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Surveillance of Healthcare-Associated Bloodstream and Urinary Tract Infections in a National Level Network of Indian Hospitals

Published online by Cambridge University Press:  02 November 2020

Purva Mathur
Affiliation:
All India Institute of Medical Sciences, New Delhi
Paul Malpiedi
Affiliation:
US Centers for Disease Control and Prevention
Kamini Walia
Affiliation:
Indian Council of Medical Research, New Delhi
Rajesh Malhotra
Affiliation:
All India Institute of Medical Sciences, New Delhi
Padmini Srikantiah
Affiliation:
Former CDC/BMGF
Omika Katoch
Affiliation:
All India Institute of Medical Sciences, New Delhi
Sonal Katyal
Affiliation:
All India Institute of Medical Sciences, New Delhi
Surbhi Khurana
Affiliation:
All India Institute of Medical Sciences, New Delhi
Mahesh Chandra Misra
Affiliation:
MGMC Jaipur
Sunil Gupta
Affiliation:
Safdarjang Hospital, New Delhi
Subodh Kumar
Affiliation:
All India Institute of Medical Sciences, New Delhi
Sushma Sagar
Affiliation:
All India Institute of Medical Sciences, New Delhi
Naveet Vig
Affiliation:
All India Institiute of Medical Sciences, New Delhi
Pramod Garg
Affiliation:
All India Institute of Medical Sciences, New Delhi
Arti Kapil
Affiliation:
All India Institute of Medical Sciences, New Delhi
Manoj Sahu
Affiliation:
All India Institute of Medical Sciences, New Delhi
Arunaloke Chakrabarti
Affiliation:
PGI Chandigarh
Pallab Ray
Affiliation:
PGI Chandigarh
Manisha Biswal
Affiliation:
PGI Chandigarh
Neelam Taneja
Affiliation:
PGI Chandigarh
Priscilla Rupali
Affiliation:
Christian Medical College
Vellore Binila Chacko
Affiliation:
CMC Vellore
Joy Sarojini Michael
Affiliation:
CMC Vellore
Veeraraghavan Balaji
Affiliation:
CMC Vellore
Camilla Rodrigues
Affiliation:
Hinduja Hospital, Mumbai
Vijaya Lakshmi Nag
Affiliation:
AIIMS Jodhpur
Vibhor Tak
Affiliation:
AIIMS, Jodhpur
Vimala Venkatesh
Affiliation:
KGMU Lucknow
Chiranjay Mukhopadhyay
Affiliation:
KMC Manipal
KE Vandana
Affiliation:
KMC Manipal
Muralidhar Varma
Affiliation:
Kasturba Medical College, Manipal University
Vijayshri Deotale
Affiliation:
MGIMS Sevagram
Ruchita Attal
Affiliation:
MGIMS Sevagram
Kanne Padmaja
Affiliation:
NIMS Hyderabad
Chand Wattal
Affiliation:
Sir Ganga Ram Hospital, Delhi
Neeraj Goel
Affiliation:
Sir Ganga Ram Hospital, Delhi
Sanjay Bhattacharya
Affiliation:
Tata Medical Center
Tadepalli Karuna
Affiliation:
AIIMS Bhopal
Saurabh Saigal
Affiliation:
AIIMS Bhopal
Bijayini Behera
Affiliation:
AIIMS Bhubaneswar
Sanjeev Singh
Affiliation:
Amrita Institute of Medical Sciences
MA Thirunarayan
Affiliation:
Apollo Hospital, Chennai
Reema Nath
Affiliation:
Assam Medical College
Raja Ray
Affiliation:
IPGMER Kolkata
Sujata Baveja
Affiliation:
LTMMC Mumbai
Mammen Chandy
Affiliation:
Tata Medical Centre, Kolkata
Sudipta Mukherjee
Affiliation:
Tata Medical Centre, Kolkata
Manas Roy
Affiliation:
Tata Medical Centre, Kolkata
Gaurav Goel
Affiliation:
Tata Medical Centre, Kolkata
Swagata Tripathy
Affiliation:
AIIMS Bhubaneswar
Satyajeet Misra
Affiliation:
AIIMS Bhubaneswar
Anupam Dey
Affiliation:
AIIMS Bhubaneswar
Tushar Mishra
Affiliation:
AIIMS Bhubaneswar
Hirak Raj
Affiliation:
IPGMER Kolkata
Bashir Fomda
Affiliation:
SKIMS Kashmir
Gulnaz Bashir
Affiliation:
SKIMS Kashmir
Shaista Nazir
Affiliation:
SKIMS Kashmir
Sulochana Devi
Affiliation:
RIMS Imphal
Khuraijam Ranjana Devi
Affiliation:
RIMS Imphal
Langpoklakpam Chaoba Singh
Affiliation:
RIMS Imphal
Padma Das
Affiliation:
All India Institute of Medical Sciences, Raipur
Anudita Bhargava
Affiliation:
AIIMS Raipur
Ujjwala Gaikwad
Affiliation:
AIIMS Raipur
Neeta Khandelwal
Affiliation:
GMC Surat
Geeta Vaghela
Affiliation:
GMC Surat
Tanvi Sukharamwala
Affiliation:
GMC Surat
Prachi Verma
Affiliation:
MGMC Jaipur
Mamta Lamba
Affiliation:
MGMC Jaipur
Shristi Jain
Affiliation:
MGMC Jaipur
Prithwis Bhattacharyya
Affiliation:
NEIGRIHMS Shillong
Anil Phukan
Affiliation:
Neigrihms Shillong
Clarissa Lyngdoh
Affiliation:
NEIGRIHMS Shillong
Rajeev Sharma
Affiliation:
US Centers for Disease Control and Prevention
Rajni Gaind
Affiliation:
Safdarjung Hospital and VMMC, Delhi
Rushika Saksena
Affiliation:
Vardhman Mahavir Medical College and Safdurjung Hospital
Lata Kapoor
Affiliation:
National Centre for Disease Control
Neil Gupta
Affiliation:
US Centers for Disease Control and Prevention
Aditya Sharma
Affiliation:
US Centers for Disease Control and Prevention
Daniel VanderEnde
Affiliation:
US Centers for Disease Control and Prevention
Anoop Velayudhan
Affiliation:
US Centers for Disease Control and Prevention
Valan Siromany
Affiliation:
Centers for Disease Control & Prevention
Kayla Laserson
Affiliation:
Former CDC/BMGF
Randeep Guleria
Affiliation:
All India Institute of Medical Sciences, New Delhi
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Abstract

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Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.

Funding: None

Disclosures: None

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
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