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Regular Surveillance Can Reduce Hospital-Acquired Infection

We are writing in response to the article by Johnson et al¹ on bacterial colonization of patients’ bath basins in 3 acute care hospitals in the United States. Without question, regular surveillance of any reservoir of bacterial colonization in every hospital would assist in our collective efforts toward reducing nosocomial infection.

In fact, just such surveillance took place at Sant Parmanand Hospital, a 140-bed, multispecialty, tertiary care hospital in Delhi, India. Beginning in 2003, swabs were drawn from different operative sites for major or minor surgical interventions. Wards for patients in intensive care as well as medical, surgical, and neonatal units also were sampled. These samples were collected at frequent intervals from wash basins, electrical switches and appliances, trolleys, floors, and cupboards.

In 2007 and 2008, a total of 1274 and 1651 swabs were drawn from environment sites, and 1782 and 1411 were drawn from intensive care sites. Six isolates from surgical operation sites were identified in 2007 and 1 was identified in 2008. In 2007, Klebsiella pneumoniae, was isolated from wards on 5 occasions. During 2008, in addition to isolation of K pneumoniae, again on 5 occasions, Pseudomonas aeruginosa was isolated twice and Proteus species once.

Our hospital uses a low concentration of formaldehyde-free Bacillocid rasant for cleaning and disinfection. Any microbial isolation in the surgical operative sites or wards serves as a warning for staff to act instantly to disinfect the incriminated sites using a high-concentration liquid organic cleaner. The process is accompanied by fresh samplings at repeated intervals.

Concurrently, since October 2002, culture-based surveillance for hospital-acquired infection (HAI) also is being performed. HAI cases are identified by a cutoff of 2 to 3 days between hospitalization and positive culture for a pathological specimen from the patient.² Initial data for the first 6 months were set as the baseline. The incidence per 100 admissions in the beginning was 0.97 (standard error 0.26), while subsequent rates have been significantly lower, the latest being 0.42 ±0.11 and 0.46 ±0.04.

Culture-based scrutiny of any reservoirs for bacterial infection¹ as well as any culture-based identification of HAI episodes would be helpful for addressing the scourge of HAI in multidisciplinary hospitals.

FINANCIAL DISCLOSURES
None reported.

REFERENCES

1. Johnson D, Lineweaver L, Maze LM. Patients’ bath basins as potential sources of infection: a multicenter sampling study. Am J Crit Care. 2009;18(1):31–40.[Abstract/Free Full Text]
2. Arya SC, Agarwal N, Agarwal S. Hospital acquired infection—point prevalence or culture-based surveillance [letter]? J Infect Prevention. 2008;9(2):23–24.

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