes the highest percentage (60%) in the district of Sylhet in Bangladesh. http://dx.doi.org/10.1016/j.jpsic.2015.10.039