**10. Routine monitoring of health care set up**

Though for developed countries it is said that routine monitoring of Hospital Environment e.g. bacteriological sampling of air, floor or surfaces is not required unless and until there is 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 patients to actually zero in our hospital.

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 incubated at 370 C overnight. Colony counts and detection of organisms are done by Infection 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.

## **10.1. Hospital infection report form**

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,

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

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

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

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‐

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

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

Though for developed countries it is said that routine monitoring of Hospital Environment e.g. bacteriological sampling of air, floor or surfaces is not required unless and until there is

length polymorphism (RFLP), Multilocus sequence typing (MLST) etc.

ceae in OTICU or Post operative ward etc. need special attention.

throat or nasal carriage of Staphylococcus aureus especially MRSA.

**10. Routine monitoring of health care set up**

patients both clinically and Microbilogically should be done, in any outbreak.

targeted surveillance etc [70].

22 Infection Control

be mentioned in detail.

**9.3. Antibiotic policy**

antibiotic prescription

**9.2. Surveillance of infections in HCWs**

**9.1. Calculation of rate of infection**

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, sent to Microbiology laboratory and informed to Infection Control Team.
