Hospital Practices and Research

Abstract Background: Hospital-acquired infections (HAIs), particularly device-associated infections (DAIs) in ICUs, pose a significant global health burden, especially in low- and middle-income countries.
Objectives: This study aims to estimate the HAI burden by analyzing DAI rates and resistance patterns in ICU settings, contributing to evidence-based infection control strategies.
Methods: We conducted a six-month prospective observational study in the adult ICU of GTBH (July–December 2024), focusing on patients with DAIs. Incidence and device utilization rates were calculated using CDC-standardized metrics based on device and patient days.
Results: Out of 286 patients, 40 developed a total of 62 DAIs, comprising 25 cases of ventilator-associated pneumonia (VAP) (40.3%), 19 cases of catheter-related bloodstream infections (CLABSI) (30.65%), and 18 cases of catheter-associated urinary tract infections (CAUTI) (29.03%). VAP had the highest cumulative infection rate (22.6%), followed by CLABSI (21%) and CAUTI (10.8%). Acinetobacter baumannii was the dominant isolate in VAP cases, Klebsiella pneumoniae and Enterobacter spp. were predominant in CLABSI cases, and non-albicans Candida was the leading pathogen in CAUTI cases. Significant antimicrobial resistance was observed, especially among Acinetobacter and Pseudomonas species. Notably, the case fatality rate among DAI patients reached 57.5%.
Conclusion: In conclusion, our surveillance study highlights a substantial burden of DAIs in the ICU, with VAP being the most prevalent. The dominance of multidrug-resistant pathogens and the striking 57.5% fatality rate emphasize the urgent need for robust infection control, tailored stewardship programs, and continuous local epidemiological monitoring.

Abstract Background: Alcohol-based antiseptics are widely used in clinical settings for skin disinfection prior to procedures, with efficacy dependent on both concentration and adequate wet contact time. Despite recommendations to allow antiseptics to air dry naturally, practices such as fanning or blowing are commonly used to hasten drying. The impact of such practices on antiseptic efficacy and safety remains unclear.
Objectives: To systematically map the existing literature on the effects of accelerated drying, particularly through fanning, blowing, or forced evaporation, on the antimicrobial efficacy of alcohol-based antiseptics used for skin disinfection.
Methods: A scoping review was conducted following the Arksey and O’Malley framework and the PRISMA-ScR guidelines. Five databases (PubMed, Embase, Scopus, CINAHL, and Web of Science) and grey literature sources were searched from inception to July 2025. Eligible studies examined alcohol-based antiseptics and assessed drying methods or contact time in relation to antimicrobial efficacy. Data were synthesized thematically.
Results: Eighteen publications met inclusion criteria, comprising experimental studies, clinical guidelines, technical protocols, and reviews. Four key themes emerged: (1) Sufficient wet contact time is essential for antimicrobial efficacy; (2) Fanning or accelerated evaporation reduces microbial kill rates, particularly for Staphylococcus aureus; (3) Surgical and clinical guidelines emphasize complete natural drying due to infection and fire risk; and (4) There is a lack of clinical trials evaluating infection outcomes or real-world adherence to drying recommendations.
Conclusion: Accelerating the drying of alcohol-based antiseptics can compromise antimicrobial efficacy by shortening contact time and has no support in current guidelines. Despite its widespread use, fanning remains unvalidated and potentially harmful. There is a need for clinical research on the impact of drying practices and adherence to protocols in real-world settings.

Abstract The choice between disposable and reusable medical supplies remains a critical challenge in healthcare systems worldwide, particularly in low- and middle-income countries. While disposable items offer the advantage of infection prevention, they contribute significantly to biomedical waste and impose recurring financial burdens. Reusable supplies, on the other hand, present economic and environmental benefits but carry infection control risks if sterilization practices are inadequate. This paper explores the trade-offs between safety, sustainability, and cost in the context of Indian healthcare institutions, including experiences from apex institutes like AIIMS. Global trends, environmental implications, and emerging innovations in reprocessing technologies are also discussed. The findings support the need for a hybrid, risk-based strategy that optimizes both resource utilization and patient safety. Strengthening sterilization infrastructure, establishing national reuse protocols, and investing in low-cost innovations are recommended to balance the competing priorities of modern healthcare delivery.

Abstract Background: Device-Associated Infections (DAIs) pose significant challenges in healthcare settings, leading to increased morbidity, mortality, and healthcare costs. Understanding the impact of the COVID-19 pandemic on DAIs and device utilization rates is crucial for optimizing infection control practices and enhancing patient safety.
Objectives: This study aims to elucidate the shifts in infection rates, specifically CAUTI, VAP, and CLABSI in a tertiary care centre before and after the onset of the global pandemic.
Methods: In this retrospective study, we analysed trends in DAIs and device utilization rates before (October 2019 - March 2020) and after (August 2021 - January 2022) the COVID-19 pandemic. Data on urinary catheter days, central line days, ventilator days, and rates of Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infection (CLABSI), and Ventilator-Associated Pneumonia (VAP) were collected from medical records.
Results: According to the findings of the present study, fluctuations in CAUTI, CLABSI, and VAP rates pre- and post-pandemic, with no significant difference in infection rates between the two periods (P >0.05) were observed. There was a notable increase in urinary catheter days post-pandemic, accompanied by reductions in ventilator days and central line days. The urinary catheter utilization ratio substantially increased post-pandemic, while ventilator and central line utilization ratios showed slight declines.
Conclusion: This study highlights the dynamic nature of DAIs and device utilization rates in the wake of the COVID-19 pandemic. Implementing evidence-based protocols and continuing research in infection control practices are essential for optimizing healthcare delivery and enhancing patient safety in the post-pandemic era.

Abstract Background: Device-associated infections (DAIs) like ventilator-associated pneumonia (VAP), central-line-associated blood stream infections (CLABSI), and catheter-related urinary tract Infection (CAUTI) constitute predominant healthcare-associated infections (HAIs) in intensive care units (ICUs).
Objectives: The study aims to elucidate their trends in an adult ICU.
Methods: Over 21 months, monthly VAP, CLABSI, and CAUTI rate, and device utilization ratios were calculated in an adult ICU of a tertiary care hospital as part of routine surveillance activity. All cases of VAP, CLABSI, and CAUTI during these 21 months were included. In addition, monthly hand hygiene compliance rates were assessed during the latter period of the study by direct observation method.
Results: Nosocomial DAI rate was 49.38 DAI/1000 ICU days. CAUTI, CLABSI, and VAP rates were 17.38, 26.85, 21.08 per 1000 device days, and device utilization ratios were 0.99, 0.61, and 0.02, respectively.
Conclusion: The institute had high DAI rates in comparison to other studies from the same city. The declining trend of CAUTI rates roughly coincided with surveillance for hand hygiene compliance in ICU. Thus, it establishes baseline data and underscores the need for focused HIC to maximize patient outcomes.

Abstract Legionella infections caused by contaminated water are a widespread problem worldwide. Discharge lamps like mercury vapor lamps are widely known for the disinfection properties of their radiation, but they suffer technical disadvantages, like high voltages and toxic content, and are, therefore, not suitable for some infection control applications. New high-intensity ultraviolet (UV) and violet LEDs offer new approaches for Legionella control, because these bacteria are significantly light sensitive compared to other pathogens. One of the most important infection pathways is the inhalation of Legionella-containing aerosols during showering. This problem could be reduced by a single strong UV LED within the shower head, which irradiates the passing water for some milliseconds. This practice can be especially beneficial in hospitals and care facilities. UV light offers only a limited penetration depth, however, even in pure water. To disinfect larger water volumes, e.g., in water dispensers, visible violet LEDs are more appropriate. Unfortunately, up to now, neither approach has been given much attention by potential users.