title: Device-associated infections at a level-1 trauma centre of a developing nation: impact of automated surveillance, training and feedbacks.
abstract: OBJECTIVE
  Device-associated infections constitute the majority of health care-associated infections (HAIs) in ICUs. Trauma patients are predisposed to acquire such infections due to various trauma-related factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the impact of an intensive surveillance on the rates and outcome of device-associated infections in trauma patients from a developing country and compares the rates with a previous pilot observation.
  
  
  METHODS
  The study was conducted at a level-1 trauma centre of India. Surveillance for ventilator-associated pneumonia (VAP), central line-associated blood stream infections (CLA-BSIs) and catheter-associated urinary tract infections (CA-UTIs) was done based on centre for disease control-National Healthcare Safety Network (CDC-NHSN) definitions. The impact of an intensive surveillance, education and awareness drive on the rates of infections over the study period, and compliance to preventive bundles and hand hygiene was assessed.
  
  
  RESULTS
  A total of 15,462 ventilator days, 12,207 central line days and 17,740 urinary catheter days were recorded in the study population. The overall rates of VAP, CLA-BSI and CA-UTI were respectively 17, 7.2 and 15.5/1000 device days. There was a significant correlation between device days and the propensity to develop infections. Infections were the cause of death in 36.6% of fatal trauma cases. A significantly higher rate of VAP, CLA-BSI and CA-UTIs was noted in fatal cases. The compliance to ventilator bundle, central line bundle, bladder bundle and hand hygiene were 74.5%, 86%, 79.3% and 64.6%, respectively. A high rate of multi-drug-resistance was observed in all pathogens. A gross reduction in the rates of all infections was observed over time during the study due to implementation of a stringent surveillance system, feedbacks and education. The compliance to hand hygiene and preventive bundles also increased over time.
  
  
  CONCLUSIONS
  The automated surveillance was easy and useful for data entry and analysis. Surveillance had a significant impact on reduction of HAIs and mortality in trauma patients.
authors.affiliation: Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India.
authors.forename: P
authors.initials: P
authors.lastname: Mathur
authors.forename: V
authors.initials: V
authors.lastname: Tak
authors.forename: J
authors.initials: J
authors.lastname: Gunjiyal
authors.forename: S A
authors.initials: SA
authors.lastname: Nair
authors.forename: S
authors.initials: S
authors.lastname: Lalwani
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: B
authors.initials: B
authors.lastname: Gupta
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: D
authors.initials: D
authors.lastname: Gupta
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001521:Behavior Therapy / Q000379:methods*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D003906:Developing Countries; D004502:Education, Medical, Continuing; D062665:Epidemiological Monitoring; D004864:Equipment and Supplies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult