Hospital infection control(Indicators)

HOSPITAL INFECTION CONTROL(INDICATORS) DR JAYANT BALANI CONSULTANT MICROBIOLOGIST(MBBS,MD)) DHARAMSHILA HOSPITAL &RESEARCH CENTRE, NEW DELHI

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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


CLABSI(PERM)

012345678

Jul-12 Aug-12

Sep-12

Oct-12 Nov-12

Dec-12


CENTRAL LINE ASSOCAITED BLOODSTREAM INFECTION(CLABSI

PERM)

0

2

4

6

8

Jan-12 Feb-12 Mar 12 Apr-12 May-12 Jun-12


CATHETER ASSOCIATED URINARY TRACT INFECTION(CAUTI)

01234567

Jan-12 Feb-12 Mar12

Apr-12 May-12

Jun-12


CAUTI

01234567

Jul-12 Aug-12

Sep-12

Oct-12 Nov-12

Dec-12


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


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


SURGICAL SITE INFECTION(CONTAMINATED)

02468

10121416

Jan-12 Feb-12 Mar12

Apr-12 May-12

Jun-12


SURGICAL SITE INFECTION(CONTAMINATED)

0

2

4

6

8

10

Jul-12 Aug-12

Sep-12

Oct-12

Nov-12

Dec-12


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



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



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



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


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



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



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



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



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, multidrug 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

Health & Medicine

Hospital infection control(Indicators)