K-487. Infection Control in a Public Sector: Surgical Intensive Care Unit in Pakistan
Session: Poster Session: (Almost) Everything You Wanted to Know about VAP/HAP
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: Health care associated infections and antimicrobial resistance are major challenges in resource limited settings. We describe efforts towards introducing infection control (IC) practices and establishment of antimicrobial resistance surveillance in a public sector hospital in Karachi. Methods: This study was conducted in an 8 bedded Intensive Care Unit. IC principals were introduced through interactive sessions; minimum contact time/person; 6 hours, with pre and post session questionnaire based knowledge assessments. Surveillance for Ventilator Associated Pneumonia (VAP) was conducted (May-November 2007) and rates compared with retrospective data (July-December 2006). Respiratory isolates of all patients with VAP were screened for antimicrobial resistance (AMR) in accordance with CLSI guidelines. Results: While the assessment indicated knowledge transfer, VAP rates were similar in the pre and post intervention periods. Of 37 VAP patients, Acinetobacter spp was isolated in 28(75.7%), P. aeruginosa in 18(48.6%) and K.pneumoniae in 9(24.3%). 23(62.1%) had more than one organism. All of Acinetobacter spp and 72% of P.aeruginosa were multidrug resistant (resistant to more than two classes of drugs). Antibiotic selection was inappropriate in 89% (25) of cases with Acinetobacter spp and in 56% (10) with P.aeruginosa. Mean stay of nosocomially infected patients (6.5days) was significantly higher than for uninfected group (2.1 days) (p<0.0001). Mortality rate of patients infected with two organisms was 56% versus 43% in those with a single organism. Conclusions: Our data points to limitations of educational sessions in impacting infection control practices, and to the need for additional behavioural changes tools in such settings. High AMR and inappropriate antimicrobial choice are cause of concern. Impact of nosocomial infections resulting in increased hospitalisation and greater morbidity in low resource settings needs further study.
Afia Zafar, MBBS, FRCPath1, Farhan Zafar, MBBS2, Muhammad Khan, MB, BS3, Rumina Hasan, MBBS, PhD, FRCPath1, Saeeda Haider, MBBS, MCPS, FCPS4, Safia Siddiqui, MBBS, MCPS, FCPS4 and  M. S. Khan, None., (1)Aga Khan University, Karachi, Pakistan, (2)Aga Khan Univ. Hosp., (3)Aga Khan Univ. Hosp., Karachi, Pakistan, (4)Dow Univ. of Health Sciences