**9.1. Calculation of rate of infection**

This can be estimated by Prevalence rate, Incidence rate, Attack rate (cumulative incidence rate), Antimicrobial resistance rate (no. of MRSA/100 admissions) and incidence rate (MRSA/ 1000 patient days). Prompt feedback to clinicians and HCWs is most essential part to reduce the incidence of HAI and to identify the areas for improvement in quality patient care. Even molecular methods can be adopted for typing and early detection like Restriction fragment length polymorphism (RFLP), Multilocus sequence typing (MLST) etc.

In case of outbreak, the immediate control measures should be undertaken to break the chain of transmission. The control measures including, isolation or cohorting of infected case, strict hand washing and aseptic practices should be immediately implemented. Follow up of patients both clinically and Microbilogically should be done, in any outbreak.

Time to time uptodate information must be given to hospital administration, public health authorities, district, state and National Health bodies. In the final report, the cause of outbreak whether facilities available for detection of causative organisms in health care set up, measures taken to control out break and contribution of each member in Infection Control Team should be mentioned in detail.

Major outbreak generally occurs in Health Care set up due to Staphylococcus aureus/MRSA/ Pseudomonas aeruginosa in NICU, or Salmonella sp. in any wards or MRSA/ESBL producing MDRO or MBL producing Pseudomonas aeruginosa/Carbapenem resistant Enterobacteria‐ ceae in OTICU or Post operative ward etc. need special attention.

#### **9.2. Surveillance of infections in HCWs**

Surveillance in HCWs is specially required for blood borne pathogens e.g. HIV, HCV and tuberculosis, detection of carrier stage for Salmonella typhi in kitchen staffs or surgeons/ residents/HCWs working in OT/Post operative wards/different ICUs should be screened for throat or nasal carriage of Staphylococcus aureus especially MRSA.

#### **9.3. Antibiotic policy**

Every health care set up must have its own antibiotic policy and a system for monitoring of antibiotic prescription
