Shivinder Singh1, Rakhee Goyal2, G S Ramesh3, V Ravishankar4, R M Sharma5, D V Bhargava6, S K Singh7, M K John8, Anoop Sharma8. 1. Senior Adviser (Anaesthesiology & Critical Care), Command Hospital (Western Command), C/O 56 APO, India. 2. Senior Advisor (Anaesthesiology), Command Hospital (Southern Command), Pune 411040, India. 3. Ex-Professor & Head, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India. 4. Commandant, Command Hospital (Southern Command), Pune 411040, India. 5. Associate Professor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India. 6. Clinical Tutor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India. 7. Assistant Professor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India. 8. Resident, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India.
Abstract
BACKGROUND: The service setting has some unique strengths and weaknesses that must be kept in mind when organizing Hospital acquired infections (HAI) prevention interventions. METHODS: Following an initial study to gather data regarding HAI in the Surgical intensive care unit (ICU) we put into place various infection control interventions. The present study was carried out to analyse the effect of these interventions on the incidence of HAI in the ICU. RESULTS: The total admissions to the ICU were 253 patients. Eighty eight patients (34.78%) were admitted for more than 48 hr, 165 patients stayed for less than 48 h. The frequency of HAI was 7.95% (95% CI 3.54, 15). Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%) (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000 ventilator days. Bloodstream infection was detected in 3 out of 88 patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections per 1000 Central Venous Catheter days. Urinary tract infection was observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per 1000 catheter days. As compared to the previous study we found that there was a decline of HAI ranging from 60 to 70%. CONCLUSION: Our study demonstrated that by meticulously following infection control protocols especially tailored to the service setting the incidence of HAI's can be reduced. However, the challenge is in maintaining the gains achieved since there is a rapid turnover of manpower in the ICU and a lack of a structured ICU design model.
BACKGROUND: The service setting has some unique strengths and weaknesses that must be kept in mind when organizing Hospital acquired infections (HAI) prevention interventions. METHODS: Following an initial study to gather data regarding HAI in the Surgical intensive care unit (ICU) we put into place various infection control interventions. The present study was carried out to analyse the effect of these interventions on the incidence of HAI in the ICU. RESULTS: The total admissions to the ICU were 253 patients. Eighty eight patients (34.78%) were admitted for more than 48 hr, 165 patients stayed for less than 48 h. The frequency of HAI was 7.95% (95% CI 3.54, 15). Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%) (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000 ventilator days. Bloodstream infection was detected in 3 out of 88 patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections per 1000 Central Venous Catheter days. Urinary tract infection was observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per 1000 catheter days. As compared to the previous study we found that there was a decline of HAI ranging from 60 to 70%. CONCLUSION: Our study demonstrated that by meticulously following infection control protocols especially tailored to the service setting the incidence of HAI's can be reduced. However, the challenge is in maintaining the gains achieved since there is a rapid turnover of manpower in the ICU and a lack of a structured ICU design model.
Authors: James K Stoller; Douglas K Orens; Cynthia Fatica; Morgan Elliott; Lucy Kester; Jeff Woods; Lori Hoffman-Hogg; Matthew T Karafa; Alejandro C Arroliga Journal: Respir Care Date: 2003-05 Impact factor: 2.258
Authors: S S Carson; C Stocking; T Podsadecki; J Christenson; A Pohlman; S MacRae; J Jordan; H Humphrey; M Siegler; J Hall Journal: JAMA Date: 1996 Jul 24-31 Impact factor: 56.272
Authors: Christopher P Landrigan; Gareth J Parry; Catherine B Bones; Andrew D Hackbarth; Donald A Goldmann; Paul J Sharek Journal: N Engl J Med Date: 2010-11-25 Impact factor: 91.245