Epidemiology of device-associated infections in an intensive care unit of a teaching hospital in Nepal: A prospective surveillance study from a developing country

Parajuli, Narayan Prasad; Acharya, Subhash Prasad; Dahal, Sumit; Singh, Jaya; Mishra, Shyam Kumar; Kattel, Hari Prasad; Rijal, Basista Prasad; Pokhrel, Bharat Mani

doi:10.1016/j.ajic.2017.02.040

Cited by 20 publications

(25 citation statements)

References 34 publications

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“…From June 2017 to June 2018, the average incidence density rate was 5.06 VAP/1000 MV-day, with an incidence of 7.61% new cases, and an average use of ventilator in 62,2% per patient-day, similar to the results found in other studies (14) . VAP is the most prevalent infection in the ICU, when compared to the other HICS (2,8) .…”

Section: Discussionsupporting

confidence: 87%

Education to prevent ventilator-associated pneumonia in intensive care unit

et al. 2020

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Objective: to evaluate nursing adherence to the Ventilator-Associated Pneumonia Prevention Bundle and the incidence rate, before and after Continuing education. Methods: a quasi-experimental, retrospective study with a total of 302 patients on mechanical ventilator admitted to the Intensive Care Unit. Data obtained from the application of the bundle, from June 2017 to June 2018. In December 2017, a training on the infection was carried out with 48 professionals. Results: the mean age of patients was 62.39±17.06 years old. Appropriate measures before and after training, respectively: position of the ventilator filter 94.8% and 96.2%, p=0.074; elevated headboard 88.4% and 94.5%, p<0.001; oral hygiene with chlorhexidine 89.5% and 98.2%, p<0.001; teeth brushing 80.8% and 96.4%, p<0.001; and cuff pressure 92.7% and 95.6%, p=0.002. Incidence density was 7.99 for 4.28 infections/1000 ventilators per day. Conclusion: the bundle application and education made it possible to increase adherence and decrease infection.

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Section: Discussionsupporting

confidence: 87%

Education to prevent ventilator-associated pneumonia in intensive care unit

et al. 2020

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“…This correlates with our previous study done in the same NSICU in 2018 where Acinetobacter spp was the most prevalent isolates. 22 Our study also is in concurrent with the study done by other authors 17,23,24 where Acinetobacter spps was reported as the commonest isolates from the tracheal aspirates . The ubiquitous nature in the ICU environment and inadequate infection control practice has continuously raised the incidence of this particular organism.…”

Section: Discussionsupporting

confidence: 87%

Bacteriological Profile and Antibiogram of Endotracheal Aspirates in Patients Admitted in Neurosurgical Intensive Care Unit at a Tertiary Care Hospital

Kumari¹,

Jha²,

Adhikaree³

2020

J Coll Med Sci-Nepal

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Background: The patients with head injury have reduced consciousness, they are prone to aspirations of oral secretions. The tracheotomized patients are colonized mostly by gram negative bacteria and are likely develop pneumonia causing life threatening consequences due to severe, persistent, resistant infections. This study was undertaken to identify the common organisms which cause respiratory tract infection and their Antibiogram of ventilated patients in Neurosurgical Intensive Care Unit. Methods: A cross-sectional study was conducted to determine the prevalence and antibiotisc susceptibility analysis of Endotracheal aspirates of the patients who were admitted in Neurosurgical intensive care unit, College of medical sciences, teaching hospital, Bharatpur, for a period from October 2019 to July 2020. Aspirates were cultured onto Blood agar, McConkey and Chocolate agar. Isolation and identification was done using conventional techniques and Biochemical reactions. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method as per CLSI guidelines. Results: Out of 163 samples, 147(90.18%) were culture positive. 78 samples were found to be polymicrobial. 16 samples showed no growth. Acinetobacter baumanii (36.05%) was the most common isolate followed by Enterobacter sp (25.85%), Klebsiella pneumoniae (15.65%), Pseudomonas aeruginosa (13.61%), Escherichia coli (5.44%), Citrobacter freundii (2.04%), and Staphylococcus aureus (1.36%). The gram negative bacilli were all sensitive to colistin. Comparatively, they were also sensitive to Imipenem, Meropenem, Cefaperozone/sulbactam. Staphylococcus aureus is sensitive to Vancomicin. Conclusions: Respiratory tract infection in intubated patients is risk factors which lead to morbidity and mortality. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. The study reported the alarming condition of MDR in tracheal aspirates. Hence, surveillance for source of multi drug resistant bacteria would be beneficial for intervention of infection related to it.

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“…The central line-associated blood stream infection (CLABSI) rates were at least five times higher in Indian ICUs when compared to the US CDC/NHSN rates (67). Although multi-center studies reporting HAIs in other countries were not published, a single-center study in an ICU reported a high device associated HAI incidence rate of 27.3 per 1000 patient-days in Nepal (68). In Pakistan, a single pediatric ICU study reported a device associated HAI incidence rate of 6.3 per 1000 patient-days (69), whereas in Cambodia, the device associated HAI incidence rate in one pediatric ICU was reported as 4.6 per 1000 patientdays (70).…”

Section: Bacterial Disease Burden In Hospital-acquired Infectionsmentioning

confidence: 97%

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

Alvarez-Uria²,

et al. 2020

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SUMMARY Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization’s Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.

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Epidemiology of device-associated infections in an intensive care unit of a teaching hospital in Nepal: A prospective surveillance study from a developing country

Cited by 20 publications

References 34 publications

Education to prevent ventilator-associated pneumonia in intensive care unit

Education to prevent ventilator-associated pneumonia in intensive care unit

Bacteriological Profile and Antibiogram of Endotracheal Aspirates in Patients Admitted in Neurosurgical Intensive Care Unit at a Tertiary Care Hospital

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

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