Priyanka Patil
Breach Candy Hospital Trust, India
Title: Prevention of Health Care Associated Infections (HAIs) - 10 year study from a tertiary care hospital in Mumbai
Biography
Biography: Priyanka Patil
Abstract
Background:
Healthcare associated infections (HAI) are among the major complications of modern medical treatment. The most important HAIs related to invasive devices are central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP) as well as related to invasive procedure which is called surgical site infections (SSI). These are associated with significant morbidity, mortality and healthcare costs. This is a prospective study of the outcomes of introducing preventive strategies at different time intervals based on our surveillance and audits observations over a 10 year period to prevent infectious complications associated with invasive devices & procedures in our hospital.
Objective:
To identify Healthcare associated infections due to invasive devices & procedures. Analyse microbiological aetiology causing these HAIs. To implement Infection Control Guidelines and to assess its impact on preventing infectious complications associated with invasive devices & & procedures.
Methodology: This study was conducted from January 2012 to December 2021. We formulated an Infection Control Policy based on current standards with annual review to include protocols for care of invasive devices & procedures. Surveillance & annual audit plan was prepared to determine compliance to existing protocol. Regular and new joinee training was an integral part of this program. Prospective observational surveillance & audit data was captured by the Infection Control Team based on international recommendations. Laboratory diagnosis & calculation of HAIs rate was as per National Healthcare Safety Network (NHSN) USA surveillance system. Interventions were introduced after analysing the HAIs.
Results:
Over a period of 10 years, 466 device associated & procedure associated infections (DAIs) were identified among 400 patients with mortality 17% (77/466). With the interventions made over the last 10 years, the incidence of catheter related blood stream infection (CRBSI) was reduced from 3.7/1000 device days to 3.2/1000 device days, incidence of catheter associated urinary tract infections (CAUTI) was reduced from 1.4/1000 device days to 0.3/1000 device days whereas incidence of ventilator associated pneumonia (VAP) reduced from 3.4/1000 device days to 0.4 /1000 device days. Surgical site infections have increased from 0.33% to 0.58% which is within benchmark.
Discussion:
Amongst HAIs SSI was most common HAI identified followed by CLABSI, CAUTI and VAP. However the mortality was highest with VAP (50%) followed by CLABSI (28%), SSI (9%) & CAUTI (5%). Klebsiella pneumoniae was the most common pathogen responsible for HAIs followed by Fungi.