Guidelines for prevention of hospital acquired infections

Yatin Mehta; Abhinav Gupta; Subhash Todi; Sn Myatra; D P Samaddar; Vijaya Patil; Pradip Kumar Bhattacharya; Suresh Ramasubban

doi:10.4103/0972-5229.128705

Guidelines for prevention of hospital acquired infections

Indian J Crit Care Med. 2014 Mar;18(3):149-63. doi: 10.4103/0972-5229.128705.

Authors

Yatin Mehta¹, Abhinav Gupta², Subhash Todi³, Sn Myatra⁴, D P Samaddar⁵, Vijaya Patil⁶, Pradip Kumar Bhattacharya⁷, Suresh Ramasubban⁸

Affiliations

¹ Institute of Critical Care and Anesthesiology, Medanta- The Medicity, Gurgaon, India.
² Critical Care, Medanta - The Medicity, Gurgaon, India.
³ AMRI Group of Hospitals, Kolkata, India.
⁴ Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai, India.
⁵ Department of Anaesthesiology and Critical Care, Tata Main Hospital, Tata Steel Limited, Jamshedpur, Jharkhand, India.
⁶ Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Dr. E Borges Road, Parel, India.
⁷ Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
⁸ Critical Care, Apollo Gleneagles Hospital, Kolkata, West Bengal, India.

Abstract

These guidelines, written for clinicians, contains evidence-based recommendations for the prevention of hospital acquired infections Hospital acquired infections are a major cause of mortality and morbidity and provide challenge to clinicians. Measures of infection control include identifying patients at risk of nosocomial infections, observing hand hygiene, following standard precautions to reduce transmission and strategies to reduce VAP, CR-BSI, CAUTI. Environmental factors and architectural lay out also need to be emphasized upon. Infection prevention in special subsets of patients - burns patients, include identifying sources of organism, identification of organisms, isolation if required, antibiotic prophylaxis to be used selectively, early removal of necrotic tissue, prevention of tetanus, early nutrition and surveillance. Immunodeficient and Transplant recipients are at a higher risk of opportunistic infections. The post tranplant timetable is divided into three time periods for determining risk of infections. Room ventilation, cleaning and decontamination, protective clothing with care regarding food requires special consideration. Monitoring and Surveillance are prioritized depending upon the needs. Designated infection control teams should supervise the process and help in collection and compilation of data. Antibiotic Stewardship Recommendations include constituting a team, close coordination between teams, audit, formulary restriction, de-escalation, optimizing dosing, active use of information technology among other measure. The recommendations in these guidelines are intended to support, and not replace, good clinical judgment. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of evidence supporting the recommendation, so that readers can ascertain how best to apply the recommendations in their practice environments.

Keywords: Antibiotic Stewardship; Burns; Hospital Acquired Infection prevention; Monitoring Surveillance; Standard Precautions.