title: Control of hospital acquired infections in the ICU: A service perspective.
abstract: BACKGROUND
  The service setting has some unique strengths and weaknesses that must be kept in mind when organizing Hospital acquired infections (HAI) prevention interventions.
  
  
  METHODS
  Following an initial study to gather data regarding HAI in the Surgical intensive care unit (ICU) we put into place various infection control interventions. The present study was carried out to analyse the effect of these interventions on the incidence of HAI in the ICU.
  
  
  RESULTS
  The total admissions to the ICU were 253 patients. Eighty eight patients (34.78%) were admitted for more than 48 hr, 165 patients stayed for less than 48 h. The frequency of HAI was 7.95% (95% CI 3.54, 15). Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%) (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000 ventilator days. Bloodstream infection was detected in 3 out of 88 patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections per 1000 Central Venous Catheter days. Urinary tract infection was observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per 1000 catheter days. As compared to the previous study we found that there was a decline of HAI ranging from 60 to 70%.
  
  
  CONCLUSIONS
  Our study demonstrated that by meticulously following infection control protocols especially tailored to the service setting the incidence of HAI's can be reduced. However, the challenge is in maintaining the gains achieved since there is a rapid turnover of manpower in the ICU and a lack of a structured ICU design model.
authors.affiliation: Senior Adviser (Anaesthesiology & Critical Care), Command Hospital (Western Command), C/O 56 APO, India.
authors.forename: Shivinder
authors.initials: S
authors.lastname: Singh
authors.affiliation: Senior Advisor (Anaesthesiology), Command Hospital (Southern Command), Pune 411040, India.
authors.forename: Rakhee
authors.initials: R
authors.lastname: Goyal
authors.affiliation: Ex-Professor & Head, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India.
authors.forename: G S
authors.initials: GS
authors.lastname: Ramesh
authors.affiliation: Commandant, Command Hospital (Southern Command), Pune 411040, India.
authors.forename: V
authors.initials: V
authors.lastname: Ravishankar
authors.affiliation: Associate Professor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India.
authors.forename: R M
authors.initials: RM
authors.lastname: Sharma
authors.affiliation: Clinical Tutor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India.
authors.forename: D V
authors.initials: DV
authors.lastname: Bhargava
authors.affiliation: Assistant Professor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Resident, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India.
authors.forename: M K
authors.initials: MK
authors.lastname: John
authors.affiliation: Resident, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India.
authors.forename: Anoop
authors.initials: A
authors.lastname: Sharma
keywords: Catheter associated urinary tract infection; Catheter related blood stream infection; Hospital acquired infections; Ventilator-associated pneumonia