428 Hospital-Associated Infections (HAI) in Children a Resource Limited Setting

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Vikas Manchanda, MBBS, MD , Chacha Nehru Bal Chikitsalaya, Delhi, India
Meenakshi Aggarwal, MBBS, MD , Chacha Nehru Bal Chikitsalaya, Delhi, India
Bornali Saikia, BSc, Nursing , Chacha Nehru Bal Chikitsalaya, Delhi, India
Background: Limited studies are available to assess the burden of disease due to HAI in resource-limited settings.  Surveillance of hospital infections is the most integral part of the health care delivery system. Lack of hospital information system & electronic health records is a major impediment for surveillance of such infections in most developing countries. Morbidity & mortality can be minimised using an effective hospital infection control program (HICP).
Objective: To establish an effective HICP in a resource limited setting [Lacking Hospital Information System (HIS) and Laboratory Information System(LIS)]
Methods: Setting : A 215 bedded paediatric tertiary care centre.  Tools : i) Laboratory tools : Database of WHONET software available free of cost at WHO website    ii) HICP Tools : Identification of infection control nurse (ICN) for the program, microbiologist as infection control officer (ICO) &paper forms as per format described by NHSN  with adaptation of latest  HAI guidelines (customised to current healthcare setting)  Surveillance methods:  (i) Passive Surveillance : i) Laboratory based surveillance for alert organisms in which each positive sample is traced back to inpatient unit by ICN ii) In-patient unit  based surveillance wherein the staff notifies ICN about the occurrence of an alert condition on a prescribed format. (ii) Active Surveillance: i) Microbiology laboratory reports information about suspected HAI to the ICN for further evaluation. ii) High-risk areas of the hospital e.g. ICU, Operation theatre, transfusion unit, food handlers, drinking water sources & Centralised Sterilisation Services Department (CSSD) are periodically tested for bacteria flora. Data collected from all sources was analysed on daily & monthly basis. Policies were reviewed on monthly basis initially & new tools were added as per need of the program (e.g. WHO, Hand hygiene monitoring tool) HIC Indicators: Device-associated infections (VAP, CRBSI, CAUTI rates), SSI Rate & Device utilization ratios etc. were assessed.
Results: At our pediatric healthcare facility VAP & SSI were the most common HAI followed by BSI.   The organisms commonly involved in VAP included A. baumanii complex (39%) followed by K. pneumoniae (18%). Interventions like emphasis of hand hygiene, regular training of hospital staff & introduction of device care policies helped minimising HAI (p>.05) (table). Hand hygiene compliance improved from 40% to 94% in critical care units.
HAI Rate
 May 2008
Oct 2009
VAP Rate
(per 1000 ventilator days)
Healthcare associated BSI
(per 1000 patient days)
SSI Rate
(per 1000 surgical procedures)
Conclusions: In a resource limited setting we are able to measure burden of HAI in hospitalized children and implementation of interventions were able to reduce the rates of HAI.  Commitment from administration and hospital staff can bring success to a HICP despite technological and financial constraints.