**9. Surveillance of Hospital Acquired Infections(HAI)**

The rates of HAI serve as indicators of quality and safety of patient care at the Health care facility. The Hospital infection Surveillance system is for early detection of outbreaks or appearance of a new organism or new MDRO or even new antimicrobial resistant organism. Surveillance should be done at hospital level and at Regional or National level.

The most commonly utilized sources of surveillance are Microbiology reports and are part of 'alert organism surveillance'. The methods are mainly daily analysis of Microbiology reports, laboratory records and clinical assessment, infection prevalence, HAI incidence study, targeted surveillance etc [70].

an outbreak. But we have experienced that routine monitoring of OT specially for Clostridium perfringens and Clostridium tetani has reduced tetanus and gas gangrene in post operative

Infection Control Practices in Health Care Set-Up

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We collect minimum 5 swabs for each OT from the sites like 1. OT table, 2. Overhead lamp, 3. Boyle's apparatus, 4. Instrument trolly, 5. Floor near OT table routinely on Monday morning. After fumigation on Saturdays and closing the OT for 40 - 48 hours about 80 – 100 swabs on every Monday morning are collected. With proper cleaning of wound and implementing all aseptic practices, no tetanus or gas gangrene cases have been reported in last 10 years, even from Trauma ICU and Emergency OTs where Road accident cases are handled. Moreover, our Infection Control Nurse, collect swab from different wards and ICUs from 5 minimum sites and maximum 10 sites e.g. 1. Disinfectant solution, 2. Dressing trolly, 3. IV stand, 4. Fabric, 5. Switch Board, 6. Gauge Piece, 7. O2 Cylinder, 8. Ventilator 9. Suction machine, 10. Gown.

On every Tuesday, approximately 50 – 80 swabs, moistened with Brain Heart Infusion broth are collected from those above mentioned sites and cultured on Nutrient agar and then

Control Technician and Microbiologists in the Infection Control Team. Disinfectant solutions where cheatle forceps are kept and gauze pieces which are used in dressings, eye drop from ophthalmology wards, pads from Labour room and Gynaecology & Obstetric wards are compulsorily taken for monitoring. If any organism is grown from disinfectant solution, gauze pieces or eye drops, immediately the clinician and ward sister is informed telephonically to discard it. Though our hospital is a tertiary care hospital but it is in a rural set up and caters patients from different nearby villages also. By observing this protocol, major outbreaks in Ophthalmology or Post operative wards could be reduced to almost nil in last 10 years.

Every Health care set up must have their own Hospital infection Report form The Hospital infection report form must include name of the patient, age & sex, registration number, laboratory number, date of admission, bed number, ward, name of the clinician, clinical diagnosis, history of any major invasive procedure or operation (date/OT used/duration of ICU stay), nature of infection, antibiotics received etc. The form should be filled up by clinician,

We also take different educational programmes like CMEs and Workshops for HCWs, technitians and doctors from time to time about infection control practices e.g. hand hygiene,

The only silver lining to the serious problem of HAI is 36% of all HAIs are preventable if Infection Control Practices are followed by HCWs. Hand hygiene is the simplest and most

effective measure before and after each patient contact to reduce the risk of HAI.

sent to Microbiology laboratory and informed to Infection Control Team.

**11. Educational programmes for hospital staffs**

antimicrobial resistance, sterilization of OT etc.

C overnight. Colony counts and detection of organisms are done by Infection

patients to actually zero in our hospital.

**10.1. Hospital infection report form**

incubated at 370
