Ganesan Vithiya, Sundaramurthy Raja, Thiruvanamalai Rajendran, Sivakumar Vijay Anand, Udayasankar Sridhurga, Arunagiri Ramesh, Charles Jhansi, Chavan Sunil Kumar, Balan Yuvaraj, Sakthivadivel Varatharajan
Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND.
Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND.
Cureus. 2021 Nov 7;13(11):e19331. doi: 10.7759/cureus.19331. eCollection 2021 Nov.
Background and objective The prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital. Materials and methods A prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting. Results The surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by 30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in was 28.5% (2/7). Conclusion DUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.
背景与目的 由于缺乏系统的主动监测，发展中国家医院获得性感染（HAIs）的患病率报告不足。本研究基于一家三级护理医院封闭重症监护病房（ICUs）两年的主动监测及现场集束护理，报告了与设备相关的医院获得性感染（DA-HAIs）的负担。材料与方法 在一所私立三级护理医学院医院的140张床位的重症监护病房（拥有2100张床位的医院）开展了一项前瞻性监测研究。由经过培训的感染控制护士（ICNs）以及负责HAI监测的质量冠军护士，使用带有集束护理审核的HAI监测表格，对导管相关尿路感染（CAUTI）、呼吸机相关事件（VAE）和中心静脉导管相关血流感染（CLABSI）进行每日主动监测，该表格附在所有使用设备患者的病历上。DA-HAIs的监测定义采用了美国疾病控制与预防中心（CDC）的国家医疗安全网络（CDC-NHSN）2017年监测标准。每月末对数据进行分析，以得出累积设备相关感染（DAI）率和设备使用率（DUR）。将这些数据与NHSN和国际医院感染控制协会（INICC）-印度的HAI率进行比较，并传达给相应的重症监护病房，同时在医院感染控制委员会（HICC）会议上进行汇报。结果 在研究期间，共报告了71877个患者日的监测数据。导尿管、呼吸机和中心静脉导管的DUR分别为0.53、0.16和0.22。CAUTI、VAE和CLABSI率分别为每1000个设备日0.97、10.5和0.43。在报告的166例DA-HAIs中，鉴定出182种病原体。是分离出的最常见病原体，占所有DA-HAI病例的37.4%，其次是（占30.8%）。大多数革兰氏阴性菌对碳青霉烯类耐药（153/175；87.4%）。的万古霉素耐药率为28.5%（2/7）。结论 在我们三级护理单元的几乎所有重症监护病房中，DUR以及CAUTI、VAE、CLABSI率低于/与INICC和CDC-NHSN的基准相当。87.4%的碳青霉烯耐药革兰氏阴性病原体使情况恶化。通过集束护理进行适当的主动监测以及ICNs的培训，使所有DA-HAI率有了显著差异，尤其是VAE，从每1000个呼吸机日23.6降至10.5。由训练有素的感染预防团队进行持续的HAI主动监测和集束护理审核，并实施严格的抗生素政策，是应对DAIs的当务之急。
