Background Global randomised controlled trials of the anti-IL-6 receptor antibody tocilizumab in patients admitted to hospital with COVID-19 have shown conflicting results but potential decreases in time to discharge and burden on intensive care. Tocilizumab reduced progression to mechanical ventilation and death in a trial population enriched for racial and ethnic minorities. We aimed to investigate whether tocilizumab treatment could prevent COVID-19 progression in the first multicentre randomised controlled trial of tocilizumab done entirely in a lower-middle-income country. Methods COVINTOC is an open-label, multicentre, randomised, controlled, phase 3 trial done at 12 public and private hospitals across India. Adults (aged ≥18 years) admitted to hospital with moderate to severe COVID-19 (Indian Ministry of Health grading) confirmed by positive SARS-CoV-2 PCR result were randomly assigned (1:1 block randomisation) to receive tocilizumab 6 mg/kg plus standard care (the tocilizumab group) or standard care alone (the standard care group). The primary endpoint was progression of COVID-19 (from moderate to severe or from severe to death) up to day 14 in the modified intention-to-treat population of all participants who had at least one post-baseline assessment for the primary endpoint. Safety was assessed in all randomly assigned patients. The trial is completed and registered with the Clinical Trials Registry India (CTRI/2020/05/025369). Findings 180 patients were recruited between May 30, 2020, and Aug 31, 2020, and randomly assigned to the tocilizumab group (n=90) or the standard care group (n=90). One patient randomly assigned to the standard care group inadvertently received tocilizumab at baseline and was included in the tocilizumab group for all analyses. One patient randomly assigned to the standard care group withdrew consent after the baseline visit and did not receive any study medication and was not included in the modified intention-to-treat population but was still included in safety analyses. 75 (82%) of 91 in the tocilizumab group and 68 (76%) of 89 in the standard care group completed 28 days of follow-up. Progression of COVID-19 up to day 14 occurred in eight (9%) of 91 patients in the tocilizumab group and 11 (13%) of 88 in the standard care group (difference −3·71 [95% CI −18·23 to 11·19]; p=0·42). 33 (36%) of 91 patients in the tocilizumab group and 22 (25%) of 89 patients in the standard care group had adverse events; 18 (20%) and 15 (17%) had serious adverse events. The most common adverse event was acute respiratory distress syndrome, reported in seven (8%) patients in each group. Grade 3 adverse events were reported in two (2%) patients in the tocilizumab group and five (6%) patients in the standard care group. There were no grade 4 adverse events. Serious adverse events were reported in 18 (20%) patients in the tocilizumab group and 15 (17%) in the standard care group; 13 (14%) and 15 (17%) patients died during t...

Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

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Background and Objectives Nosocomial infections are significant public health problems in developed as well as developing countries. To tackle this problem, it is vital to sensitize healthcare students (HCSs) at early period of their clinical practise. Thus, this study was conducted to access the existing knowledge among HCSs and determine the impact of educational and training programs regarding nosocomial infections, standard precautions, and hand hygiene. Methods This was a cross-sectional cum interventional, questionnaire based, single center study. Total 728 MBBS, BDS and BSC nursing students were targeted for workshop on nosocomial infections, standard precautions, and hand hygiene based on the Centers for Disease Control and prevention (CDC) and World Health Organization (WHO) guidelines. Infection control standardized questionnaire (ICSQ) was administered as a pretest and posttest. Results were analyzed by SPSS software. Results A paired-samples t-test was conducted to access the impact of educational and training programs on knowledge of HCS. There was a significant difference in the scores of pretests (M = 37.30, SD = 4.81) and posttests (M = 42.03, SD = 4.55); t (727) = 22.162, p ≤0.005 and also statistically significant difference in scores of all 3 domains- 1. Nosocomial infections: Pretest (M = 6.61, SD = 1.57) and Posttest (M = 7.98, SD = 4.65); t (727) = 20.589, p ≤ 0.005; 2. Standard Precautions: Pretest (M = 20.81, SD = 3.06) and Posttest (M = 41.88, SD = 4.30); t (727) = 4.584, p ≤ 0.005; 3. Hand Hygiene: Pretest (M = 9.88, SD = 2.68) and Posttest (M = 12.54, SD = 2.92); t (727) = 19.527, p ≤ 0.005. The results suggest that educational and training programs have positive impact on knowledge of HCS. Conclusion This study highlighted the need for regular educational and training programs in primary training time for retention of knowledge regarding nosocomial infections and reinforcement of the principals of standard precautions and hand hygiene. How to cite this article Goyal M, Chaudhry D. Impact of Educational and Training Programs on Knowledge of Healthcare Students Regarding Nosocomial Infections, Standard Precautions and Hand Hygiene: A Study at Tertiary Care Hospital. Indian J Crit Care Med 2019;23(2):227–231.

Background:There is limited data regarding the microbiology of Intensive Care Unit (ICU)-acquired infections, such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and catheter-related bloodstream infections (CRBSI) from India.Objectives:To explore the microbiology and resistance patterns of ICU-acquired infections and evaluate their outcomes.Materials and Methods:This was a multicenter observational study, conducted by Indian Society of Critical Care Medicine (MOSER study) between August 2011 and October 2012. Patients in the ICU ≥48 h with any ICU-acquired infection within 14 days of index ICU stay were included. Patient demographics, relevant clinical, and microbiological details were collected. Follow-up until hospital discharge or death was done, and 6-month survival data were collected.Results:Of the 381 patients included in the study, 346 patients had 1 ICU infection and 35 had more than one ICU infection. Among patients with single infections, 223 had VAP with Acinetobacter being the most common isolate. CAUTI was seen in 42 patients with Klebsiella as the most common organism. CRBSI was seen in 81 patients and Klebsiella was the most common causative organism. Multidrug resistance was noted in 87.5% of Acinetobacter, 75.5% of Klebsiella, 61.9% of Escherichia coli, and 58.9% of Pseudomonas isolates, respectively. Staphylococcus constituted only 2.4% of isolates. Mortality rates were 26%, 11.9%, and 34.6% in VAP, CAUTI, and CRBSI, respectively.Conclusion:VAP is the most common infection followed by CRBSI and CAUTI. Multidrug-resistant Gram-negative bacteria are the most common organisms. Staphylococcus aureus is uncommon in the Indian setting.

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