Prevelance of device associated health care associated infections and microbiological profile

Background: Limited data available regarding burden of disease due to healthcare –associated infections (HAI)  in India-in a resource limited setting. Inadequate training for infection control, high turnover of healthcare workers, inadequate emphasis on judicious use of antibiotic and high prevalence of multi drug resistant organisms makes situation challenging. AIMS hospital in South India is a multi-speciality referral hospital with 10 different ICUs - Cardiacsurgery, Coronary care (includes intermediate or step down), Medical, Surgical, Gastrosurgery, Neuro/Ortho, Head & Neck Surgery, Neonatal, Neuro-Stroke and Pediatric.

Objective: To describe device-associated HAI and microbiological profile in a 10 critical care units of a university teaching hospital Methods: Active surveillance for HAI was performed during the 3 year study period from Jan 2006 to Dec 2008. Infection control nurses collected the data on multi specialty 210 ICU beds. CDC-NHSN definitions for all device-associated HAI were used and rates were calculated per 1000 device days.  Device utilization ratio for each device was calculated. Microbiological profile for each HAI was noted and top three organisms are outlined. Results: Most common HAI in ICU was VAP with 4.8 per 1000 ventilator days (max in CV surgery SICU of 8.3 and min at Medical ICU of 1.34), followed by CR-BSI of 4.4 per 1000 central line days (max in CCU with 6.7 and min of 2.2 in Head & Neck ICU), followed by CA-UTI of 3.9 days (max in NeuroICU of 6.9 and min of surgical ICU at 1.3).  Device utilization ratio of central line was 0.53 (varying from 1.87 in CVSurgery ICU to 0.01 in Intermediate CCU), urinary catheterization of 0.51 (varying from o.88 in Neuro ICU and 0.10 in ICCU) and ventilator of 0.24 (varying from 0.35 in MICU to 0.13 in Head & Neck ICU).  The most common isolate in CR-BSI was Klebsiella, followed by non-fermenter gram negative bacilli (NFGNB) and Enterobacter with high resistance to ceftzidime suggesting of ESBL production. The most common isolates for CA-UTI was Yeast, E Coli and Enterococcus and for VAP the most common isolates were Pseudomonas, NFGNB and Klebsiella Conclusions: VAP was the most common HAI followed by CA-UTI and CR-BSI. ESBL producing GNR emerging as the most common pathogens causing HAI.  

Variables	VAP	CR-BSI	CA-UTI
Infection rates 2006	9.90	4.82	5.72
Infection rates 2007	4.80	5.21	5.33
Infection rates 2008	7.77	3.31	4.72
DUR	0.24	0.53	0.51
3 most common organisms	Pseudomonas, NFGNB, Klebsiella	Yeast, E Coli, Enterococcus	Klebsiella, NFGNB, Enterobacter