Impact of conducting hand hygiene audit in COVID-19 care locations of India-A large scale national multicentric study - HHAC study.

PURPOSE: Hand hygiene (HH), the core element in infection prevention in healthcare, especially for multidrug resistant organism's transmission. The role of HH audits and HH adherence rates in the COVID-19 pandemic, especially in resource limited settings, are yet to be established.
METHODS: A nationwide multicenter study was conducted in India, involving public, private, teaching and non-teaching COVID healthcare facilities (COVID-HCFs) using the IBhar mobile application based on WHO's hand hygiene audit tool. The HH adherence rates (HHAR) such as complete HHAR (HHCAR), total HHAR (HHTAR), profession specific HHAR, WHO's 5 HH moment specific HHAR and associated variables were measured over 6 month duration (June-December 2021).
RESULTS: A total of 2,01,829 HH opportunities were available and the HHCAR and HHTAR were 27.3% and 59.7%. The HHTAR was significantly higher in the west zone (72.2%), private institutes (65.6%), non-teaching institutes (67.7%), nurses (61.6%), HH moments 2 (71.8%) and 3 (72.1%), and morning shift (61.4%). The HHTAR was better in non-COVID HCFs (65.4%) than COVID-HCFs (57.8%) as well as non-COVID ICUs (68.1%) than COVID ICUs (58.7%). The HHTAR was increased from month 1 to month 6 except a small decrease in the month of December.
CONCLUSIONS: The hand hygiene adherence is comparable with adherence rate during COVID-19 pandemic in western countries as well as the resource limited settings. The use of gloves during the pandemic and simplified HH techniques and their influence over the HH adherence to be studied further. The sustainable adherence rate over long duration needs to be ensured by continuing the HH audit using multimodal interventions.

Introduction

Hand hygiene (HH) is a simple, efficient measure to reduce healthcare associated infections (HAIs) in COVID-19 health care facilities (COVID-HCFs), but the HH adherence remains low among the Healthcare workers (HCWs), despite increasing awareness in this pandemic [1, 2, 3, 4, 5, 6, 7, 8]. The low adherence is possibly due to increased work pressure, misconceptions that HH has no role in COVID-HCFs as all are COVID positive; HCWs are protected with personal protective equipment (PPE) and continuous use of gloves are replacement for HH [2,3,9,10].

A pilot study from a South Indian institute, primarily focused on COVID ICUs, highlights that the HH audits with timely feedback to the stakeholders are essential to improve and maintain the HH adherence in a sustainable way [11]. No data on HH compliance in COVID-HCFs, which includes COVID ICUs, non-COVID ICUs, COVID wards and non-COVID wards during the pandemic, is available from any COVID-HCFs in India.

Therefore, a large-scale multicentric study in different COVID-HCFs of India was planned to determine the HH adherence rate, to evaluate the impact of HH audit with regular feedback, to compare HH adherence among various professions, WHO's five HH moments, shifts and institute types and to evaluate the impact of glove use in COVID-HCFs. The study aimed to create a national baseline data of India, which can be used for quality improvement.

Materials and methodology

Study settings

A prospective study was conducted from 92 COVID-HCFs (24 public-teaching; 19 private-teaching; 18 private non-teaching; 4 public non-teaching) across India over 6 months (July–December 2021). All 92 HCFs were selected and included by voluntary participation, by dissemination of study protocol to various institutes all over India. All HCWs from these COVID-HCFs [doctors, nurses, housekeeping staff and other allied staff (OAS)] were audited. The study has ethical approval from the nodal center (JIP/IEC/2021/014 dated May 31, 2021) and all participating centers obtained approval from institute ethics committee (IEC) or concerned authorities of their institutes. The centers with necessary approval were included in the study.

Data collection method and training of auditor

The HH audits were performed electronically using IBHAR mobile application (IBHAR Technologies Pvt Ltd, India), a direct observation method adapted and modified from the WHO's HH audit tool [4]. The auditors (infection control nurses and resident doctors) followed all COVID appropriate guidelines during the HH auditing [3]. They were trained to reduce inter-auditor variation, observational bias, confirmation bias and confounding bias (induction training through virtual mode by the project principal investigator, site training by the site investigators, monthly training through virtual mode by designated investigators) [11].

HH audit parameters

The following information was collected—date and time of audit, profession and gender of the HCWs, available HH opportunities (HH moments), presence of gloves during HH, number of steps and duration of HH. The duration of ≥20 ​min/day and/or until a daily minimum of 20 HH opportunities were recorded. The HH event was marked as ‘completely followed’ when all the 6 WHO steps of HH were performed for the recommended duration (>20 ​s for hand rub and >40sec for hand wash). When ≥1 WHO's HH steps were missed and/or the duration of HH was less than recommended, such HH events were marked as ‘partially followed’ [4, 5, 6].

Interventions implemented

First, onsite advice and corrections by HH auditors were given to the HCWs at the end of every audit to improve the HH practices. Second, a monthly HH audit report was shared to the stakeholders.

Statistical plan and data analysis

The HH complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR i.e., complete ​+ ​partial) were determined as previously described [11]. Profession-specific HHAR, gender-specific HHARs and HH moment-specific HHARs were calculated [2,5,9]. The month-wise trend of HHTAR was used to measure the impact of HH audit [10]. All participating centers were divided into East, North, South and West zones. Further subgroup analysis was carried out to determine the differences in HH practices between public and private sector hospitals, teaching and non-teaching hospitals. Data in excel was generated from the IBHAR cloud site. The dependable parameters were expressed in percentage. Differences and significance between the HH practices were analyzed by test, univariate and multivariate analysis using IBM SPSS Statistics 28.0.

Results

Hand hygiene opportunities and overall compliance

A total of 2,01,829 available HH opportunities over 2,31,076 ​min were captured. Centers from south zone (n ​= ​52/92) captured 1,06,444 opportunities over 1,22,505 ​min [Supplementary Table 1]. The overall HHCAR and HHTAR 27.3% and 59.7% respectively.

Specific compliances

These rates specific to zones, institute type, profession, WHO HH moment, area, sex of HCW, working shift and gloves use are shown in Fig. 1 and Supplementary Table 1. The profession specific compliance rates in respect to institute types are shown in Supplementary Table 2 and in respect to WHO HH moment and study months are shown in Supplementary Table 3.

Fig. 1

HHCAR and HHTAR. HHCAR and HHTAR specific to zones, institute type, profession, WHO five hand hygiene moments, area, sex of HCW, working shift and gloves use.

Zone specific compliance

The HHCAR was 37.5% in the west zone, followed by south (31.2%), north (19.9%) and east (17.9%) zone. The west (72.2%) or south (61.9%) zone had significantly higher HHTAR than east (54.1%) or north zone (51.9%). The west zone had significantly higher HHTAR than other zones (RR-1.75; OR-2.4; p ​< ​0.05) [Supplementary Table 1].

Institute specific compliance

The HHCAR, HHTAR were significantly higher among private than public institutes (32.4% vs 21.9% and 65.6% vs 53.6%; RR-1.2; OR-1.64; p ​< ​0.05 respectively) and significantly higher among non-teaching than teaching institutes (30.1% vs 26.2% and 67.7% vs 56.7%; RR-1.4; OR-1.6; p ​< ​0.05 respectively). The HHTAR was significantly higher among private non-teaching institutes (70.1%; OR-2.120; p ​< ​0.05) and lower among public teaching institutes (52.5%) [Supplementary Table 1].

Profession specific compliance

The HHCAR was 28.3% among nurses followed by doctors (27.1%), housekeeping staff (26.4%) and OAS (24.2%). The HHTAR of nurses was significantly higher (61.6%; OR-1.2; p ​< ​0.05) than other HCWs. There was no difference between the housekeeping and OAS [Supplementary Table 1].

The compliances of various HCWs were similar to zone specific and data [Supplementary Table 2] with few exceptions as follows; HHCAR was significantly higher in public-teaching than public non-teaching institutes among nurses (24.4% vs 19.5%), doctors (23% vs 20.2%) and housekeeping staff (19% vs 16%); HHTAR of doctors from east (60.2%) was higher than south (56.5%); HHCAR of housekeeping staffs was higher in north (17.8%) than east (16.2%); Compliance of OAS was higher in private-teaching (HHCAR-38%, HHTAR-72.3%) than private non-teaching institutes (HHCAR-30.5%, HHTAR-66.9%).

WHO hand hygiene moment specific compliance

The compliance during WHO HH moment 2 (HHCAR-39.6%, HHTAR-71.8%) and 3 (HHCAR-38.7%, HHTAR-72.1%) were significantly higher than other moments (OR-3.09, 3.13 respectively) and moment 5 (HHCAR-18.4%, HHTAR-45.1%) was significantly lower than other moments [Supplementary Table 1].

The HHTAR was higher among doctors during the moment 1 (58.9%) and moment 2 (75.6%) than others; higher among nurses during the moment 3 (73.8%) and moment 4 (69.4%) than others; higher among housekeeping (47.7%) and OAS (47.8%) than others during moment 5. The HHTAR was lower among private non-teaching institutes during moment 3 than private teaching [Supplementary Table 3].

Shift and sex specific compliance

The compliance was higher among HCWs during the morning shift (HHCAR-28.9%, HHTAR- 61.4%) followed by afternoon shift (26.1%, 58.5%) and less during the night shift (22.7%, 55.5%). There was no difference noticed between male and female HCWs [Supplementary Table 1].

Gloves specific compliance

The compliance among the HCWs without gloves had better compliance (HHCAR-30.4%, HHTAR-65.2%) than those with gloves (25.6%, 56.8%) [Supplementary Table 1].

Area specific compliance

The HHTAR was higher (OR-1.37, p ​< ​0.05) in non-COVID care areas (65.4%) than COVID care areas (57.8%); the compliance was significantly higher in non-COVID ICUs (68.1%; OR-2, p ​< ​0.05) followed by COVID ICUs (58.7%), non-COVID wards (58.7%) and COVID wards (51.5%) [Supplementary Table 1].

Hand hygiene compliance trend over 6 months

The compliance increased among various profession and institute types from the onset of study to end of study (Fig. 2 ). The compliance (both HHCAR and HHTAR) was showing an increasing trend from month 1 of the study to month 6 of the study participation as well as from June month to December month. In the month of December overall HHCAR dropped below 20% (Fig. 3 ).

Fig. 2

Percentage increase in HH adherence. The percentage increase in HH adherence from 1st month of study to 6th month of study among various professions and different health care settings.

Fig. 3

Hand Hygiene Adherence (HHCAR and HHTAR) trend. Hand Hygiene Adherence (HHCAR and HHTAR) trend over Month 1 to month 6 of study in which all centers assigned according to their months of participation. The trend over July to December calculated by cross sectional HH data on these month specific data rather than institute specific data. Monthly proportions ​of COVID-19 cases from India were plotted over July to December based on data from WHO over these months.

Discussion

The hand hygiene non-adherence is one of the important contributing factors which accounts for the majority of multidrug-resistant organisms and fungi related outbreaks in various ICUs and wards during COVID-19 pandemic [12]. A total of 2,01,829 available opportunities were audited over 6 month in 92 centers all over India, which was the largest documented audit. A recent systematic review by Clancy et al. showed wide range of available HH opportunities (255-59,122) observed by direct method [13]. The overall national compliances from this study were 27.3% (HHCAR) and 59.7% (HHTAR). The study by Clancy et al. showed a wide range of baseline HH compliance (2%–88%) with mean compliance of 41% [14]. The baseline compliance of lower-middle and lower income countries was 29% [14]. Another systematic review showed the HH compliance from COVID-19 pandemic increased to 74% compared to pre-COVID pandemic studies [15]. The above compliance rates are comparable with our study.

The west (37.5%) and south zones (31.2%) had higher compliances while east (19.9%) and north (17.9%) zones had lower compliances than the overall national compliance. The HHCAR and HHTAR in COVID-19 ICUs of public-teaching institutes from south zone were found to be 30.8% and 65.3% respectively [11]. The complete adherence in resource limited setting using WHO six-step hand rub technique is as poor as 0%–8.5% [16]. In our study, the less HHCAR could be explained by the overall partial adherence rate (32.5%) which was due to either less than recommended duration (<20 ​s) of HH (13.4%) or partial steps (<6 steps) (4.4%) or both (10.58%). The partial adherence was very poor than a study from a north Indian public-teaching institute where the adherence to steps and duration was 52.8% and 53.1% respectively [17].

The overall HHCAR was higher in private institutes than public institutes and non-teaching institutes than teaching institutes. There were no such studies during the COVID-19 pandemic comparing different HCFs in India as for our knowledge. A multicenter study from private non-teaching institutes in Norway, showed HH compliance of 58.3%; the HH decreased from 65.8% to 51.4% with wide variation among different wards (26.4%–83.1%) [18]. A multicenter study from India before COVID-19 pandemic showed higher compliance rate in private hospitals than academic hospitals (74.2% vs. 66.3%) [19]. The less compliance in public sectors could be explained by following factors: more COVID-19 cases admitted in public sector than private sectors, low HCWs to patient ratio, limited resources and alcohol based hand rub supply. The high compliance in non-teaching institutes possibly explained by their primary focus in patient care than academic activities. The private non-teaching had high compliance rate due to better infrastructure, manpower and resources and administrative support [19].

A recent systematic review shows that during the pandemic period, nurses had the highest compliance rate of 80% (95% CI, 74%–87%) and auxiliary HCW had the lowest compliance rate of 70% (95% CI, 62%–77%) [15]. The study from south zone showed profession-specific HHAR was found to be highest among doctors (67.5%) and nurses (66.4%) [11]. Majority of studies showed higher compliance in nurses while very few studies showed higher compliance among doctors. It is difficult to compare profession specific compliance, because of diverse HCFs, different HCWs under observation, especially HCWs other than nurses and doctors i.e. “other group” [14]. The higher compliance among nurses could be explained by relatively higher patient care activities than other HCWs, which leads to formation of habit of better HH practice while poor compliance among the housekeeping staff due to attitude, educational status, perception on HH and learning skill to practice the HH method [14,18].

The after moments HH adherence was better than before moments may be due to the of HCWs that they perform HH to protect themselves than the patients [18]. Constraints inherently associated with moment specific adherence concepts are the workload, multiple interventions in single patient care activity especially in acute care settings, lack of precise activities in those five moments and complexity in steps with hand rub and hand wash techniques with its duration [14,20]. But, often the concept of five moments are overlooked and misunderstood in various setting which hampers the implementation and compliance of HH related with all moments [21]. Proper implementation of the core elements of WHO's improvement strategy such as system change and reminders in workplace/communication will alleviate the issue related with moment specific compliance [21]. Overcrowding with shortage in HCWs in resource limited countries are another factor which influence the concept of patient zone and health care zone in implementation of WHO 5 moments of HH [16].

There was no significant difference observed among different shifts in HH compliance in the Norway study [18]. study showed more adherence during morning shift. The HH compliance was significantly lower when wearing gloves as compared to those with no glove use (41.3% vs 68.2%) during COVID-19 pandemic in Indonesian PICU [22]. The multicenter study from Norway shows lower compliance during gloved hands (35.3% vs 65.3%) [18]. The above studies are comparable with our study. Failure to remove gloves between patients and the use of hand rub over the gloved hands are associated with cross-contamination and outbreaks [12].

During peak in the COVID-19 wave, the compliance was better and over time from June to December the COVID-19 cases were decreasing in India (Fig. 3) and compliance also was decreasing. The study from the south zone showed a significant rise in HHTAR from 26.7% to 68.4% over months [11]. The majority of HCW completed their first dose of COVID vaccine in the initial phase of study and completed their vaccination schedule during the end of study. The decreased HHCAR and increased HHTAR in end of the study possibly explained by the change in of HCWs to adhere with all HH steps and recommended HH duration due to decline in fear over COVID-19 due to declined COVID-19 cases in India as well as vaccination against COVID-19 among the HCWs. The above possibilities were similar with the Norway study [18].

Studies have demonstrated that Group electronic monitoring significantly improve HH adherence rate [23,24]. A trial showing 3 step technique is equally effective in microbial load reduction with improved HH compliance compared to 6 step technique [25]. Our study shows better compliance when including both complete (all steps with recommended duration) and partial compliance (less than recommended steps and duration). There is a need for more such trials on the HH steps which are especially beneficial in improving compliance in developing countries where the high workload and short timespan for patient care influences the HH compliance. Our study has few limitations such as lack of data on device associated infection rate, volume of hand rub used, feedback from HCWs for the low compliance and multi-modal intervention-based evaluation.

Conclusions

The HHCAR was poor among all zones of India, irrespective of type of facility (private, public, teaching, non-teaching), type of HCWs (20–40% considered as poor), gender, shifts and COVID care vs non-COVID care areas. The hand hygiene adherence is poor when considering the complete steps and duration recommended by WHO but it is good when considering the partial adherence rate. The use of gloves during the pandemic and its influence over the HH adherence to be studied further. The HH adherence is increasing over time when continuous feedback is available but the sustainable adherence rate over long duration needs to be ensured by continuing the HH audit using multimodal interventions.

Credit author statement

Sivanantham Krishnamoorthi: Methodology, Data curation, Formal analysis, Investigation, Writing - original draft; Ketan Priyadarshi: Methodology, Data curation, Investigation; Writing - reviewing; Deepashree Rajshekar: Methodology, Data curation, Investigation; Writing - reviewing; Raja Sundaramurthy: Methodology, Data curation, Investigation; Writing - reviewing; Sarumathi Dhandapani: Methodology, Data curation, Investigation; Writing - reviewing; Haritha Madigubba: Methodology, Data curation, Investigation, Methodology; Apurba Sankar Sastry: Conceptualization, Methodology, Data curation, Formal analysis, Investigation, Supervision, Validation, Writing - reviewing and editing; HHAC study Group: Data curation, Investigation, Validation, Writing – reviewing.

HHAC Study Group

Dr Apurba Sankar Sastry, Additional Professor of Microbiology and Officer in-charge, HICC, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry

Dr Ketan Priyadarshi, Senior Resident & Fellowship in HIC, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry

Dr Deepashree R, Assistant Professor, Department of Microbiology and Assistant Surveillance Officer, HIC, JSS Medical College, Mysore

Dr Chetak K B, Assistant Professor, Department of Paediatrics and Surveillance Officer, HIC, JSS Medical College, Mysore

Dr Sonali Shinde, Consultant Microbiologist, Jupiter Lifeline Hospitals, Pune

Dr Raksha K, Head of Department, Consultant Microbiologist and Infection Control Officer, St. Martha's Hospital, Bangalore

Dr Archana Nagarajan, Associate Consultant & Infection Control Officer, MGM Healthcare, Chennai

Dr Manisha Subrao Mane, Professor & Head, Dept of Microbiology, ESIC Medical College and PGIMSR, KK Nagar, Chennai

Dr PremLatha P, Senior Resident, Dept of Microbiology, ESIC Medical College and PGIMSR, KK Nagar, Chennai

Dr Sarumathi D, Senior Resident, Dept of Microbiology, ESIC Medical College and PGIMSR, KK Nagar, Chennai

Dr Arcy Billoria, Consultant Microbiologist and Infection Control Officer, Lotus Hospitals, Hyderabad

Dr Tessa Antony, Assistant Professor of Microbiology and Infection Control officer Sri Ramachandra Hospital, Sri Ramachandra Institute of Higher Education and Research

Dr M.K. Renuka, Professor & HOD of Critical Care Medicine, Sri Ramachandra Institute of Higher Education and Research

Dr K. Sneha Jigisha, Assistant Professor of Microbiology and Infection Control Officer, Telangana Institute of Medical Sciences and Research, Hyderabad

Dr Abhilasha Korani, Assistant Professor of Microbiology and Infection Control Officer, Telangana Institute of Medical Sciences and Research, Hyderabad

Dr Abiroo Jan, Assistant professor of microbiology, Government Medical College, Anantnag

Dr Roopika Berry, Consultant Microbiology and Secretary HICC, Narayana Multispeciality Hospital, Ahmedabad

Dr Deepti Chaurasia, Professor and head of Microbiology, Gandhi Medical College, Bhopal

Dr Simmi Dubey, Professor and Head Medicine, Gandhi Medical College, Bhopal

Dr Lokendra Dave, Professor Pulmonary Medicine, earlier Suprintendent Hamidia hospital, Gandhi Medical College, Bhopal

Dr Archa Sharma, Assistant Professor Microbiology, Gandhi Medical College, Bhopal

Dr Jaya Lalwani, Associate Professor and OIC, HICC, Gandhi Medical College, Bhopal

Dr Shahzad Mirza, Associate Professor of Microbiology and Hospital Infection Control Officer, DR D Y Patil Medical College Hospital And Research Centre, Pune

Dr Amber Prasad, Assistant Professor and Hospital Infection Control Officer, All India Institute of Medical Sciences (AIIMS), Rishikesh

Dr Pratima Gupta, Professor of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh

Dr Prasan Kumar Panda, Associate Professor of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh

Dr Smita Sinha, Associate Professor, All India Institute of Medical Sciences (AIIMS), Rishikesh

Dr Biswajeet Sahoo, Assistant Professor of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh

Dr Vanya Singh, Senior Resident, All India Institute of Medical Sciences (AIIMS), Rishikesh

Dr Suneeta Sahu, Senior Consultant, and HOD Clinical Microbiology and Immunoserology, Chairperson HICC, Apollo Hospitals, Bhubaneswar

Dr Rani Sahu, Associate Consultant Clinical Microbiology and Immunoserology, Apollo Hospitals, Bhubaneswar

Dr Shyamala R, Associate Professor, Infection Control Officer, Quality Assurance Nodal Officer, Kodagu Institute of Medical Sciences, Madikeri

Dr Rangineni Jayaprada, Associate Professor of Microbiology, HICC Incharge, Department of Microbiology, Sri Venkateswara Institute of Medical Sciences, Tirupathi

Dr N.Ramakrishna, Assistant Professor, Department of Microbiology, Sri Venkateswara Institute of Medical Sciences, Tirupathi

Dr Mamta bhatt, Consultant Microbiologist, Utkal Institute of Medical Sciences, Bhubaneswar

Dr Mini P N, Additional Professor of Microbiology and HICC Officeri, Government Medical College, Kozhikode

Dr Fairoz CP, Assistant professor, Government Medical College, Kozhikode

Dr Vishnu k, Assistant Professor, Government Medical College, Kozhikode

Dr Asfia Sultan, Assistant Professor, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University (AMU), Aligarh

Dr Fatima Khan, Associate Professor, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University (AMU), Aligarh

Dr Atanu Chakravarty, Associate Professor of Microbiology and Secretary, HICC, Jorhat Medical College and Hospital, Jorhat

Dr Rajib Hazarika, Professor and Head of Anesthesiology, Jorhat Medical College and Hospital, Jorhat

Binita Bhuyan, Demonstrator of Microbiology and Infection Control Officer, HICC, Jorhat Medical College and Hospital, Jorhat

Dr K V Leela, Head of Department and Hospital Infection Control Officer, SRM Medical College Hospital and Research Centre, Chennai

Dr Anusha Gopinathan, Associate Professor, Department Of Microbiology, SRM Medical College Hospital and Research Centre, Chennai

Dr Lavanya Sriramajayam, Assistant Professor of Microbiology and Secretary, Infection control Officer - HICC, PSG Institute of Medical Sciences and Research, Coimbatore

Dr M. Mohamadiya Rizwana, Assistant Professor of Microbiology, PSG Institute of Medical Sciences and Research, Coimbatore

Dr Rupali Ashok Akude, Senior Specialist & Hospital Infection Control Officer, ESIC Medical College & Hospital, Hyderabad

Dr Mahamad Wajid, Associate professor, Department of Microbiology ESIC Medical College Sanath nagar Hyderabad, ESIC Medical College & Hospital, Hyderabad

Dr Shazia Naaz, Assistant Professor of Microbiology, ESIC Medical College & Hospital, Hyderabad

Deepthi Karumanchi, Infection control officer and microbiology, Krishna Institute of Medical Sciences Limited, Hyderabad

Dr Avula Renuka Devi, Professor Nodal officer IPC & HICC, Kurnool Medical College, Kurnool

Dr Kammineni Chakrapani, Assistant professor Incharge HICC, IPC, Kurnool Medical College, Kurnool

Poonam Gupta, Consultant and Head Microbiology and Officer in-charge, HICC, Reliance Hospital, Navi Mumbai

Bharat Jagiasi, Director, Critical Care, Reliance Hospital, Navi Mumbai

Dr Jaya Banerjee, Consultant Microbiologist and Infection Control Officer, Yashoda Hospital, Secunderabad

Dr Anuradha Gopalkrishna Tolpadi, Professor of Microbiology and Incharge Infection Control, Bharati vidyapeeth( Deemed to be University) Medical college Hospital & Research centre, Pune

Dr Abhijeet Kantilal Mane, Associate Professor of Microbiology and Coordinator - Infection Control Department, Bharati vidyapeeth( Deemed to be University) Medical college Hospital & Research centre, Pune

Dr Haritha Madigubba, Consultant Microbiologist and Infection Control Officer, Yashoda Hospital, Malakpet, Hyderabad

Dr Raja Sundaramurthy, Assistant Professor of Microbiology, All India Institute of Medical Sciences (AIIMS), Bibinagar Hyderabad

Dr Lakshmi Jyothi Tadi, Additional Professor of Microbiology, All India Institute of Medical Sciences (AIIMS), Bibinagar Hyderabad

Dr Rahul Narang, Professor and Head of Microbiology, All India Institute of Medical Sciences (AIIMS), Bibinagar Hyderabad

Dr Sunil Kumar D Chavan, Assistant Professor of Microbiology, All India Institute of Medical Sciences (AIIMS), Bibinagar Hyderabad

Dr. Ujjwala Nitin Gaikwad, Additional Professor of Microbiology and Infection Control Officer, All India Institute of Medical Sciences (AIIMS), Raipur

Dr Sivanantham Krishnamoorthi, Assistant Professor, Department of Microbiology and Officer in-charge, Infection Control, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab

Dr Moonis Mirza, Assistant Professor, Department of Hospital Administration and Member, HICC, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab

Dr Manisha Khandait, Professor and Head Department of Microbiology, Shree Guru Gobind Singh Tricentary Medical College, Hospital and Research Institute, Budhera, Gurgaon, Haryana

Dr Mukesh Sharma-, In charge HICC, Shree Guru Gobind Singh Tricentary Medical College, Hospital and Research Institute, Budhera, Gurgaon, Haryana

Dr Kavya P, Head of the department of Microbiology and Officer in-charge,HICC, Daya General Hospital and speciality surgical centre, Thrissur

Dr Aboobacker Siddiq, Physician (Internal Medicine), Daya General Hospital and speciality surgical centre,Thrissur

Dr Penmetcha Uma, Professor And HOD of Microbiology and ICO, HICC, NRI Medical College & GH, Chinakakani, Guntur

Dr Padmaja Yarlagadda, Professor of Microbiology, NRI Medical College & GH, Chinakakani, Guntur

Dr Prudhivi Sumana, Professor of Microbiology, NRI Medical College & GH, Chinakakani, Guntur

Dr Naseema Shaik, Assistant Professor, NRI Medical College & GH, Chinakakani, Guntur

Dr Sheela Devi Chandrakesan, Professor of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry

Dr Sujitha Elan Seralathan, Associate Professor, Pondicherry Institute of Medical Sciences, Puducherry

Dr Arthi E, Associate Professor, Pondicherry Institute of Medical Sciences, Puducherry

Vidya J, Assistant Professor- College of Nursing and Infection Control Nurse, Pondicherry Institute of Medical Sciences, Puducherry

Dr Divya Suguna Jayakar, Associate professor of Microbiology, PK DAS Institute of Medical Sciences, Ottapalam

Dr Balaram Padala, Associate professor of Anaesthesia, PK DAS Institute of Medical Sciences, Ottapalam

Dr Rajive Kumar Sureka, Professor & HOD of Microbiology, Mediciti Institute of Medical Sciences, Medchal, Hyderabad

Dr Kiranmai Sannithi, Associate Professor of Microbiology, Mediciti Institute of Medical Sciences, Medchal, Hyderabad

Dr T. Ashita Singh, Assistant Professor of Microbiology, Mediciti Institute of Medical Sciences, Medchal, Hyderabad

Dr Pragathi Kottapalli, Consultant Microbiologist and Infection Control Officer, Asian Institute of Gastroenterology AIG, Gachibowli, Hyderabad

Dr. Ashit Bhusan Xess, Consultant Microbiologist, Ispat General Hospital, Rourkela

Dr Rajeev Kumar Seth, Consultant Microbiologist, Ispat General Hospital, Rourkela

Dr Rajya Bardhan Pattanaik, Additional Chief Medical Officer, Ispat General Hospital, Rourkela

Dr Narayan Prasad Sahoo, Chief Medical Officer, Ispat General Hospital, Rourkela

Dr Bijayini Behera, Additional Professor, Department Of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar

Dr Ashoka Mahapatra, Additional Professor, Department Of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar

Dr Varsha Gupta, Professor, Microbiology and Incharge HICC, Government Medical College and Hospital sector -32. Chandigarh

Dr Preeti Chaudhary, Assistant Professor Microbiology, Government Medical College and Hospital sector -32. Chandigarh

Dr J Gerard Rakesh, Associate Professor, Sri Venkateswaraa Medical College Hospital and Research Centre, Pondicherry

Dr J Margaret Theresa, Assistant Professor of Pathology, Sri Venkateswaraa Medical College Hospital and Research Centre, Pondicherry

Dr Kala Yadav M L, Professor and HOD Microbiology and Member secretary HICC, Bowring lady Curzon Medical College and Research Institute, Bangalore, Karnataka

Dr Chetana G S, Assistant Professor and Infection control officer, Bowring lady Curzon Medical College and Research Institute, Bangalore, Karnataka

Dr. Ashok Kumar Sharma, Associate Professor & HOD, Microbiology, Rajendra Institute of Medical Sciences, Ranchi

Dr. Kumari Seema, Assistant Professor, Rajendra Institute of Medical Sciences, Ranchi

Dr. Manju Boipai, Assistant Professor of Microbiology, Rajendra Institute of Medical Sciences, Ranchi

Dr. Abhay Kumar, Assistant Professor of Microbiology, Rajendra Institute of Medical Sciences, Ranchi

Dr. Rajendra Bhanudas Surpam, Professor and Head of Microbiology, Government Medical College, Chandrapur

Dr. Virendra Kolhe, Assistant Professor of Microbiology and In-charge HICC, Government Medical College, Chandrapur

Dr Abiramasundari V K, Assistant Professor of Microbiology and Infection Control Officer, HICC, Saveetha Medical College and Hospital, Chennai

Dr Tuhina Banerjee, Professor, Department of Microbiology and Infection Control Officer, HICC, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi

Dr Neha Rathor, SENIOR CONSULTANT(MICROBIOLOGY) AND INFECTION CONSULTANT MICROBIOLOGY, QRG Health City, Faridabad

Dr Yamini Verma, Senior Consultant, QRG Health City, Faridabad

Dr Vinitha Mary Joy, Senior Resident, Amala Institute of Medical Sciences, Thrissur

Dr Subi Das, Associate Professor, Amala Institute of Medical Sciences, Thrissur

Dr Mohammed Khaleel, Professor, Microbiology, Deccan College of Medical Sciences, Hyderabad

Dr Shashikala Shivaprakasha, Consultant Microbiology, Seven Hills Hospital- Reliance Covid beds, Mumbai

Swapna Pawar, Infection Control Manager, Seven Hills Hospital- Reliance Covid beds, Mumbai

Dr Nipa Singh, Associate Professor of Microbiology and Infection Control Officer, Kalinga Institute of Medical Sciences, Bhubaneswar

Dr Subhra Snigdha Panda, Associate Professor, Kalinga Institute of Medical Sciences, Bhubaneswar

Dr Nirav Pandya, Consultant Microbiologist & Chairperson - HICC, Bhailal Amin General Hospital, Vadodara

Dr. Swathi. CM, Associate professor, Microbiology, ICO, Mallareddy Narayana Multispeciality Hospital, Hyderabad

Dr. Gunturu Sowjanya, Assistant professor, ICO, Mallareddy Narayana Multispeciality Hospital, Hyderabad

Dr P.Swathi Prakasham, Consultant Microbiologist and Infection control officer, Yashoda hospital Somajiguda, Hyderabad

Dr Geetarani Purohit, Associate Consultant Microbiology and Infection Control Officer, Vikash Multi-Speciality Hospital, Bargarh

Dr Uday Hembram, Associate Consultant Microbiology, Vikash Multi-Speciality Hospital, Bargarh

Dr Tupili Ramya, Assistant professor of microbiology, Government Medical College, Nizamabad

Dr Kasawar Darahasa, Assistant professor, Government Medical College, Nizamabad

Dr Syeda Amtul Moqueeth, Professor, Government Medical College, Nizamabad

Shiva Kumar, Postgraduate, Government Medical College, Nizamabad

Spandana.T, Postgraduate, Government Medical College, Nizamabad

Dr Namita Srivastava, Assistant professor and Microbiology, Maharani Laxmi bai Medical College, Jhansi

Singh Neeraj, Pathologist, Maharani Laxmi bai Medical College, Jhansi

Dr Anshul Jain, Professor of anaesthesia and nodal officer covid, Maharani Laxmi bai Medical College, Jhansi

Dr Mandavi Agarwal, Associate professor of medicine, Maharani Laxmi bai Medical College, Jhansi

Dr. A. Mohan Kumar, Assistant Professor of Microbiology and ICO, HICC, All India Institute of Medical Sciences (AIIMS), Mangalagiri

Dr. V. Mangayarkarasi, Additional Professor of Microbiology, All India Institute of Medical Sciences (AIIMS), Mangalagiri

Dr. Rakesh Kakkar, Professor of CFM, All India Institute of Medical Sciences (AIIMS), Mangalagiri

Dr. Vamshidhar Chamala, Assistant Professor of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Mangalagiri

Dr Urvi Kamat, Consultant Microbiologist and Infection Control Team Member, South Goa district hospital

Dr Prajay N, Consultant Microbiologist, South Goa district hospital

Dr Reena Sachan, Assistant Professor of Microbiology, Moti Lal Nehru Medical College Prayagraj

Dr Abhishek Singh, Assistant Professor of Pulmonary Medicine, Moti Lal Nehru Medical College Prayagraj

Dr Smriti Singh, Associate Professor of Medicine, Moti Lal Nehru Medical College Prayagraj

Dr Sarika Prabhakar Kombade, Associate Professor of microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur

Dr Vibhor Tak, Associate Professor of microbiology and infection control officer, All India Institute of Medical Sciences (AIIMS), Jodhpur

Dr Naveen Dutt, Additional professor and head of pulmonary medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur

Dr Pradeep Kumar Bhatia, Professor snd, department of Anasthesiology and critical medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur

Dr Naresh Midha, Assistant professor of department of general medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur

Dr Ashok Kumar, Additional professor college of nursing and CNO, All India Institute of Medical Sciences (AIIMS), Jodhpur

Dr Himanshu, Associate professor college of nursing, All India Institute of Medical Sciences (AIIMS), Jodhpur

Dr Sweta shah, Consultant, microbiologist and infection prevention, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai

Dr Pooja Suresh Thakkar, Consultant Microbiology, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai

Havovi Fouzdar, General Manager - Nursing, HIPC member, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai

Sapna Malik, Professor of Microbiology, K.J. Somaiya Hospital & Research Center, Mumbai

Vidya Shetty, Associate Professor of Microbiology, K.J. Somaiya Hospital & Research Center, Mumbai

Dr Shelley Sharma Ganguly, Consultant Microbiologist and in-charge HICC, K.J. Somaiya Hospital & Research Center, Mumbai

Dr Sathyajith Ramvihar, Head, Laboratory Services & Infection Control, KIMS Alshifa Super Speciality Hospital, Perinthalmanna

Dr Shreshtha Tiwari, Consultant Microbiologist & Infection Control Officer, Balco Medical Centre, Raipur

Manisa Sahu, Head Lab Services & HICC, Balco Medical Centre, Raipur

Dr Bhaskar Narayan Chaudhuri, Chief Microbiologist and Senior Consultant, Dept. of Microbiology and Molecular Biology, and Infection Control Officer, Peerless Hospitex Hospital and Research Center Ltd., Kolkata

Dr Partha Guchhait, Associate Consultant, Dept. of Microbiology and Molecular Biology, Peerless Hospitex Hospital and Research Center Ltd., Kolkata

Santa Mukherjee, Deputy Nursing Superintendent, Peerless Hospitex Hospital and Research Center Ltd., Kolkata

Dr M.S.Ratnamani, Head and Senior Consultant Microbiologist, Infection Control Officer, Apollo Hospitals, Jubilee hills, Hyderabad

Dr J. Prathiba, Consultant Microbiologist, Member IPCC, Apollo Hospitals, Jubilee hills, Hyderabad

Dr Sneha Chunchanur, Assistant Professor and Infection control officer, HICC, Bangalore Medical College and Research Institute (Victoria Hospital) Bengaluru

Dr Shwetha J V, Assistant Professor and Infection control officer, HICC, Bangalore Medical College and Research Institute (Victoria Hospital) Bengaluru

Sneha K Chunchanur, Professor and HOD of Microbiology, Member Secretary, HICC, Bangalore Medical College and Research Institute (Victoria Hospital) Bengaluru

Dr Pravin Kumar Nair, Consultant Infection control, Bethany Hospital,Thane, Maharashtra

Dr Ranjeeta Adhikary, Consultant Microbiogist and Infection Control Officer, Manipal Hospital, HAL airport road, Bangalore

Dr Sunil Karanth, Consultant Intensivist Critical Care Medicine, Manipal Hospital, HAL airport road, Bangalore

Dr Venkatesha Gupta K V, Consultant Critical Care Medicine, Manipal Hospital, HAL airport road, Bangalore

Dr Akshith Thimmaiah, Head of laboratory services and Head of HIC, Dr. Mehta's Hospitals, Chennai

Dr Ravi Shankar Reddy Anukolu, Professor, Member Secretary, HICC, Kamineni Academy of Medical Sciences & Research Centre

Dr Ruturaj M Kolhapuri, Associate Professor, Infection Control Officer, HICC, Kamineni Academy of Medical Sciences & Research Centre

Dr Naveena Jagadeesan, Professor of Microbiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore

Dr Kavitha Karur, Assistant Professor, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore

Dr Nandini Puttamasthi Gowda, Assistant Professor, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore

Dr Vithiya Ganesan, Associate Professor of Microbiology and Officer in-charge, HICC, Velammal Medical College Hospital and Research Institute, Madurai

Dr Jhansi Charles, Professor and Head of Microbiology, Chairperson Hospital Infection Control Committee, Velammal Medical College Hospital and Research Institute, Madurai

Dr Krithika Varshini, Postgraduate of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai

Dr Shaily Krishnan, Postgraduate of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai

Dr. Kalyani.M, Professor and Head, Panimalar Medical College Hospital and Research Institute, Varadharajapuram, Poonamallee, Chennai 600123

Dr. Jayanthi.S, Professor, Panimalar Medical College Hospital and Research Institute, Varadharajapuram, Poonamallee, Chennai 600123

Dr. Shifa Meharaj S H, Associate Professor, Panimalar Medical College Hospital and Research Institute, Varadharajapuram, Poonamallee, Chennai 600123

Dr Ekta Agrawal, Associate Consultant, Dept of Microbiology and Infection Control Officer, Apollo Hospital Bilaspur

Dr Manoj Rai, Senior Consultant, Dept. of Internal Medicine, Apollo Hospital Bilaspur

Dr Chithra Valsan, Professor & HOD of Microbiology and Officer in Charge, HICC, Jubilee Mission Medical College&RI, Thrissur

Dr Ardra M, Associate Professor of Microbiology, Jubilee Mission Medical College&RI, Thrissur

Dr Champa Hemachandra, Professor and HOD, Department of Microbiology, Infection Control Officer, DM Wayanad Institute of Medical Sciences, Meppadi

Dr Cherlopalli Sunil Kumar, ENT Head and Neck Consultant, DM Wayanad Institute of Medical Sciences, Meppadi

Dr Lakshmikanth BM, Professor and HOD of Anatomy, DM Wayanad Institute of Medical Sciences, Meppadi

Dr Aruna Poojary, Professor and HOD Microbiology, Breach Candy Hospital, Mumbai

Dr Priyanka Patil, Senior Infection Control Officer, Breach Candy Hospital, Mumbai

Dr. Archana G.J, Post Graduate -Hospital Adminstration, Gandhi Medical College and Hospital, Hyderabad

Dr. Navneetha Ch, Associate Professor Of MiCROBIOLOGY, Gandhi Medical College and Hospital, Hyderabad

Dr.K. Raja Rao, Superintendent, Gandhi Hospital, General Medicine, Gandhi Medical College and Hospital, Hyderabad

Dr. Rajeshwar Rao, Professor and HOD, Department of Microbiology, Gandhi Medical College and Hospital, Hyderabad

Dr.K. Nagamani, Professor, Microbiology, Gandhi Medical College and Hospital, Hyderabad

Dr T Mangaiyarkarasi, Professor of Microbiology and Infection Control Officer, HICC, Sri Manakula Vinayagar Medical College and Hospital, Puducherry

Dr S. Sunil Shivekar, Associate Professor of Microbiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry

Dr.K. Deepika, Assistant professor of Microbiology, KMCH IHSR, KMCH Institute of Health Sciences and Research, Coimbatore

Dr.J. Jayalakshmi, Professor and Head of Microbiology, KMCH IHSR, KMCH Institute of Health Sciences and Research, Coimbatore

Dr. Selvarajan N, ICU incharge, Critical care consultant, KMCH Institute of Health Sciences and Research, Coimbatore

Dr Avantika Shukla, Consultant Microbiologist, Thunga Hospital, Mumbai

Dr HB Veena Kumari, Professor Microbiology, NIMHANS (National Institute of Mental Health and NeuroSciences, Bengaluru

Dr Nagarathna S, Professor, NIMHANS (National Institute of Mental Health and NeuroSciences, Bengaluru

Dr Jayasree Shivadasan, Consultant Microbiology, Apollo Hospital, Bannerghatta Road, Bangalore

Dr. Chandana Devaraj, Registrar, Apollo Hospital, Bannerghatta Road, Bangalore

Dr Subha S, Consultant Microbiologist and Infection Control Officer, Dr Rela institute and medical Centre, Chennai

Dr Vidhyalakshmi PR, Consultant ID Physician, Dr Rela institute and medical Centre, Chennai

Dr Jyoti S Kabbin, Professor Of Microbiology, Bangalore Medical college and research institute (Super speciality Hospital PMSSY)

Dr. Amrita Gupta, Consultant Microbiologist, Metro Heart Institute with Multispecility, Faridabad

Funding

None.

Declaration of competing interest

None.