Usha Krishnan, K (2018) A Study on Assessment of Challenges and Effectiveness of Infection Control Measures in a Tertiary Care Hospital using Specific Infection Control Indicators. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.
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Abstract
HCAI is a major threat to the safety of patient care and it is a growing problem all over the world especially public sector hospital in a developing country. MAJOR INFECTION CONTROL INTERVENTIONS DURING THE STUDY: Focus Group Discussion, Training and education of HCPs on hand hygiene and infection control practices, Bundle approach was introduced for CAUTI prevention, maintaining charts in the form of monitoring tools on CAUTI and MDROs isolated from patients‟ clinical samples, and Providing Information Education Charts (IEC), ready reckoner materials at work place. • A total of 359 patients in the pre intervention and 353 patients in the post intervention phase were included in the study. • There was no significant variation in the male:female ratio.(1.01:1). • Various clinical samples with suspected infection, a total of 439 specimen in the pre intervention and 441 specimen in the post intervention were collected and subjected to culture in the study period. • The most common isolates were gram negative pathogens. There was no significant difference between infection rate between base line and the post interventional phases. p =0.218. • In catheterised patient with clinically suspected CAUTI, 168 urine specimen in the pre intervention phase and 130 urine specimen in the post intervention phase were collected and subjected to culture. The rate of development of CAUTI was higher as the duration of catheterization increased. p value 0.033946, Chi square value 6.766. • CAUTI rate calculated at the end of the pre and post intervention phase 22 and 21 per 1000 catheter days respectively. • The mean duration of catheterisation was 11 days and 8.7 days in the pre and post intervention phases respectively. • Trend analysis of CAUTI rate was done by comparing 4 data points‟ showed significant reduction in infection rate. p= 0.012. • In this study, maximum number of MDR pathogens were isolated from Tracheal aspirate specimen. K.pneumoniae (33%) was the most common MDR pathogen followed by Acinetobacter spp. (25%) and Pseudomonas spp. (20%). • ESBL rate was 78% and 70% in the pre and post intervention phases respectively. • There was no significant difference in the carbapenemase production (p= 0.667) in both the phases of the study. • After the intervention, there was a vast improvement in the HHC (p=0.007) and CAUTI rate was reduced significantly. • In an IMCU setting, the urinary tract of catheterized patients is highly susceptible to infection by MDR pathogens. • HCAI associated with varied microbiological etiology and 39-46% of them was MDROs. • As the rate of development of CAUTI is significantly associated with the duration of catheterization emphasis should be made on reducing the duration of catheterization. • Intervention by training and education of HCP in infection control and HH significantly increased HHC. • Introduction of Bundle concepts in the prevention of CAUTI was very much beneficial with decrease in mean duration of catheterization by 2.3 days and CAUTI rate was significantly reduced in the post intervention phase. • Practising the IC methods such as HH and CAUTI bundle approach ultimately leads to cost effective patient care and patient safety. • MDRO rate and infection rate of Blood, tracheal aspirate, sputum and sterile fluid specimen were not significantly decreased. • CAUTI prevention bundle approach was successful as it was specific and focused. • Problems associated with infection prevention and control in a public sector hospital is multifactorial involving infrastructure, environmental and personnel. Comprehensive infection control intervention should not only involve training and education but should address all these factors. • Major barriers to Infection control, recognized in this study related to lack of administrative support leading to inconsistent and inadequate supply of alcoholic hand hygiene products and under staffing and high bed occupancy of patients. • Understanding the perspectives of infection control practices among HCPs is essential in planning interventions in a health care setting. • Epidemiological Surveillance of HCAI is essential to understand the nature and extent of problem also it supports the clinicians in treating infections and helps in planning the prevention strategies to ensure a quality health care in any hospital. • Administrative support is critical and it plays a pivotal role in effective implementation of infection control practices. LIMITATIONS: The study analyzed the effectiveness of IC practices using only three indicators. Many factors should be involved for improving IC in IMCU, as it is very difficult and complicated to improve IC.
| Item Type: | Thesis (Doctoral) |
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| Additional Information: | 24131/2015 |
| Uncontrolled Keywords: | Challenges, Effectiveness, Infection Control Measures, Tertiary Care Hospital, Specific Infection Control Indicators. |
| Subjects: | MEDICAL > Microbiology |
| Depositing User: | Subramani R |
| Date Deposited: | 01 Apr 2022 17:19 |
| Last Modified: | 01 Apr 2022 17:19 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19145 |
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