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 ORIGINAL ARTICLE
Year : 2015  |  Volume : 33  |  Issue : 1  |  Page : 51-62

Device-associated infections at a level-1 trauma centre of a developing Nation: Impact of automated surveillance, training and feedbacks


1 Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India
2 Department of Hospital Infection Control, JPNA Trauma Centre, AIIMS, New Delhi, India
3 Department of Forensic Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India
4 Department of Surgery, JPNA Trauma Centre, AIIMS, New Delhi, India
5 Department of Anaesthesiology, JPNA Trauma Centre, AIIMS, New Delhi, India
6 Department of Neurosurgery , JPNA Trauma Centre, AIIMS, New Delhi, India
7 Department of Surgery; Department of Surgical Disciplines, JPNA Trauma Centre, AIIMS, New Delhi, India

Correspondence Address:
P Mathur
Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi
India
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Source of Support: This study was funded by a grant from the Indian Council of Medical Research. We acknowledge the financial suppor t of ICMR for the performance of this study, Conflict of Interest: None


DOI: 10.4103/0255-0857.148378

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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) definitions. 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 significant correlation between device days and the propensity to develop infections. Infections were the cause of death in 36.6% of fatal trauma cases. A significantly 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 significant impact on reduction of HAIs and mortality in trauma patients.






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