Saroj Delhi IFC PDF

[Downloaded free from http://www.nabh.ind.in on Friday, April 10, 2015, IP: 182.73.172.
138] || Click here to download free Android application for this journal
ORIGINAL ARTICLE
Healthcare associated infections: A menace-

role of management at a multi-super-specialty
hospital in North West Region of Delhi
Abstract
Background: Healthcare-associated infections (HAIs) are usually related to a

procedure or treatment used to diagnose or treat the patient’s initial illness or injury.
Aim: To find and compare the incidence of HAI in different Intensive Care Units
(ICU’s) of Hospital A. To show a correlation, between HAI with mortality, morbidity
and average length of stay (ALOS).
Materials and Methods: The study was carried out at three ICU’s of Hospital A in
North-West Delhi-Surgical Intensive Care Unit (SICU), Respiratory Intensive Care
Unit (RICU) and Medical Intensive Care Unit (MICU). All patients admitted were
followed from admission to 2 days after discharge from the ICU during a period
of January 2010-December 2011-December-2012. The total sample amounted to
35,582 patient device days-13,051 for 2010 and 11,659 for 2011 and 10,872 for
2012. Continuous training was there from 2011 onwards for bundle approach and
hand hygiene monitoring.
Results: The rate of ventilator-associated pneumonia (VAP) from 55.93 per 1000
device days to 7.91 per 1000 device days from 2010 to 2012, catheter-associated
urinary tract infection (CAUTI) decreased from 6.33 per 1000 device days to 1.43
per 1000 device days but catheter-related bloodstream infection (CRBSI) increased
from 8.46 per 1000 device days to 21.80 per 1000 device days. There is a significant
correlation between mortality and HAI P value 0.03 with no significant correlation
between morbidity and HAI P value 0.74 also no significant correlation in ALOS
and HAI P value 0.17.
Kiran Chawla, Arun Madan, Conclusion: The trend in VAP and CAUTI in 3 ICU’s from 2010 to 2012 shows a
Rakesh K. Chawla, decreasing trend, the trend of CRBSI in 3 ICU’s from 2010 to 2012, which shows
Aditya K. Chawla a decreasing trend in MICU with no trend in SICU and RICU. There is a significant
Department of Quality and correlation between mortality and HAI with no significant correlation between
Medical Operations, Jaipur morbidity and HAI also no significant correlation in ALOS and HAI.
Golden Hospital, Saroj Hospital
and Heart Institute, Rohini, New Key words: Average length of stay, catheter-associated urinary tract infection,
Delhi, India
catheter-related bloodstream infection, hospital-acquired infection, intensive care
Address for correspondence: areas, ventilator-associated pneumonia
Dr. Kiran Chawla,
Singhania University, Pacheri
Bari, Rajasthan, India.
E-mail: chawlakiran00@ INTRODUCTION
gmail.com
Healthcare-associated infection
Access this article online
An infection that is acquired by or originates in a patient while in hospital or other health care
Website: www.nabh.ind.in facility and refers to a new disorder associated with being in a hospital, unrelated to the patient’s
DOI: 10.4103/2348-6139.151301 primary condition for which he or she is admitted.[1] Healthcare-associated infection (HAI) had
Quick Response code:
its humble beginning as late as the eighteenth century. Early nineteenth century saw segregation
of fever hospitals from general hospitals. Ignaaz Semmelweiss (1861) pioneered the concept of
asepsis. A dramatic reduction in infection rates was brought by the simple technique of hand
washing with chlorinated lime.[2] By the end of the nineteenth century, use of surgical gloves was
introduced in USA. In the early part of 20th-century cubicle and barrier, nursing was introduced.
The first infection control nurse was appointed in the UK in early 1970’s.[3] In the mid-20th
century established method of infection control, were laid down — clean air for operating
The Journal of National Accreditation Board for Hospitals & Healthcare Providers | Jul-Dec 2014 | Vol 1 | Issue 2 44
[Downloaded free from http://www.nabh.ind.in on Friday, April 10, 2015, IP: 182.73.172.138] || Click here to download free Android application for this journal
Chawla, et al.: Healthcare associated infections
theaters, aseptic procedures for wound dressing, isolation changed was sent for culture. The cultures were taken on 3rd day
procedures, establishment of antibiotic policies, Hospital (48-72 h) of admission provided same organism is not there at or
Infection Committees.[4] About 5-10% of patients admitted to before admission. The comparison of the incidence of Hospital
acute care hospitals and long-term care facilities in the United Infection Rates among different ICU’s where different protocols
States develop a hospital-acquired, or nosocomial infection, with of PPE are being followed, as per the observational data for hand
an annual total of more than one million people. HAIs are usually hygiene compliance and observational data following the aseptic
related to a procedure or treatment used to diagnose or treat the measures during the invasive procedures in different ICU’s after
patient’s initial illness or injury. The Centers for Disease Control the procedure is done.
(CDC) of the US Department of Health and Human Services
has shown that about 36% of these infections are preventable LIMITATIONS
through the adherence to strict guidelines by health care workers
when caring for patients. The limitations of this study are:
• The patients sometimes do not have baseline cultures that
Description of the research work are to be sent on day 1 of admission.
Aim • The tips of catheters are sometimes not sent for cultures
To find and compare the incidence of HAI in different Intensive while changing the catheters.
Care Units (ICU’s) of Hospital A so as to format the quality • The sterile methods are not adopted while collecting the
improvement program. To show a correlation between HAI samples sometimes.
with mortality, morbidity and average length of stay (ALOS).
RESULTS AND OBSERVATIONS
Methodology: Research problem
• Total Incidence of HAI in ICU’s of Hospital A. Observations
• Incidence of HAI in ICU’s. When we compared VAP between MICU, SICU and RICU
• Device Related Infections in ICU’s of Hospital A. respectively for the 3 years it shows that there is a significant
• Ventilator-associated pneumonias (VAPs). difference in the three ICU‘s in 3 years, that is, 2010, 2011 and
• Catheter-associated Urinary tract Infections (CAUTIs). 2012. The trend in VAP in 3 ICU’s from 2010 to 2012 shows
• Catheter-related bloodstream infections (CRBSIs). a decreasing trend. Once we observe CAUTI for the 3 years it
• Causative organisms. shows that there is a significant difference in the three ICU‘s
• Comparing with data as per other organizations. and the trend of CAUTI in three ICU’s from 2010 to 2012
• Continuous Quality Improvement. shows a decreasing trend. The trend in 3 ICU’s from 2010 to
2012 for CRBSI shows a decreasing trend in MICU with no
The study was carried out at three ICU’s of Hospital A in North- trend in SICU and RICU. In 2012, all ICU‘s have improved.
West Delhi-Surgical Intensive Care Unit (SICU), Respiratory There was a significant decrease in mortality in 3 ICU’s in
Intensive Care Unit (RICU) and Medical Intensive Care Unit 2011 and in 2012. There is a significant correlation between
(MICU). All patients admitted were followed from admission mortality and HAI with no significant correlation between
to 2 days after discharge from the ICU during a period of morbidity and HAI also no significant correlation in ALOS
January 2010-December 2011-December-2012. The total sample and HAI. The data for causative organisms is given as shown
amounted to 35,582 patient device days-13,051 for 2010 and in the tables and figures.
11,659 for 2011 and 10,872 for 2012.
Table 1 shows that there is a significant difference in the three
Patients admitted were followed up daily for the development ICU’s (P value 0.047) in 2010 and post-hoc comparison shows
of device-related nosocomial infections — VAPs, CAUTIs this significant difference lies between MICU and SICU (P value
and CRBSIs. The CDC and Prevention Case definitions were 0.038) with no significant difference in MICU versus RICU
followed. (P value 0.073) and SICU versus RICU (P value 0.817).
MATERIALS AND METHODS In 2011 also there is a significant difference in the three ICU’s
(P value 0.032) and post-hoc comparison this significant difference
For VAP we took Endotracheal (ET) Secretions, ET tip, lies between MICU and SICU (P value 0.011) with no significant
broncho-alveolar-lavage for culture sensitivity from patients difference in MICU vs. RICU (P value 0.562) and SICU vs. RICU
on a ventilator or with tracheostomy on ventilator. For CAUTI (P value 0.067).
sample was collected in a sterile way from the middle part of
the tube in a zigzag manner along with catheter tips. For CRBSI In 2012, all ICU’s have improved, and there is no significant
blood from the peripheral vein along with a catheter tip if difference among any of the ICU (P value 0.229).
45 The Journal of National Accreditation Board for Hospitals & Healthcare Providers | Jul-Dec 2014 | Vol 1 | Issue 2
Once we observe for the 3 years it shows that there is a significant This Graph 1 shows the trend in VAP in 3 ICU’s from 2010 to
difference in the three ICU‘s (P value 0.012) and post-hoc this 2012 which shows a decreasing trend.
significant difference lies between MICU and SICU (P value
0.003) with no significant difference in MICU versus RICU Table 2 shows that there is a significant difference in the
(P value 0.050) and SICU versus RICU (P value 0.363). three ICU’s (P value 0.005) in 2010 and post-hoc comparison
Graph 1: The month wise distribution of ventilato-associated pneumonia in Medical Intensive Care Unit, Surgical Intensive Care Unit and
Respiratory Intensive Care Unit (2010-2012) respectively
Table 1: Comparison of VAP between MICU, SICU and RICU respectively

Year Groups Mean SD Median Minimum Maximum P MICU versus SICU MICU versus RICU SICU versus RICU
2010 MICU 103.07 106.30 72.07 0.00 380.95 0.047* 0.038* 0.073 0.817
SICU 28.60 19.40 21.51 5.10 67.48
RICU 36.13 32.67 31.73 0.00 108.11
2011 MICU 46.83 35.91 45.84 0.00 97.56 0.032* 0.011* 0.562 0.067
SICU 11.24 9.20 10.08 0.00 28.57
RICU 55.66 85.84 36.70 0.00 312.50
2012 MICU 18.15 21.49 8.77 0.00 55.56 0.229 0.184 0.122 0.886
SICU 6.85 14.46 0.00 0.00 46.87
RICU 4.45 6.72 0.00 0.00 17.09
2010-2012 MICU 55.93 71.82 35.68 0.00 380.95 0.012* 0.003* 0.050 0.363
SICU 37.91 55.92 19.90 0.00 312.50
RICU 9.82 16.18 0.00 0.00 55.56
*Statistically significant at 0.05 significance level. MICU: Medical intensive care unit, SICU: Surgical intensive care unit, RICU: Respiratory intensive care unit,
VAP: Ventilato-associated pneumonia, SD: Standard deviation
Table 2: Comparison of CAUTI between MICU, SICU and RICU respectively

2010 MICU 13.37 12.22 12.16 0.00 41.38 0.005* 0.031* 0.004* 0.062
SICU 3.68 3.56 3.82 0.00 11.96
RICU 1.93 4.58 0.00 0.00 13.51
2011 MICU 6.81 5.29 5.71 0.00 18.73 0.027* 0.011* 0.295 0.042*
SICU 2.45 3.33 1.53 0.00 11.24
RICU 24.11 32.48 11.36 0.00 105.26
2012 MICU 2.72 4.28 0.00 0.00 10.45 0.038* 0.033* 0.894 0.015*
SICU 0.00 0.00 0.00 0.00 0.00
RICU 1.91 2.70 0.00 0.00 8.47
2010-2012 MICU 7.64 9.01 5.03 0.00 41.38 0.010* 0.001* 0.108 0.316
SICU 2.04 3.14 0.00 0.00 11.96
RICU 9.32 21.29 0.00 0.00 105.26
CAUTI: Catheter-associated urinary tract infection, SD: Standard deviation
this significant difference lies between MICU and SICU Table 3 shows that there is a significant difference in the three
(P value 0.031) and MICU versus RICU (P value 0.004) and with ICU’s (P value 0.010) in 2010 and post-hoc comparison this
no significant difference in SICU versus RICU (P value 0.062). significant difference lies between MICU and SICU (P value 0.019)
In 2011 also there is a significant difference in the three ICU’s and MICU versus RICU (P value 0.018) and with no significant
(P value 0.027) and post-hoc comparison this significant difference difference in SICU versus RICU (P value 0.952). In 2011, there was
lies between MICU and SICU (P value 0.011) with no significant no significant difference among any of the ICU (P value 0.818).
difference in MICU versus RICU (P value 0.295) and also In 2012 also there is a significant difference in the three ICU’s
significant difference lies between SICU versus RICU (P value (P value 0.045) and post-hoc comparison this significant difference
0.042). In 2012 also there is a significant difference in the three lies between MICU and RICU (P value 0.025) with no significant
ICU’s (P value 0.038) and post-hoc comparison this significant difference in MICU versus SICU (P value 0.547) and SICU versus
difference lies between MICU and SICU (P value 0.033) with RICU (P value 0.097). In 2012, all ICU’s have improved, and there
no significant difference in MICU versus RICU (P value 0.894) is no significant difference among any of the ICU (P value 0.229).
and also significant difference lies between SICU versus RICU Once we observe for the 3 years it shows that there is no significant
(P value 0.015). Once we observe for the 3 years it shows that difference among any of the ICU (P value 0.645).
there is a significant difference in the three ICU’s (P value 0.010)
and post-hoc this significant difference lies between MICU and This Graph 3 shows the trend in three ICU’s from 2010 to
SICU (P value 0.001) with no significant difference in MICU vs. 2012 which shows a decreasing trend in MICU with no trend
RICU (P value 0.108) and SICU versus RICU (P value 0.316). in SICU and RICU.
This Graph 2 shows the trend of CAUTI in 3 ICU’s from 2010 This Table 4 shows that there is a significant difference in morbidity
to 2012 which shows a decreasing trend. in three ICU’s in 2011 P value 0.001 and in 2012 P value 0.040. On
Table 3: Comparison of CRBSI between MICU, SICU and RICU respectively

2010 MICU 23.16 29.37 6.67 0.00 83.33 0.010* 0.019* 0.018* 0.952
SICU 8.38 13.32 0.00 0.00 34.48
RICU 9.26 32.07 0.00 0.00 111.10
2011 MICU 1.11 3.85 0.00 0.00 13.33 0.818 0.680 0.914 0.518
SICU 27.18 48.23 0.00 0.00 147.06
RICU 45.73 143.74 0.00 0.00 500.00
2012 MICU 1.10 3.80 0.00 0.00 13.16 0.045* 0.547 0.025* 0.097
SICU 9.13 16.67 0.00 0.00 40.00
RICU 18.85 23.36 15.62 0.00 71.43
2010-2012 MICU 8.46 19.79 0.00 0.00 83.33 0.645 0.386 0.831 0.446
SICU 14.89 30.85 0.00 0.00 147.06
RICU 24.61 85.05 0.00 0.00 500.00
CRBSI: Catheter-related blood stream infection, SD: Standard deviation
Graph 2: The month wise distribution of catheter-associated urinary tract infection in Medical Intensive Care Unit, Surgical Intensive Care Unit
and Respiratory Intensive Care Unit in (2010-2012)
Graph 3: The month wise distribution of catheter-related blood stream infection in Medical Intensive Care Unit, Surgical Intensive Care Unit and
Respiratory Intensive Care Unit (2010-2012)
post-hoc comparison, there is a significant difference in MICU versus Table 4: Comparison of morbidity (stay >14 days) between
SICU in 2011 P value 0.001 and MICU versus RICU P value 0.003 MICU, SICU and RICU in (2010-2012)
with no significant difference in SICU versus RICU P value 0.355. Year 2011 2012
In 2012 there is significant difference in MICU versus SICU in 2011 MICU SICU RICU MICU SICU RICU
P value 0.033 with no significant difference in MICU versus RICU Mean 1.75 3.36 2.60 1.54 2.72 1.98
P value 0.106 and SICU versus RICU P value 0.259. SD 0.47 2.13 0.66 0.42 1.76 1.10
Median 1.62 2.74 2.51 1.61 2.62 2.17
This Table 5 shows that there is a significant difference in Minimum 1.29 1.86 1.74 0.79 0.00 0.00
mortality in three ICU’s in 2011 P value 0.002 and in 2012 P value Maximum 2.89 9.80 3.67 2.29 5.26 3.16
P 0.001* 0.040*
0.035. On post-hoc comparison, there is a significant difference in
MICU versus SICU 0.001* 0.033*
MICU versus SICU in 2011 P value 0.002 and SICU versus RICU
MICU versus RICU 0.003* 0.106
P value 0.003 with no significant difference in MICU versus SICU versus RICU 0.355 0.259
SICU P value 0.644. In 2012, there was significant difference *Statistically significant at 0.05 significance level. MICU: Medical intensive
in MICU versus SICU in 2011 P value 0.002 and SICU versus care unit, SICU: Surgical intensive care unit, RICU: Respiratory intensive care
unit, SD: Standard deviation
RICU P value 0.003 with no significant difference in MICU
versus SICU P value 0.644.
Table 5: Comparison of mortality (%) between MICU,
This Table 6 shows that there is no significant difference in all SICU and RICU in (2010-2012)
ICU’s in 2011 and 2012, and they all are comparable. Year 2011 2012
MICU SICU RICU MICU SICU RICU
This Table 7 shows there is a significant correlation between
Mean 11.85 16.35 12.38 10.02 13.38 10.32
mortality and HAI P value 0.032 with no significant correlation
SD 2.41 3.31 1.89 3.17 6.75 3.06
between morbidity and HAI P value 0.739 also no significant
correlation in ALOS and HAI P value 0.168. Median 12.12 15.65 12.60 10.88 15.37 9.46
Minimum 7.89 11.11 9.78 4.76 0.00 6.19
DISCUSSION Maximum 15.02 23.44 15.78 13.97 21.67 15.71
P 0.002* 0.035*
We conducted this study in Hospital A with retrospective data
of 2010 and prospective data of 2011 and 2012. The study was MICU versus SICU 0.002* 0.024*
carried out at three ICU’s of Hospital A in North-West Delhi- MICU versus RICU 0.644 0.908
SICU, RICU and MICU. All patients admitted were followed SICU versus RICU 0.003* 0.028*
from admission to 2 days after discharge from the ICU during
*Statistically significant at 0.05 significance level. MICU: Medical intensive
a period of January 2010-December 2011-December-2012. care unit, SICU: Surgical intensive care unit, RICU: Respiratory intensive care
The total sample amounted to 35,582 patient device days- unit, SD: Standard deviation
13051 for 2010 and 11659 for 2011 and 10,872 for 2012. After
starting with the bundle approach in June 2011 and monitoring different ICU’s. Firstly only PPE difference was there among
of Hand Hygiene significant differences were observed in the three ICU’s then continuous training was there from 2011
onwards for bundle approach and hand hygiene monitoring. in different studies that increased length of stay increases
There was a decrease of 2.26 per 1000 device days in HAI in the risk of HAI, but increase in length of stay can be due to
hospital A in 2011 from 2010 and 10.93 per 1000 device days co-morbidities, delays in progression of treatment, delays in
from 2011 to 2012. The rate of HAI decreased to 10.38 per shifting out from ICU’s and if strict compliance is there of
1000 device days with continuous training and monitoring for hand hygiene and VAP bundles that risk of HAI also can be
bundle approach and hand hygiene compliance along with reduced. Hence, further studies are required, to differentiate
protocols followed during invasive procedures from 2010 to and find out the different causes for increased length of stay
2012.Whereas, rate of HAI as per above study in Hinduja compared with HAI along with following infection control
Hospital was 9.06 per 1000 device days[5] and as per the study protocols. The correlation is based upon 2011-2012 data as we
conducted in Brazil by applying the definitions of the US CDC could not get this data retrospectively. This data we could only
and Prevention National Nosocomial Infections Surveillance get from 2011 onwards. This data showed that if proper training
System (CDC-NNIS) it was 29.8 per 1000 device days.[6] The is given and followed significant differences can be made in
rate of VAP decreased in 2012-7.91 (48.02 per 1000 device ICU’s. There was significant difference as per observational
days decrease) from 2010 which was 55.93 per 1000 device data in three ICU’s where different protocols for PPE were
days., CAUTI decreased from 6.33 per 1000 device days to followed. SICU followed strict protocols for shoe covers and
1.43 per 1000 device days (4.9 per 1000 device days decrease), for all invasive procedures strict hand hygiene, mask, cap and
but CRBSI increased from 8.46 per 1000 device days to 21.80
gloves were used in SICU which was also followed in RICU but
per 1000 device days (as it was a prospective data in which we
lapses were in hand hygiene compliance, as per observational
started sending the tip of CVP Catheter culture every time
data of hand hygiene monitoring and observational data
when it was removed and awareness increased). The DAI as
following the aseptic measures during the invasive procedures
per study conducted in Brazil were VAP-20.9 per 1000 device
in different ICU’s after the procedure is done. In MICU it was
days, CAUTI was 9.60 per 1000 device days and CRBSI was
not followed properly with no proper hand hygiene protocols.
9.1 per 1000 device days and as per PD Hinduja Hospital
Continuous training and bundle approach brought significant
Study (INICC approach) VAP was 10.46 per 1000 device
difference. For VAP there was significant difference among
days, CAUTI was 1.41 per 1000 device days and CRBSI was
7.92 per 1000 device days. When compared with the data three ICU’s and on post-hoc it was in MICU and SICU although
of mortality, morbidity (stay >14 days) and ALOS. There is no significant difference in MICU and RICU or RICU and
significant correlation between mortality and HAI with no SICU. Similarly for CAUTI there was significant difference
significant correlation between morbidity and HAI also no among three ICU’s and on post-hoc it was in MICU and SICU
significant correlation in ALOS and HAI. It has been observed although no significant difference in MICU and RICU or RICU
and SICU. For CRBSI there was no significant difference in
Table 6: Comparison of ALOS (days) in MICU, SICU and any of the ICU’s and it was found that all PPE is followed in
RICU in (2010-2012) central line insertion as you have enough time to prepare for this
Year 2011 2012 procedure. Causative organisms for VAP [Table 8 and Graph 4]
MICU SICU RICU MICU SICU RICU were in the order of Acinetobacter spp., Pseudomonas aeruginosa
Mean 3.09 3.26 3.02 2.85 2.64 2.95 and then Klebsiella pneumoniae. Causative organisms for CAUTI
SD 0.41 0.45 0.51 0.27 1.29 0.52 [Table 9 and Graph 5] are candida spp., Escherichia coli and K.
Median 3.00 3.34 2.99 2.92 3.08 3.06 pneumoniae and in cases of CRBSI [Table 10 and Graph 6] the
Minimum 2.38 2.56 2.01 2.38 0.00 1.92 organisms are Acinetobacter, Staphylococcus aureus, K. pneumoniae
Maximum 3.87 3.97 3.88 3.27 3.80 3.61
and P. aeruginosa.
P 0.586 0.558
MICU versus SICU 0.386 0.272
MICU versus RICU 0.840 0.452
SICU versus RICU 0.370 1.000
*Statistically significant at 0.05 significance level. MICU: Medical intensive
care unit, SICU: Surgical intensive care unit, RICU: Respiratory intensive care
unit, SD: Standard deviation, ALOS: Average length of stay
Table 7: Correlation between morbidity, mortality

and ALOS with HAI
Variable Correlation and Morbidity Mortality ALOS
P-value
HAI R −0.040 0.253 0.164
P 0.739 0.032* 0.168
*Statistically significant at 0.05 significance level. HAI: Healthcare-associated
infection, ALOS: Average length of stay Graph 4: Causative organisms for ventilato-associated pneumonia
Table 8: Causative organisms of VAP

Organisms 2010 2011 2012
Acinetobacter spp. 32 24 18
Pseudomonas aeruginosa 29 16 10
Klebsiella pneumoniae 25 16 9
Proteus mirabilis 0 2 2
Staphylococcus aureus 2 2 1
Escherichia coli 7 5 1
Candida spp. 13 12 0
VAP: Ventilato-associated pneumonia
Table 9: Causative organisms of CAUTI

Organisms 2010 2011 2012
Grpah 5: Causative organisms for catheter-associated urinary
tract infection
Candida spp. 13 10 2
CAUTI: Catheter-associated urinary tract infections
Table 10: Causative organisms of CRBSI

Organisms 2010 2011 2012
Grph 6: Causative organisms for catheter-related blood stream infection
Candida spp. 4 1 2
Prevention and evaluation CRBSI: Catheter-related blood stream infection
An effective surveillance system must identify priorities for
preventive interventions and improvement in quality of REFERENCES
care. By providing quality indicators, surveillance enables the 1. Girard R, Perraud M, Pruss A, Savey A, Tikhomirov E, Thuriaux M,
infection control program, in collaboration with patient care et al. In: Ducci G, Fabry J, Nicolle L, editors. Prevention of Hospital —
Acquired Infections — A Practical Guide. 2nd ed. WHO; 2002. p. 47-54.
units, to improve practice, and to define and monitor new
2. Muralidhar V, Muralidhar S. In Introduction to HAI-Hospital Acquired
prevention policies. The final aim of surveillance is to decrease Infections, Power Strategies for Clinical Practice. 1st ed. Anshan Ltd;
nosocomial infections and reduce costs. Audit has to be carried 2006.
3. Wenzel, Richard P, Edmond M, Pittet D, Devaster JM, Brewer T, et al.
out intermittently in a particular manner and this a process of In: a Guide to Infection Control in the Hospital. An Official Publication
detection of deficiencies and correcting and then finally checking of the International Society for Infectious Diseases. BC Decker Inc.;
1998. p. 1-4.
if the changes made have really changed the healthcare delivery
4. Speller DC, Humphrey H. Hospital acquired infection. In: Collier L, Balows
to patients.[7-11] A, Sussman M, editors. Topley & Wilson’s Microbiology and Microbial
Infections. 9th ed., Vol. 3. Arnold Publishers; 1998. p. 187-230.
5. Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N,
Importance of the research work et al. Device-associated nosocomial infection rates in intensive care
This work is important as now awareness among patients is units of seven Indian cities. Findings of the International Nosocomial
Infection Control Consortium (INICC). J Hosp Infect 2007;67:168-74.
increasing and also as per law in some countries the financial 6. Salomao R, Rosenthal VD, Grimberg G, Nouer S, Blecher S, Buchner-
liability of HAI lies with the hospitals itself. As is rightly said Ferreira S, et al. Device-associated infection rates in intensive care units
of Brazilian hospitals: Findings of the International Nosocomial Infection
prevention is better than cure, if we prevent HAI financially Control Consortium. Rev Panam Salud Publica 2008;24:195-202.
the burden is going to be less than when we are already fighting 7. Berwick DM, Enthoven A, Bunker JP Quality management in the NHS:
with the infection. Furthermore, the mortality rate is going to The doctor’s role — I. BMJ 1992;30 4:235-9.
8. Bell D, Layton AJ, Gabbay J. Use of a guideline based questionnaire
be lesser than if we can’t prevent infections as they are positively to audit hospital care of acute asthma. BMJ 1991;302:1440-3.
correlated. 9. Crombie IE, Davies HT, Abraham SC, Florey CdV. Methods of audit.
In: The Audit Handbook. Improving Healthcare through Clinical Audit. How to cite this article: Chawla K, Madan A, Chawla RK, Chawla AK.
Chichester, England: John Wiley & Sons; 1993. p. 101-25.
Healthcare associated infections: A menace-role of management at
10. Shaw CD Aspects of audit 1. The background. Br Med J 1980;280:
a multi-super-specialty hospital in North West Region of Delhi. J Nat
1256-8.
Accred Board Hosp Healthcare Providers 2014;1:44-51.
11. Gulliford MC, Petruckevitch A, Burney PG. Hospital case notes and
medical audit: Evaluation of non-response. BMJ 1991;302:1128-9. Source of Support: Nil, Conflict of Interest: None declared.

Saroj Delhi IFC PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Saroj Delhi IFC PDF

Uploaded by

Copyright:

Available Formats

[Downloaded free from http://www.nabh.ind.in on Friday, April 10, 2015, IP: 182.73.172.

Healthcare associated infections: A menace-

Background: Healthcare-associated infections (HAIs) are usually related to a

Chawla, et al.: Healthcare associated infections

Chawla, et al.: Healthcare associated infections

Table 1: Comparison of VAP between MICU, SICU and RICU respectively

Table 2: Comparison of CAUTI between MICU, SICU and RICU respectively

Chawla, et al.: Healthcare associated infections

Table 3: Comparison of CRBSI between MICU, SICU and RICU respectively

Chawla, et al.: Healthcare associated infections

Chawla, et al.: Healthcare associated infections

Table 7: Correlation between morbidity, mortality

Chawla, et al.: Healthcare associated infections

Table 8: Causative organisms of VAP

Table 9: Causative organisms of CAUTI

Table 10: Causative organisms of CRBSI

Chawla, et al.: Healthcare associated infections

You might also like