Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East.

BACKGROUND: The proficiency of nursing professionals in the infection prevention and control (IPC) practices is a core component of the strategy to mitigate the challenge of healthcare associated infections. AIM: To test knowledge of nurses working in intensive care units (ICU) in South Asia and Middle East countries on IPC practices. METHODS: An online self-assessment questionnaire based on various aspects of IPC practices was conducted among nurses over three weeks. RESULTS: A total of 1333 nurses from 13 countries completed the survey. The average score was 72.8% and 36% of nurses were proficient (mean score > 80%). 43% and 68.3% of respondents were from government and teaching hospitals, respectively. 79.2% of respondents worked in < 25 bedded ICUs and 46.5% in closed ICUs. Statistically, a significant association was found between the knowledge and expertise of nurses, the country's per-capita income, type of hospitals, accreditation and teaching status of hospitals and type of ICUs. Working in high- and upper-middle-income countries (ß = 4.89, 95%CI: 3.55 to 6.22) was positively associated, and the teaching status of the hospital (ß = -4.58, 95%CI: -6.81 to -2.36) was negatively associated with the knowledge score among respondents. CONCLUSION: There is considerable variation in knowledge among nurses working in ICU. Factors like income status of countries, public vs private and teaching status of hospitals and experience are independently associated with nurses' knowledge of IPC practices.

Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey.

Background: Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings. Material and methods: An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols. Results: Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times). Conclusion: We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country. How to cite this article: Sodhi K, Khasne RW, Chanchalani G, Jagathkar G, Kola VR, Mishra M et al. Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey. Indian J Crit Care Med 2023;27(1):38-51.

Comparison of knowledge and awareness of infection control practices among nurses in India: A cross-sectional survey.

BACKGROUND: Healthcare-associated infections (HAIs) are a significant threat in healthcare settings. Since nurses have the most day-to-day contact with patients, their knowledge about infection control (IC) practices is crucial in preventing HAIs. We therefore conducted a study to assess the knowledge and awareness of IC practices amongst nurses across hospitals in India. METHODS: An online survey-based, cross-sectional, descriptive study for nurses was conducted in July-August 2021, through a multiple-choice questionnaire, administered via a web-based link across 13 hospitals from various cities of India. Five different aspects of IC knowledge were assessed including general IC, standard precautions, transmission-based precautions, bundle care knowledge, and COVID-19 related knowledge. RESULTS: Complete data filled by 1,000 nurses was analyzed. The knowledge of nurses varied across different aspects of IC. A statistically significant association was found between the IC knowledge and the years of experience (P = .003) and the area of working (critical vs semi-critical areas) (P < .001) of nurses. A statistically significant difference was also found in the knowledge of nurses from different hospitals depending upon the accreditation (P < .001) and the teaching status (P = .035), but no significant difference based on the city category of hospital (P > .05). Accreditation showed the strongest association {ß = 2.499 (95% CI = 1.67-3.32)} while non-teaching status had a negative impact {ß = -1.76 (95% CI = 2.543 to -2.543)} on knowledge using multivariate linear regression analysis. CONCLUSIONS: Infection prevention and control is the biggest challenge in any hospital and improving the knowledge and awareness of the nurses on the same is fundamental to its success. A multifaceted approach of continuing education programs, training, and feedback should be undertaken towards improving the awareness and compliance to IC practices.

Pattern of colistin resistance in Klebsiella isolates in an Intensive Care Unit of a tertiary care hospital in India.

BACKGROUND: Carbapenem resistance among multidrug resistant organism is a growing global concern with high rates being reported from South Asia and Mediterranean countries. It is associated not only with high morbidity and mortality, but also pose a grave health hazard. Among various studies, it has been found that among the gram-negative bacteria Klebsiella species is found to have a high resistance. The aim of the study was to evaluate the prevalence and pattern of colistin resistance in Klebsiella species (spp.) in a tertiary care hospital in India. METHODS: An audit of microbiological data of all Klebsiella spp. isolates from blood, urine, sputum and pus was collected from patients admitted to intensive care unit (ICUs) between 1st January 2015 to 31st December 2017 and the prevalence of Colistin resistance in Klebsiella spp. was calculated. RESULTS: Over a period of thirty six months, 2499 isolates were identified from culture positive specimen of blood, urine, sputum, broncho-alveolar lavage (BAL) fluid and pus from patients admitted to ICU. Among the total isolates 21.32% (n=533) of Klebsiella spp. were isolated and 1.28% (n=30) of isolates were colistin resistant. In patients admitted to ICU, colistin resistant Klebsiella spp. was identified in 8.75% (n=14) of the total blood samples, 4.26% (n=7) in urine samples and 4.4% (n=8) in sputum and BAL samples. CONCLUSION: The prevalence of Colistin resistant Klebsiella spp. was estimated to be 5.6% in our ICU. Colistin resistant Klebsiella is becoming an emerging threat in ICU settings limiting further treatment options. Stringent surveillance and robust antibiotic stewardship program to tide over this crisis is need of the hour.

Convulsions in a critically ill patient on hemodialysis: Possible role of low dose colistin.

The increasing prevalence of multi-drug resistant Gram-negative pathogens in intensive care units has led to the revival of colistin. Colistin had gone into disrepute in early 1970s because of numerous reports of adverse renal and neurological effects. The renewed interest in colistin has also revived the discussion about its toxicity. The neurotoxicity reported in literature is usually with higher doses of colistin. We present a case report of seizures in a critically ill-patient, possibly with low dose colistin. A 47-year-old hypertensive female with chronic kidney disease-5 with sepsis on colistimethate sodium 1 million units (80 mg), intravenous once daily, developed paresthesias and seizures on 12(th) day of therapy, which were subsequently controlled after withdrawl of the drug. To conclude, colistin should be considered as a cause of convulsions in critically ill-patients with renal failure, even when given in low dose and patient receiving intermittent hemodialysis, when other obvious causes have been ruled out. When possible, cessation of therapy may be considered.

Knowledge of infection control practices among intensive care nurses in a tertiary care hospital.

BACKGROUND: The threat of hospital-acquired infections persists despite advances in the health care system. A lack of knowledge regarding infection control practices among health care workers decreases compliance with these practices. We conducted a study to assess the knowledge of infection control practices among nursing professionals at our hospital. METHODS: In total, 100 nurses in the intensive care units at our hospital were given a questionnaire with 40 multiple choice questions, including 10 questions each regarding hand hygiene, standard and transmission-based precautions, care bundles and general infection control practices. The responses were scored as percentages. RESULTS: The overall knowledge and awareness regarding different infection control practices were excellent (>90% positive responses) in 5% of the nursing professionals, good (80-90% positive responses) in 37%, average (70-80% positive responses) in 40% and below average (<70% positive responses) in 18%. CONCLUSION: The infection control knowledge among the nurses was fairly good; however, there is still a wide scope of improvement with regular educational programs and in-house training.