hospital infection control(indicators)
TRANSCRIPT
HOSPITAL INFECTION CONTROL(INDICATORS) DR JAYANT BALANI CONSULTANT MICROBIOLOGIST(MBBS,MD)) DHARAMSHILA HOSPITAL &RESEARCH CENTRE, NEW DELHI
OVERVIEW OF INFECTION CONTROL PROGRAMME
• GOAL• POLICY• SURVELLANCE PROGRAM• TRAINING PROGRAME• DATA SLIDES• SPECIFIC GOALS SET FOR INFECTION CONTROL• PROCESS OUTCOME MEASURES• HURDLES /PROBLEMS/ROOT CAUSE ANALYSISS• ANTIBIOTIC POLICY• ANNEXURSES
INFECTION CONTROL PROGRAMME
• GOAL• TO REDUCE THE INCIDENCE OF HOSPITAL ACQUIRED INFECTIONS,CATER TO PATIENT AND HEALTHCARE WORKER SAFETY
DHARAMSHILA HOSPITAL & RESEARCH CENTRE VASUNDHRA ENCLAVE, DELHI –110096 INFECTION CONTROL GOALS FOR 2012-2013 • TO INCREASE THE HAND HYIEGENE COMPLIANCE TO 70% .• TO FORMULATE AUDIT DOCUMENTS IN BIOMEDICALWASTE
MANAGEMENT , KITCHEN, CSSD, LAUNDARY.• TO IMPLEMENT BUNDLE APPROACH IN VAP,CUATI, CRBSI.• TO ENSURE RUNNING OF INFECTION CONTROL
SURVEILLANCE PROGRAM AS PER SCHEDULE. DT:1/4/2012
POLICY FOR H.I.C• PROCEDURE LABORATORY BASED WARD SURVEILLANCE AND SELECTED CONTIUNING SURVEILLANCE(IC..U)
COMPONENTS• MULTIDISCILIPLINARY INFECTION CONTROL COMMITTEE AND INFECTION CONTROL TEAM TO MONITOR HOSPITAL INFECTION CONTROL
ESSENTIALS OF INFECTION CONTROL PROGRAMME
INFECTION CONTROL MANUAL– UPDATED ANNUALLY
INFECTION CONTROL COMMITTEE– MEETING QUATERLY– MEMBERS
NAME DESIGNATION IN ORGANIZATION DESIGNATION IN COMMITTEE
• DR. JAYANT BALANI DEPT. OF MICROBIOLOGY CHAIRMAN
• DR. V.R. MINOCHADEPT. OF SURGERY MEMBER
• DR. PRAVEEN TIWARI DEPT. OF MEDICINE MEMBER
• DR. PREETI MISHRA DEPT. OF ANAESTHESIA MEMBER
• MRS. S.KUMRA NURSING SUPT. MEMBER
• MRS. RENUKA ICN MEMBER
FUNCTIONS• DEVELOPS & REVIEWS INFECTION CONTROL POLICIES AND PROCEDURES• DESIGNS AND DETERMINES THE TYPE OF SURVEILLANCE AND REPORTING PROGRAME• ANALYSES THE INFECTION CONTROL SURVIELLENCE DATA.• ENSURE THAT CORRECTIVE ACTION AND CONTROL MEASURES ARE TAKEN IN THE EVENT OF OUTBREAKS• MONITORS FUNCTIONAL COMPLIANCE WITH INFECTION CONTROL POLICIES AND PROCEDURES.• DEVELOPS EDUCATIONAL PROGRAM ABOUT INFECTION CONTROL POLICIES AND PRACTICES FOR HOSPITAL
STAFF.
INFECTION CONTROL TEAM(MEETS MONTHLY)1)MICROBIOLOGIST 2)I.C.N 3)HOUSEKEEPING SUPERVISOR 4)HOSPITAL CO-ORDINATOR.
POLICY FOR H.I.C
1. BUDGETARY ALLOCATION AND AMOUNT OF 14,87,463 SPENT ON INFECTION CONTROL PROGRAMME.
SPENDINGDISIN-FEC-TANTSP.P.ESUR-VEIL-LANCE
TYPE SPENDING
DISINFECTANTS 4,63172PPERSONAL PROTECTIVE EQUIPMENT
7,79,291
SURVEILLANCE CULTURES
2,45,000
POLICY FOR H.I.C2. REGULAR TRAINING FOR INFECTION CONTROL PRACTICES.
A)STAFF B)MEDICAL STAFF C)PATIENTD)FAMILY
TRAINING SHEET TOPICS STAFF MEDICA
L STAFF
PATIENT FAMILY
Educate patients/families about central line associated bloodstream infection prevention prior to insertion of a central venous catheter
X X X
X
Educate LIP, staff regarding surgical site infections and importance of prevention at hire and annually when involved in these procedure or care of patients
X X X X
Educate patients/families who are undergoing a surgical procedure about surgical site infection prevention
X X
X X
TRAINING SHEET TOPICS
STAFFMEDICAL STAFF
PATIENT
FAMILY
Policy regarding reprocessing of single-use devices (IC 221.5)
X X
Hand hygiene guidelines X X X
X
Educate LIP, staff regarding HAI, MDRO and prevention strategies at hire and annually
X X X X
Educate patients/families who are infected or colonized with an MDRO about HAI prevention strategies
X X X
X
Educate LIP, staff regarding central line associated infections CLABSI and prevention strategies at hire and annually when involved in these procedure or care of patients
X X X X
Educate patients/families about central line associated bloodstream infection prevention prior to insertion of a central venous catheter
X X X X
TRAINING SHEET TOPICS STAFF MEDICA
L STAFF
PATIENT
FAMILY
Methods for communicating responsibilities about preventing and controlling infection
X X X X
Method to communicate emerging infections that could cause influ
X X X X
Processing medical equipment, devices, and supplies cleaning and low level disinfection (IC 221.1
X X
Performing intermediate and high-level disinfection and sterilization of medical equipment, devices and supplies as applicable (IC 221.2
X X
Appropriate disposal of medical equipment, devices and supplies (IC
X X
POLICYFOR H.I.C
4. COMPLIANCE WITH I.P.C PROCEDURES PART OF PERFORMANCE EVALUATION FOR STAFF.
5 ESTABLISHING ROLE MODELS FOR EMPLOYEES BY ENCOURAGEMENT OF STAFF FOLLOWING GOOD INFECTION CONTROL PRACTICES.
6.COMMUNICATION WITH HEALTH DEPARTMENT,DELHI GOVT. PROVIDING FEEDBACK ABOUT COMMUNICABLE INFECTIONS.
7 BENCHMARKING OF HOSPITAL DATA WITH N.H.S.N
POLICY FOR H.I.C
8. ADRESSING ISSUES RELATED TO HEALTHCARE WORKER SAFETY-NEEDLE STICK INJURY,VACCINATION OF STAFF,BIOMEDICAL WASTE MANAGEMENT.
9. MONITORING USE OF ANTIBIOTICS IN HOSPITAL AND ENCOURAGING GOOD ANTIBIOTIC PRACTICES.
10. REGALAR AUDITS IIN FOLLOWING AREAS AS MEASURE OF PROCESS OUTCOME
POLICYFOR H.I.C• ANTIBIOTIC PRESCRIBING AUDIT• SURGICAL SITE AUDIT• LAUNDARY AND HOUSEKEEPING AUDIT• KITCHEN AUDIT• ISOLATION ROOM AUDIT• C.S.S.D AUDIT.• ENDOSCOPE REPROCESSING AUDIT
SURVEILLANCE PROTOCOL
(A) AIR CULTURE REPORT
RESULT REMARK CORRECTIVE ACTION
REPEAT CULTURE
REMARK
O.T. 11 Week 2. Week3.Week4. WeekO.T. 21 Week 2. Week3.Week4. WeekO.T. 31 Week 2. Week3.Week4. WeekO.T. 41 Week 2. Week3.Week4. Week
HDU (monthly)
ICU (monthly)
MONTHLY SURVEILLANCE PRLOTOCOL
B) SWAB C/S RESULT REMARK CORRECTIVE ACTION
REPEAT CULTURE
REMARK
1.Anesthesia 2. Sodalime jar3. Suction machine E4. Suction machine C5. Suction machine BIPAP6. Breathing Bag 7.Curtain Room No. 8. Curtain Room No9. Curtain Room No10. Door knob Room No. 11. Door knob Room No.12. Door knob Room No.13. Keyboard area14. Keyboard area
MONTHLY SURVEILLANCE PROTOCOL
(C) Biological indicator RESULT REMARK CORRECTIVE ACTION
REPEAT CULTURE
REMARK
1. C.S.S.D 1 week2. week3. week4. week 2. T.S.S.U. (monthly)
(D)DIALYSIS UNIT1. R.O. Water (monthly)
2. Dialysis fluid (monthly)
(F) WATER TESTING (WATER COLLERS)1. Water cooler No. 2. Water cooler No. 3. Water cooler No. 4. Water cooler No. (G) KITCHEN STAFF 1. Sputum for AFB stain
2. Stool Routine and C/S3. Chest X-ray (annual)
MONTHLY SURVEILLANCE PROTOCOL
DISINFECTANTS
S.NO PURPOSE ITEM NAME GENERIC NAME BRAND PACK SIZE
NET RATE/PCS
CONSUMPTION Apr 11 to Jan 12 (10 months)
TOTAL PURCHASE IN Rs.
1 CARBOLISATION/ FLOOR AND SURFACE DISINFACTANT
PHENOL IP CARBOLIC ACID AGGRAWAL 400 GM 147.60 95 14022.00
2 FUMIGATION MICROGEN D-125
MICROGEN 1 LTR 285.60 23 6568.80
3 INSTRUMENT CLEANING
NEODISHER-LM2
ELDER 1 LTR 1239.75 39 48350.25
4 SURGICAL HAND WASH / SCRUB
CHLOREHEXIDINE
CHLORHEXIDINE GLUCONATE SOLUTION IP
RAMAN AND WEIL
500 ML 170.57 246 41960.22
STERIMAX BIOSHIELD 500 ML 182.50 200 bottle 36500.005 DISINFECTANT
IN INFECTED CASE
SODIUM HYPOCHLORITE 2%
SODIUM HYPOCHLORITE
MERCK 5 LTR 396.90 165 65488.50
PHENOL IP CARBOLIC ACID AGGRAWAL 400 GM 0 0 0.006 PREPERATION
OF PRE-OPERATIVE SITE
AND SKIN CLEANING.
BETADINE SOLUTION
POVIDONE IODINE IP 5%
WIN MEDICARE
1 LTR 236.25 355 83868.75
DENATURE SPIRIT
20 LTR 101.25 per ltr.
400 ltr 40500.00
7 ANTISEPTIC ACEPTIK CHLORHEXIDINE GLUCONATE SOLUTION IP, ISOPROPYL ALCOHOL IP
RAMAN AND WEIL
1 LTR 168.00 30 5040.00
8 RUST REMOVER NEODISHER-IR PHOSPHORIC ACID
ELDER 1 LTR 1721.25 10 17212.50
9 CHITTLE FORCEPS
TRIDEX 28LL TORRELL 5 LTR 549.00 36 19764.00
10 DISINFECTANT FOR EQUIPMENTS TUBINGS AND SCOPES
KORSOLEX GLUTARALDEHYDE
RAMAN AND WEIL
500 ML 448.9 184 82597.60
11 INSTRUMENT LUBRICANT
NEODISHER IP SPRAY
ELDER 500 ML 1300 1 1300.00
Total 463172.62
DATA SLIDES
Pseud
omon
as sp.
Klebsi
ella s
p.E.c
oli
Acine
tobact
er
Candid
a sp.
Citroba
ter sp
.
Enter
ococcu
s sp.
S.aure
us
Proteu
s sp.
Enter
obact
er0
50100150200250
Total isolatesH.A.I Isolates
TYPE OF ISOLATES
H.A.I INDICATORSTYPE JAN FEB MAR APR MAY JUN JULY AUG SEP. OCT. NOV. DEC.
C.R.B.S.I (I.C.U)
1.1 2.9 0.6 1.17 0.8 0.44 0.6 0 0.5 0 0 0
C.U.A.T.I (I.C.U)
5.3 6.8 5.3 3.3 4 3.5 3.3 0 1.9 0 6.8 3.9
C.A.U.T.IWARDS
4,.9 5.1 4.3 2.1 2.1 2.2 2.3 0 .8 1.1 2.3 2.1
S.S.I 6.4 5 5.7 6.6 13.5 11.1 8.1 7 9.5 10 14.5 8.5
VAP(I.C.U)
0 0 90.9*1 case
0 0 0 0 0 0 0 0 0
CLABSI(TEMP)
012345678
Jul-12 Aug-12
Sep-12 Oct-12 Nov-12
Dec-12
N.H.S.N DHARAM HOSP. I.N.I.C.C
CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION(CLABSI
TEMP.LINE)
0
2
4
6
8
Jan-12 Feb-12 Mar12
Apr-12 May-12
Jun-12
N.H.S.N DHARAM HOSP. I.N.I.C.C
CLABSI(PERM)
012345678
Jul-12 Aug-12
Sep-12
Oct-12 Nov-12
Dec-12
N.H.S.N DHARAM HOSP. I.N.I.C.C
CENTRAL LINE ASSOCAITED BLOODSTREAM INFECTION(CLABSI
PERM)
0
2
4
6
8
Jan-12 Feb-12 Mar 12 Apr-12 May-12 Jun-12
N.H.S.N DHARAM HOSP. I.N.I.C.C
CATHETER ASSOCIATED URINARY TRACT INFECTION(CAUTI)
01234567
Jan-12 Feb-12 Mar12
Apr-12 May-12
Jun-12
N.H.S.N DHARAM HOSP. I.N.I.C.C
CAUTI
01234567
Jul-12 Aug-12
Sep-12
Oct-12 Nov-12
Dec-12
N.H.S.N DHARAM HOSP. I.N.I.C.C
VENTILATOR ASSOCIATED PNEUMONIA(VAP)
05
1015202530
Jan-12 Feb-12 Mar12
Apr-12 May-12
Jun-12
N.H.S.N DHARAM HOSP. I.N.I.C.CVAP
02468
10121416
Jul-12 Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
N.H.S.N DHARAM HOSP. I.N.I.C.C
DHARAMSHILA HOSPITAL HAI RATES 2012NHSN-NATIONAL HEALTHCARE SAFETY NETWORK,CDC,ATLANTA
*INICC-INTERNATIONAL INFECTION CONTROL CONSORTIUM(INCLUDES DATA FROM ASIAN,EUROPEAN COUNTRIES)
SURGICAL SITE INFECTION(CLEAN)
0
0.5
1
1.5
2
2.5
Jan-12 Feb-12 Mar12
Apr-12 May-12
Jun-12
N.H.S.N DHARAM HOSP.
SURGICAL SITE INFECTION (CLEAN)
0
5
10
15
Jul-12 Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
N.H.S.N DHARAM HOSP.
SURGICAL SITE INFECTION(CONTAMINATED)
02468
10121416
Jan-12 Feb-12 Mar12
Apr-12 May-12
Jun-12
N.H.S.N DHARAM HOSP.
SURGICAL SITE INFECTION(CONTAMINATED)
0
2
4
6
8
10
Jul-12 Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
N.H.S.N DHARAM HOSP.
DEVICE UTILIZATION RATIO(D.U.R)PATIENT DAYS CENTRAL LINE
DAYSDUR
36813 32507 0.88
PATIENT DAYS CATHETER DAYS DUR
36813 5589 .02
PATIENT DAYS VENTILATOR DAYS
DUR
36813 258 .001
BENCHMARKING DATA
CATEGORY DHARAMSHILA HOSPITAL
I.N.I.C.C2004-2009MEAN(95%c.i)
U.S N.H.S.N2006-2008Mean95%c.i
CRBSI 0.67 6.8 1.5
C.A.U.T.I 3.675 7.1 3.1
V.A.P 7.5 18.4 1.9
S.S.I 8.32 15*Jjournal of hospital infection,2000:45:173-184
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Ak CPS CPZ CST CAZ Cat CIS CIPCOT
Ipm Mem NET0
20
40
60
80
100
120
73.657.8
5.218.4
44.7
63.1
15.7
44.7
13.110.513.15.2
15.726
47.3
84.2
10.5
63.168.4
18.431.536.8
5.22.62.6
52.655.2
99
23.6
Pseudomonas
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Amika
cin
Azyreo
nam
Ceftazi
dime
Cefope
razon
e/Sulb
actam
Ceftria
xone/S
ulbact
am
Co-trim
oxazol
e
Cefepim
e/tazo
bacta
m
Cefope
razon
e
Ceftria
xone
Cefurox
ime
Imipe
nem
Moxiflo
x
Nitrofur
antoi
n
Pipera
cillin
Tigicy
cline
0102030405060708090
33.7
12.12.76.74 4
29.714.8
22.9
81
5.40.816.2
6.712.118.95.48.12.7
21.6
68.9
1.310.814.8
1.3
52.7
1.3
28.3
55.4
Klebsiella
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Amoxy
cillin/
Sulba
ctam
Azyreo
nam AM
P
Ceftazi
dime/t
azoba
ctam
Ciprofl
oxacin
Cefepim
e/tazo
bacta
m
cepha
lothin
Cefepim
e/Sulb
actam
Co-trim
oxazol
e
Ceftria
xone
Doxicyc
line
Imipe
nem
Nitrofur
antoi
n
Pipera
cillin/
tazob
actam
Polym
yxin
020406080
100
22.211.1
4440
2.213.315.542.2
6.631.140
93.3
6.62026.6
6.68.817.74.4112.22.2
28.8
91.1
11.122.240
53.36068.8
E. Coli
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
020406080
100
4020
4020 20 10
5030 40
90
10.130 30
10 10
40
0
40 50
10
40 3050 40
60
Acinetobacter
DHRAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Amika
cin
Azyreo
nam
Amoxy
cillin/
Sulba
ctam
Ceftazi
dime/t
azoba
ctam
Ceftazi
dime
cepha
lothin
Cefope
razon
e/Sulb
actam
Ciprofl
oxacin
Ceftria
xone/S
ulbact
amColis
tin
Co-trim
oxazol
e
Cefepim
e/tazo
bacta
m
Cefope
razon
e
Cefope
razon
e/tazo
bacta
m
cefota
xime
Cefurox
ime
Gentam
icin
Imipe
nem
Moxiflo
x
Netilm
icin
Polym
yxin
Pipera
cillin/
tazob
actam
Tigicy
cline
020406080
100
39.6
1326
8.6 13 8.6
39.1
1317.3
86.9
8.630.4
1317.317.38.630.4
65.2
8.630.4
52.147.865.2
Citrobacter
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Amika
cin amp
Ceftazi
dime
Cefope
razon
e/Sulb
actam
Ceftria
xone/S
ulbact
am
Co-trim
oxazol
e
Cefope
razon
e
cefota
xime
Gentam
icin
Moxiflo
x
Polym
yxin
Tigicy
cline
020406080
100120
55.533.3
22.211.1
22.211.1
22.222.211.1
66.6
11.122.222.222.2
33.3
0
44.4
100
22.233.3
44.4
77.766.6
Enterobacter
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Amika
cin amp
Ceftazi
dime/t
azoba
ctam
cepha
lothin
Ciprofl
oxacin
Colistin
Cefepim
e/tazo
bacta
m
Cefope
razon
e/tazo
bacta
m
Cefurox
ime
Imipe
nem
Netilm
icin
Pipera
cillin/
tazob
actam
020406080
100120
83.350
33.316.6
33.366.6
16.6
83.3100
33.333.313.3
50 50 5083.3
16.650
83.366.6
16.616.6
83.350
Proteus
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Ak Cat lpm NIT TEC
0
20
40
60
80
100
120
0 0 0 0 0 0 0 0 0 0
78.9
31.531.5
78.968.4
15.7
47.3
26.310.5
26.3
5.2
42.152.6
94.778.9
52.652
10.5
31.5
57.8
15.9
78.9
100
Staphylococcus
DHARAMSHILA HOSPITAL AND RESEARCH CENTRE
ANTIBIOTIC SENSITIVITY PROFILE
Ak amp CD CEP CU DO
GEN Ipm NIT OXTG
C VA0
102030405060708090
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33.3
516.616.6
33.3
83.3
33.3
16.6
83.383.3
Entrococus
A BLOOODSTREAMINFECTIONS(ANTIBIOTIC SUSEBTIBILTY)IWARDS) DHARAMSHILA HOSPITAL Most Common Pathogens1 Prevalence % Antibiotic Sensitivity (%)Escherichia coli 42.80% Polymyxin (99%) tigecyclin (95%) Colistin (93.3%) Imipenem (91.1%)
Cefoperazone/tazoactam (76.9%) Cefoperazone/Subactam(71.4%)Amikacin (71.1%)
Klebsiella pneumoniae 33.30% Polymyxin (98.6%) Colistin (81%) Imipenem (68.9%) tigcycline (55.4%) Amikacin (33.7%) cefoperazone sulbactam (29.7%) Ceftriaxone sulbactam (22.97%)
Pseudomonas sp. 11%% Polymyxin(99%) Colistin (90.6%), Gentamycin (76.6%) Amikacin (73.6%), Imipenem (70.5%), Cefoperazone/taobacter (66.6%) piperacillin (63.3%)
Acinetobacter sp. 4.70% Polymyxin(99%) Colistin (90%), tigcycline (60%) Imipenem(50%) cefoperazone sulbactam (50%) Moxiflox(40%) Gentamycin (40%)
Citrobacter sp. 4.70% Polymyxin(99%) Colistin (86.9%), Imipenem(65.2%) tigcyclin (65.2%) piperacillin taxobactum (47.8%) %) Amikacin (39.6%) cefoperazone sulbactam (39.1%)
Enterobacter sp. 4.70% Imipenem (100%) Polymyxin (98.2%) piperacillin taxobactum (77.7%) Colistin (66.6%), tigcyclin (66.6%) Amikacin (55.5%) Gentamycin (44.4%)
TOTAL 100%
A BLOOODSTREAMINFECTIONS(ANTIBIOTIC SUSEBTIBILTY)I.C.U DHARAMSHILA HOSPITAL Most Common Pathogens Prevalence % Antibiotic Sensitivity Blood (%) Klebsiella pneumoniae 52.00% Polymyxin (98.6%) Colistin (81%) Imipenem (68.9%) tigecyclin
(55.4%) Amikacin (33.7%) cefoperazone sulbactam (29.7%) Ceftriaxone sulbactam (22.97%)
Escherichia coli 16.00% Polymyxin (99%) tigecyclin (95%) Colistin (93.3%) Imipenem (91.1%) Cefoperazone/tazoactam (76.9%) Cefoperazone/Subactam(71.4%)Amikacin (71.1%)
Enterobacter sp. 16.00% tigecyclin(95%) Imipenem (90%) Colistin (85.7%), Polymyxin (80%) piperacillin taxobactum (77.7%) Cefeperazone/tazobactam (66.6%)
Staphylococcus aureus 16.00% Vancomycin (100%) Tigicycline (100%) Linizolid (94.7%) Teicoplanin (83.3%)Amikacin (81.2%) Chloromphenicol (78.9%) Imipenem (76%)
TOTAL 100.00%
COMPARISON OF ANTIMICROBIAL RESISTANCE RATES IN THE ICUS OF DHARAMSHILA HOSPITAL VS THE INTERNATIONAL NASOCOMIAL INFECTIONS CONTROL CONSORTIUM.
PATHOGEN ANTIMICROBIAL
NO, OF PATHOGENICISOLATED TESTED POOLED(DHARAMSHILA HOSPITAL)
RESISTANCE PERCENTAGE%
NO, OF PATHOGENICISOLATED TESTED POOLED(I.N.I.C.C)
RESISTANCE PERCENTAGE
Staphylococus aures OXA 67 31.50% 646 84.40%Enterococcus FaecalisVAN 26 15.10% 98 5.10%Pseudomonas aeruginosaFQS 149 53.30% 285 42.10%PIP or TZP 149 35.30% 589 36.20%AMK 149 27.70% 278 27.70%IPM or MEM 149 42.20% 217 47.20%FEP 149 100.00% 2 100.00%Klebsiella pneumoniae CRO or CAZ 227 76.30% 447 76.30%IPM, MEM or ETP 227 42.10% 508 7.90%Acinetobacter baumsnniiIPM or MEM 36 50.00% 667 55.30%Esherichia coli
CRO or CAZ 180 82.00% 171 66.70%IPM, MEM or ETP 180 15.00% 182 4.40%FQs 180 82.00% 133 53.40%
Months Number of patient less than 5 days
Number of patient more than 5 Days
Total Patient Total Ventilation
days
January 8 Nil 8 9
February 9 Nil 9 11
March 10 Nil 10 10
April 11 2+1 12 34
May 17 Nil 17 37
June 7 2 9 26
July 16 2 17 28
VENTILALATOR PATIENTS DATA
Month Average period of catheterization CUATI
Average period of catheterization non - CUA. T - I
Average period of central line days CRBSI patient
Average period of central line days Non CRBSI patient
January 6.9 8.1 20.4 51Februar
y 7.9 8.6 24.7 28.7
March 7.2 27 24.7 28
April 4.7 20 24.8 41.5
May 7.78 8.5 32.5 37.5
June 7.3 11.5 28.4 12
August 7.1 28 37.4 32
POSITIVE/NEGATIVE H.A.I DATA
CENTRAL LINE/CATHETER/VENTILATOR DAYS DATA
• AVERAGE PERIOD OF CATHERISATION 8 DAYS• AVERAGE PERIOD OF CATHERISATION WITH CUATI 19 DAYS• AVERAGE EXTRA DAYS WITH CAUTI 11 DAYS• AVERAGE CENTRAL LINE DAYS WITHOUT CRBSI 32 DAYS• AVERAGE CENTRAL LINE DAYS WITH CRBSI 38 DAYS
• EXTRA DAYS ASSOCIATED WITH CRBSI 6 DAYS• NO. OF PATIENTS VENTILATED <5 DAYS 86%• NO. OF PATIENTS VENTILATED >5 DAYS 14%
CRUDE MORTALITY RATESWITH HAI/WITHOUT HAI
NO.DEATHS
NO. PATIENTS
POOLED CRUDE MORTALITY%
95% C.I
CRUDE MORTALITY RATE OF PATIENTS WITHOUT DA-HAI
264 6294 4
CRUDE MORTALITY RATE OF PATIENTS WITH C.L.A.B
4 1126 0.35
CRUDE EXCESS MORTALITY RATE OF PATIENTS C.L.A.B
4 1126 _3.65
CRUDE MORTALITY RATE OF PATIENTS C.A.U..IT
7 910 .76
CRUDE EXCESS MORATLITY RATE OF PATIENTS C.A.U.T.I
7 910 _3.24
CRUDE MORTALITY RATE OF PATIENTS V.A.P
1 160 .63
CRUDE EXCESS MORTALITY RATE v.a.p
1 160 _3.35
5
LENGTH OF STAYWITH HAI/WITHOUT HAI
LOS,TOTALDAYS
NO.PATIENTS
AVERAGE LOS,DAYS
95% C.I
LOS OF PATIENTS WITHOUT DA-HAI
36813 6294 5.8
LOS OF PATIENTS WITH CLAB
32,507 1126 28.86
EXTRA LOS OF PATIENTS WITH CLAB
32,507 1126 23
LOS OF PATIENTS WITH CAUTI
5589 910 6.14
EXTRA LOS OF PATIENTS WITH CAUTI
5589 910 0.4
LOS OF PATIENTS WITH VAP
258 160 1.6
EXTRA LOS OF PATIENTS WITH VAP
258 160 _4.2
MULTIDRUG RESISTANT ORGANISIMS(M.D.R.O)
ORGANISINTYPE
NO.OF CASES LOCATION
TOTAL DAYS
RATE=NO.CASES/ TOTAL PATIENT DAYS X100
MDR PSEUDOMONAS
ICU 1 598 0.16
WARD 4 9839 0.04
MDR KLEBSIELLA
ICU 6 598 1.0
WARDS 10 9839 0.10
MDR AINETOBACTER
ICU 3 598 0.5
WARDS 0 9839 0
MDR TOTAL
ICU 16 598 2.6
WARDS 17 9839 0.17
VRE ICU 1 589 0.16
WARDS 0 9839 0
ORGANISINTYPE
NO.OF CASES
TOTAL DAYS
RATE=NO.CASES/ TOTAL PATIENT DAYS X100
M,R,S,A ICU 1 598 0.16%
WARDS 4 9839 0.04%
E,S,B.L ICU 1 598 0.16%\
WARDS 3 9839 0.03%
NEEDLE STICK INJURY DATA
NEEDLE STICK INJURY
HANDLING B,M,W
SURGICAL PROCEDURES
WITHDRAWING BLOOD
16 02 02
ANTIBIOTIC AUDIT DATA
SURGICAL SITE AUDIT DATA
HAND HYIEGINE COMPLIANCE
DOCTORS
NURSING ST
AFF
PHYS
IOTHER
APIST
HOUSEKE
EPING ST
AFF
020406080
HAND WASHHAND RUB
HAND RUB AVAILIBILITY DATA
Category 1
Category 2
Category 3
Category 4
012345
Series 1
Series 1
POSITIVE SURVEILLANCE CULTURES
DATE AREA ORG GROWN REPORT RESULT2/2/2011OR-I Medi Solution Pseudomonas 2/11/2011No Growth2/9/2011ICU-Meddis Solution Pseomonas 2/11/2011No growth
3/7/2011OT-I Air Culture 25 Colonies of GNB 3/9/2011No growth
4/4/2011OR-I Breathing Bag 7 Colonies of GPC 4/7/2011No growth
4/11/2011Dialysis Water Coliforms grown 4/18/2011No growth
7/18/2011CSSD-Biological indicator Positive 7/20/2011No growth
8/1/2011OR-I Sodalime Jar Stephalococcus 8/5/2011No growth8/26/20113rd Floor- Water Coliforms grown 8/29/2011No growth 9/3/20114th Floor Water Coliforms grown 9/10/2011No growth
11/7/2011OR-II Breathing Bag MRSA 11/10/2011No growth
11/29/2011ICU Air culture > 35 colonies of GPC 12/6/2011No growth
11/29/2011Hdu Air culture > 35 colonies of GPC 12/3/2011No growth
12/10/20112nd-D- Water Coliforms grown 2/14/2011No growth 12/10/20113rd -A-Water Coliforms grown 2/14/2011No growth
2/13/2011Dialysis Water Coliforms grown 2/16/2011No growth
DHARAMSHILA HOSPITAL & RESEARCH CENT . VASUNDHRA ENCLAVE, DELHI –
110096
• INFECTION CONTROL GOALS FOR 2013-2014• • TO INCREASE THE HAND HYIEGENE COMPLIANCE TO 90%• TO DECREASE THE INCIDENCE OF NEEDLE STICK INJURIES AMONG HEALTHCARE
STAFF PARTICULARLY HOUSEKEEPING STAFF.• TO DECREASE THE INCIDENCE OF INFECTIONS IN TEMPORARY CENTRAL LINE AS IT IS
NOT MEETING INICC BENCHMARK.• TO ENSURE RUNNING OF INFECTION CONTROL SURVEILLANCE PROGRAM AS PER
SCHEDULE.• • DT. 1/4/2013
INFECTION CONTROL GAP ANALYSIS
Area/Issue/Topic/Standard
Current Status Desired Status Gap(Describe)
Action PlanAnd Evaluation
Incomplete implementation of CDC Hand Hygiene (HH) Guideline (NPSG 01.07.01)
Only 80% of units and services are following CDC HH Guideline and hospital policy.
Full implementation of required elements upto level 0f 90%
10% of units and services are not following CDC HH Guideline and hospital policy.
Develop proactive implementation plan.Make a leadership priority. Workplace reminders like posters,screen savers.Evaluate existing hand hygiene compliance.Provide feedback to staff monthly .
Central line-associated bloodstream infections (temporary CLABSIs in medical ICU are very high compared to INICC
CLABSI in medical ICU at 75th percentile of INICC benchmark.
Reduce CLABSI s to 50 percentile INICC benchmark or lower.
Processes to prevent CLABSIs are not flowed consistently among staff.
Reinforce use of the BSI bundle.Monitoring insertion practices for CLABSI and documenting the same.Evaluate the bundle processes and the outcomes and report to leadership and ICC monthly.
Needlesticks in employees increasing (particularly housekeeping staff)
The incidence of needlesticks among environmental services (ES) staff is 30%Analysis shows that greatest risk is during changing of needle containers.
Reduce needle sticks in ES staff .
Process for emptying sharp containers is faultySharp containers disposal schedule is not adhered to.
Switch to puncture proof containers for sharp storage and disposal. Reinforce disposal schedule and enhance d coordination between housekeeping staff and nurses.Training for housekeeping staff in sharp disposal, use of PPE.Display ongoing data to show number of weeks without needle sticks.Revaluate needle stick injuries in 3 and 6 months and report to staff and ICC
INFECTION CONTROL RISK ANALYSIS
PROBABILITY OF OCCURRENCE PATIENT EFFECT
INTENSITY OF ORGANIZATION’S
RESPONSE NEEDED TO ADDRESS THE
RISK
ORGANIZATION PREPAREDNESS
TO ADDRESS SUCH A RISK AT
THIS TIME
RISK LEVEL
High (3)
Med (2)
Low (1)
None (0)
Life Threat (3)
Perm Harm
(2)
Temp Harm (1)
None (0) High (3)
Med (2)
Low (1)
None (0)
Poor (3)
Fair (2)
Good (1)
Geography and Community
High Risk Patients1. Surgical 2. ICU3. NICU4. Oncology 5. Dialysis 6. Transplant 7. Antibiotic
resistance, multi- drug resistant organism.
INFECTION CONTROL RISK ASSESSMENT
H.A.I BARRIERSBARRIERS OUTCOMES MEASURES
STAFF ATTRITION DECLINE IN INFECTION CONTROL PRACTICES
TEACHING,BETTER H.R INITIATIVES
BUDGETARY ALLOCATION H.I.C
REDUCED SPENDIND ON H.I.C
TAKING/RESULTS TO HOSPITAL ADMINISTRATORS
OVERPRESCIBING OF ANTIBIOTICS
INCREASED COSTS,INCREASE INCIDENCO OF M.D.R.O
FEEDBACK BY QUARTERLY ANTIBIOGRAMS,LOCAL ANTIBIOTIC REGIME FOR I .C.U/WARDS,REGALAR ANTIBIOTIC AUDITS,
ANTIBIOTIC PRACTICES• EDUCATION REGULAR FEEDBACK PROVIDED TO
DOCTORS NURSING STAFF ABOUT HOSPITAL ANTIBIOGRAMS
• FORMULARY RESTRICTION
ANTIOTIC RESTRICTION FORM BEING USED FOR RESERVE ANTIBIOTICS TEIGYCYCLINE,TEICOPLANIN,VANCOMYCIN AND LINEZOLID
• INTRAVENOUS TO ORAL SWITCH
BEING MONITORED BY REGULAR ANTIBIOTIC AUDITS
• COMPUTERISED ORDER ENTRY
COMPUTERISED ORDER ENTRY IN PHARMACY
• AUTOMATIC STOP ORDERS
NOT IMPLEMANTED
ANTIBIOTIC PRACTICES
•INCORPORATION OF GUIDELINES
LOCAL DATA OF I.C.U AND WARDS USED TO FORMULATE EMPIRIC POLICY FOR AREAS.DATA RELEASED IN INFECTION CONTROL BULLETIN.
•EXTENDED INFUSION OF BETA LACTUM ANTIBIOTICS
BEING DONE FOR M.D.R PATIENTS
INITIATIVES FOR INFECTION CONTROL/PROJECTS UNDERWAY• COLOUR CODING OF CLEANING ARTICLES AND PATIENT EQUIPMENT
ZONEWISE E.G. I.C.U/WARDS/OPD/DIAGNOSTICS• INCORPORATION OF SELECTIVE ANTIBIOTIC REPORTING IN LAB
SOFTWARE .• NEW REGIMES/EXTENDED ZONE INFUSIONS TO TACKLE WITH MDRO
ORGANISIMS.• AUTOMATION OF LAB EQUIPMENT FOE FASTER DETECTION AND
SURVEILLANCE• PRE MRSA SWABS FOR HIGH RISK PATIENTS/NEUTROPENIC PATIENTS