National Database of a resource limited setting: How does it fare with benchmark standards

Background: There is 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 antibiotics and high prevalence of MDROs makes the situation challenging

Objective: To pool device associated infection (DAI) rates and microbiological profile from 4 tertiary care centers in India and compare the rates with benchmark National Healthcare Security Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) data.

Methods:

4 private hospitals who were accredited by the National Accreditation Board of Hospitals and Healthcare providers (NABH) in India were selected. A consensus meeting was organized on standardization of surveillance and report collection format. NHSN definitions, standard surveillance format and uniform formulas with common denominators were agreed upon. Training was imparted to the Infection Control Nursing staff and quarterly webinars for training was conducted. Regular monitoring of surveillance activities was done by Chair of each ICC units. 2009 data was collected for all DAIs from CVTS ICUs. Device utilization ratio (DUR) and microbiological profile for each DAI were noted.

Results: Most common HAI in ICU was VAP with 6.3 per 1000 ventilator days, followed by CR-BSI of 3.7 per 1000 central line days, followed by CA-UTI of 4.6 per catheter days.  Device utilization ratio of central line was 0.53, urinary catheterization of 0.51 and ventilator of 0.24 in CVTS 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 suggestive 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. The multi centric India rates were better than INICC data (from developing countries). To reach the ball park figure of NHSN, it would require more standardization of practices, robust training and re-training and putting more resources and manpower for IC.

Conclusions: VAP, followed by CR-BSI and UTI, were the most frequent HAI with ESBL producing GNR emerging as the most common pathogens. The multi centric India data was better than INICC data and requires strengthening of practices to achieve NHSN benchmarks.

	VAP(Per 1000 vent days)	CR-BSI (per 1000 line days)	CA-UTI (per 1000 catheter days)
INDIA (multi centric)	6.3	3.7	4.6
NHSN (2008)	3.0	2.0	3.3
INICC (2009)	20.0	9.0	6.0
DUR (India)	0.24	0.53	0.51
3 most common organisms (India)	Pseudomonas, NFGNB, Klebsiella	Klebsiella, NFGNB, Enterobacter	Yeast, E Coli, Enterococcus