Device-associated infections at a level-1 trauma centre of a developing Nation: Impact of automated surveillance, training and feedbacks.
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Date
2015-01
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Abstract
Purpose: Device-associated infections constitute the majority of health care-associated infections (HAIs) in ICUs.
Trauma patients are predisposed to acquire such infections due to various trauma-related factors. The prevalence of
HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the impact of
an intensive surveillance on the rates and outcome of device-associated infections in trauma patients from a developing
country and compares the rates with a previous pilot observation. Materials and Methods: The study was conducted at
a level-1 trauma centre of India. Surveillance for ventilator-associated pneumonia (VAP), central line-associated blood
stream infections (CLA-BSIs) and catheter-associated urinary tract infections (CA-UTIs) was done based on centre for
disease control-National Healthcare Safety Network (CDC-NHSN) defi nitions. The impact of an intensive surveillance,
education and awareness drive on the rates of infections over the study period, and compliance to preventive bundles
and hand hygiene was assessed. Results: A total of 15,462 ventilator days, 12,207 central line days and 17,740 urinary
catheter days were recorded in the study population. The overall rates of VAP, CLA-BSI and CA-UTI were respectively
17, 7.2 and 15.5/1000 device days. There was a signifi cant correlation between device days and the propensity to
develop infections. Infections were the cause of death in 36.6% of fatal trauma cases. A signifi cantly higher rate of
VAP, CLA-BSI and CA-UTIs was noted in fatal cases. The compliance to ventilator bundle, central line bundle, bladder
bundle and hand hygiene were 74.5%, 86%, 79.3% and 64.6%, respectively. A high rate of multi-drug-resistance was
observed in all pathogens. A gross reduction in the rates of all infections was observed over time during the study due
to implementation of a stringent surveillance system, feedbacks and education. The compliance to hand hygiene and
preventive bundles also increased over time. Conclusion: The automated surveillance was easy and useful for data entry
and analysis. Surveillance had a signifi cant impact on reduction of HAIs and mortality in trauma patients.
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Keywords
Catheter-associated urinary tract infections, central line-associated blood stream infections, device-associated infections, ICU, ventilator-associated pneumonia
Citation
Mathur P, Tak V, Gunjiyal J, Nair S A, Lalwani S, Kumar S, Gupta B, Sinha S, Gupta A, Gupta D, Misra M C. Device-associated infections at a level-1 trauma centre of a developing Nation: Impact of automated surveillance, training and feedbacks. Indian Journal of Medical Microbiology. 2015 Jan-Mar ; 33 (1): 51-62.