Point prevalence surveys (PPS) have been used to document antimicrobial use in healthcare organizations. Antimicrobial resistance is a global concern, more so for developing countries like India, where the burden of antimicrobial resistance and infectious diseases are very high. A web based PPS developed by University of Antwerp, Belgium for the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used to enter data from pediatric and neonatal wards and intensive care units (ICU) from 8 centers across India. All patients who were receiving systemic antibacterial treatments on the day of the survey inclusive of antibacterial prophylaxis for surgery were included. 195 patients were surveyed across India: 105 (54%) medical and 90 (46%) surgical. 192 (98%) patients received multiple antimicrobials out of which 187 (95%) were given parenterally. Empirical antimicrobials were prescribed in 138 (71%) patients and targeted therapy in 57 (29%). The commonest infections for which antimicrobials were prescribed were healthcare associated infections 180 (41.76%) followed by surgical prophylaxis 90 (21%) and community acquired infections 84 (18%). Antimicrobials usage was maximal in ICUs. More than a single dose (5.6%) for more than a day (86.7%) was used for surgical prophylaxis. The Web based PPS suggests widespread antibiotic usage among pediatric and neonatal patients in selected tertiary Indian hospitals and underscores the need for antibiotic stewardship in order to promote rational and evidence based practice to limit the emergence of antibiotic resistant microbes.
Aim
The aim of this study was to collect the multicenter data of healthcare-associated infections (HAIs) to assess the infection control scenario in India in context with CDC/NHSN and INICC database.
Materials and methods
Four National Accreditation Board for Hospitals and Health Care Providers (NABH) accredited hospitals were selected on random basis and raw data on healthcare-associated infections—number of days and number of infections in all intensive care patients was obtained as per the CDC-NHSN definitions and formula. Three major device related infections were considered for analysis based on the prevalence of HAIs and discussions with subject matter experts. All nodal champions from each hospital were trained and common data collection sheet for surveillance in accordance to CDC-NHSN was formed. The pooled means for HAI rates and average of the pooled means for all were calculated using data from four hospitals and were compared with CDC/NHSN and international nosocomial infection control consortium (INICC) percentiles of HAIs rates.
Results
The Indian pooled mean HAI rates for all infections were above CDC/NHSN percentile threshold but below INICC percentile. Ventilator-associated pneumonia (VAP) was considered as matter of prime concern, crossing P90 line of CDC/NHSN threshold. However, no HAI rate was in limit of P25.
Conclusion
Indian HAI rates were higher when mapped with CDC threshold. This promotes the need for more standardized and evidence-based protocols been adhered to so as to bring HAI within CDC/NHSN thresholds. However, the four hospitals have better HAI rates as compared to pooled INICC database.
How to cite this article
Singh S, Chakravarthy M, Sengupta S, Munshi N, Jose T, Chhaya V. Incidence Rates of Healthcareassociated Infections in Hospitals: A Multicenter, Pooled Patient Data Analysis in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):86-90.
of the treatment regime. The Angina Plan is a home based rehabilitation programme initially aimed at patients with newly diagnosed angina. It uses a cognitive behavioural model to aid comprehension of the condition, addresses anxiety and fears, encourages risk factor management, and aims to increase exercise levels.
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