835 Prevalence and Spectrum of Healthcare-associated Infections (HAI) in Critical Care Units of a Pediatric Tertiary Care Hospital in India

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Vikas Manchanda, MBBS, MD , Chacha Nehru Bal Chikitsalaya, Delhi, India
Bornali Saikia, BSc, Nursing , Chacha Nehru Bal Chikitsalaya, Delhi, India
Meenakshi Aggarwal, MBBS, MD , Chacha Nehru Bal Chikitsalaya, Delhi, India
Rajan Chopra, MBBS, MD , Chacha Nehru Bal Chikitsalaya, Delhi, India
Background: Data on healthcare associated infections (HAI) is imperative to design and monitor hospital infection control program in India.

Objective: To study the prevalence and the microbiological profiles of HAI in, a pediatric tertiary care hospital.

Methods: During a period of 17 months (Jun 2008 to Oct 2009) HAI data which included details of patients and microbiology data were collected. CDC/ WHO definitions for HAI were used. Physicians were also trained to suspect and report HAI. Microbiology laboratory data was fed in WHONET software ver 5.1. HAI data was analyzed on daily, weekly and monthly basis. HAI indicators like ventilator associated pneumonia (VAP), healthcare associated blood stream infections (HA-BSI), Catheter related blood stream infections (CRBSI), Catheter associated urinary tract infections (CAUTI), device utilization ratios of catheters, and ventilators etc. were monitored.

Results: HAI most commonly occurred in PICU 52 (8.2%) followed by NICU 58 (6.7%) cases. While HA-BSI were most common in the NICU (51.7%), ventilator associated pneumonia (VAP) was predominant in PICU (57.7%).Of a total critical care load of 9762 patient days in the Neonatal ICU (NICU) and 4922 patient days in the Pediatric ICU (PICU), VAP rates observed in NICU and PICU were 53.1 and 24.8 per 1000 ventilator days respectively. HA-BSI rates among patients in PICU and NICU were 7 and 4.1 per 1000 patient days respectively. CRBSI were not observed in PICU but in NICU the rate was 7.6 per 1000 catheter days. Acinetobacter baumanii (23.5% in NICU, 17.3% in PICU) and Klebsiella pneumoniae (21.9% in NICU, 19.2% in PICU) were the two most common organisms isolated in both settings, with yeast also being frequently isolated in NICU (16.4%).

Conclusions: Active surveillance for HAI is of utmost importance for minimizing hospital acquired infections in patients. Microbiological diagnosis along with clinical spectrum can help identify most of the HAIs and an appropriate antibiotic stewardship program is required for reducing infections with multi-drug resistant organisms and for implementation of early and effective control measures.