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: 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 Background: Endotracheal intubation (EI) associated with mechanical ventilation (MV) is frequently performed in critically ill patients admitted to intensive care unit (ICU) with sepsis.
Objectives: This study aimed to assess the impact of important factors on the duration of tracheal intubation in patients with sepsis at the ICU admission.
Methods: Adult patients admitted to the mixed medical–surgical ICUs with sepsis at the ICU admission who needs prolonged mechanical ventilation (PMV) (≥ 21 days) were included in this retrospective secondary analysis study. The primary outcome was ICU mortality. Baseline demographic and clinical characteristics of all patients were assessed as risk factors associated with the duration of MV by univariate and multivariate Binary logistic regression.
Results: Eighty-five patients required more than 21 days of MV. Out of the 85 patients, 52 (61.2%) patients were intubated within 30 to 34.50 days and 33 (38.8%) patients had intubation within 34.51 to 65 days, and categorized as PMV and very prolonged MV groups, respectively. Two parameters were significantly associated with very prolonged MV which are as follows: older age 1.229 (95% CI: 1.002-1.507, P = 0.048) and long hospital stay (LOS) 2.996 (95% CI: 1.676-5.356, P < 0.001). No significant survival difference was observed between the two groups of study. (33.3% vs. 25%, P = 0.406).
Conclusion: Our observations showed that the older age and LOS as pre-ICU stay in patients with positive sepsis at the ICU admission can prolong the duration of intubation. In addition, no significant survival difference was observed between patients with PMV and very prolonged MV.

Abstract Background: Sepsis is a very common serious medical condition among patients admitted to the intensive care units (ICUs) that increases with age and ICU length of stay (LOS).
Objectives: The primary goal of this study was to estimate the mortality rate due to sepsis among adult patients admitted to the mixed medical–surgical ICUs for a long time. The secondary goal was to identify factors associated with predicting ICU mortality in individuals with long-term ICU LOS.
Methods: Adult patients admitted to the medical ICU for a long time (≥75 days) were included in this retrospective secondary analysis study. Baseline demographic, clinical, and laboratory data were recorded upon inclusion in the study.
Results: ICU mortality occurred in 78 (43.1%) patients, out of 188 participants. A greater portion of patients with sepsis at admission (62.7%) were observed in the death group (59.2% vs. 30.8%, P < 0.001), than the survivor group. Additionally, survived patients differed significantly in terms of age, family engagement, baseline cognitive impairment, activity, nurse anticipated turnover scale (ATS), duration of a mechanical ventilator (MV), and ICU LOS. The results of multivariate binary logistic regression showed that the older age and low family intervention can increase the risk of mortality in patients with sepsis at the time of admission, with a long ICU LOS.
Conclusion: Our findings are crucially important to increase the awareness of the impact of sepsis, highlight the need for continued research into potential preventive and therapeutic interventions, and help guide resource allocation.