Ict Newsletter Final (1) - 1

INFECTION CONTROL TRENDS VOLUME 1 | ISSUE 1 | SEPT 2018
INFECTION CONTROL TRENDS

newsletter
Volume 1 | Issue 1 | September 2018
Circulation: Quarterly | All-India | e-Copy format
CHIEF EDITOR EDITOR EDITOR & CONCEPT TEAM MEMBER

Dr. Ranga Reddy Dr. T V Rao Dr. Dhruv Mamtora Sister Solbymol
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PREFACE
Respected INFECTION PREVENTIONIST,
Modern science is evolving beyond belief. However, while saving millions of lives through several advanced
healthcare interventions, we also witness an unintended consequence: Healthcare Associated Infection (HAI).
This inaugural edition of Infection Control Trends introduces some important issues regarding healthcare workers,
patients and healthcare infections.
HAI can be avoided, and healthcare workers in particular are critical in making this happen. By better
understanding HAI contributing factors, healthcare professionals can apply measures which will contribute to the
safe care that patients expect and deserve.
It has been amazing to see so many accomplished professionals very passionately supporting this project.
We thank and congratulate one and all for their contributions in making this journal see the light.
Our vision is to bring all latest trends in Infection Control in a simple, straightforward and actionable format.
Please send your comments, suggestions and contributions to help make this journal richer with each passing
edition.
Warm regards,
Dr. Ranga Reddy Burri
Dr. Dhruv Mamtora
Sister Solby
FORWARD
I wish to share a few of my thoughts on starting a WhatsApp group. It was an idea from Dr. Srinivasa and Dr.
B N Gokul. Both Freelance Clinical Microbiologists from Bangalore, they suggested we have a Professional Group
where members can share their good and scientific thoughts to all those who wish to see Medical Microbiology
in action and bring all our efforts to change how the present didactic teaching of Microbiology for the benefit of
many in the world. The idea caught on and we created the group, “Infection Control Trends”. This idea has now
formulated to form this e-Newsletter Infection Control Trends.
Dr. Ranga Reddy, President, IFCAI, and our Patron, has given the required boost to create a e-Newsletter
on Infection Control Trends. Dr. Dhruv has taken great responsibility in all matters in bringing out this present
e-Newsletter. Sister Solbymol P S is always helpful in contributing her expertise in Infection control.
This is just a beginning. At present, we are publishing all the articles sent with your expertise. Wish to receive
more cooperation and contributions.
Thanking all
Dr. T. V. Rao MD
Editorial Member
Former Professor of Microbiology
Statutory disclaimer: In no event shall Infection Control Trends be liable for any special, incidental, indirect or consequential damages
of any kind, or any damages whatsoever resulting from loss of use, data or profits, whether or not advised of the possibility of damage,
and on any theory of liability, arising out of or in connection with the use or performance of this information. The ideas and opinions
expressed in Infection Control Trends do not necessarily reflect those of Editorial team members. Infection Control Trends neither
endorses nor takes responsibility for any products, goods or services offered by outside vendors through its services or advertisements.
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EDITORIAL TEAM
Dr. T. V. Rao is former Professor of Microbiology qualified with
MD Microbiology from Andhra Medical College Visakhapatnam (AP).
He has chosen the specialty not accidentally but with determination
to be part of the system, his experiences in Zambia seeing many
dying with infections and having few resources is great challenge and
practically patients to be treated blindly, Certainly he believes much
of the progress of Microbiology started with onset of AIDS pandemic
many and the new era of Diagnostic Microbiology started , and his
association with scientific Microbiologists at ICMR ( NICED Calcutta)
taught what all we all doing is many times not right ,and it needs
dedication and sincerity and just teaching unpracticed Knowledge
will detoriate profession unless one actually involved with the
Diagnostic Laboratory and bed side medicine his observation is
Darwin’s theory is working well with Microbes and they posing a
real challenges, However it is time to rethink ones role as Medical
Microbiologists / Clinical Microbiologists and certainly the Society
Dr. T. V. Rao awakened to the present needs and demands making one to realize
Former Professor of Microbiology ANTIBIOTICS ARE NOT MAGIC BULLETS, but soft weapons to destroy
Email: doctortvrao@gmail.com the progress of Medicine, Today he has created content to help
many in the developing country, to his satisfaction he has more
than 5 million followers Globally.
Dr. Ranga Reddy Burri is Health policy enthusiast focused on

public health awareness, education and training. He is committed
to improvement of patient safety in India and other low resource
settings. His vision is to improve professional practice standards
for infection prevention and control across India and the setting
of standards and framework for credentialing of infection control
professionals.
Dr. Reddy is Physician, Public Health specialist and Social
Entrepreneur with interest in business verticals of high social
impact. He graduated from Minsk Government Medical Institute,
Belarus with MD (Physician) degree; subsequently he did his PG
Diploma in management from Pondicherry University and Advanced
Management from IESE, Barcelona, Spain with specialization in
Strategy & Business Development.
Dr. Reddy is the founder trustee of Infection Control Academy
of India (IFCAI). The organization is a result of his leadership skills,
knowledge and experience gained from working in both domestic and
international MNCs. Yet, the Academy’s most valuable strength lies
in the strong sense of empathy for humans and their health imparted
by Dr. Reddy and his colleague trustees. His effort has translated Dr. Ranga Reddy
into creating several long term programs in IPC segment. His current President IFCAI and Chief Editor
responsibility includes leading Sanmed Healthcare, a startup with
“Infection Control Trends”
world class manufacturing capabilities in external preparations.
Email: dr.rangareddy@ifcai.in
Additionally, he supports several non-profit organizations in the
capacity of advisor including Neelam Rajasekhar Reddy Research
Center for Social Progress, e-learning center of Hyderabad Central
University & Indian Institute of Public Health.
His flair for entrepreneurship has led him to mentor through
imparting knowledge to NGO’s, startups & micro-small enterprises.
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Dr. Dhruv Mamtora is a clinical microbiologist and infection

control officer at S. L. Raheja Hospital, A Fortis associate, Mahim,
Mumbai since 2015. Before joining in private sector, he has worked
with government sector both in Maharashtra state as assistant
professor at RCSM GMC Kolhapur and GMC Latur as assistant
professor and AIIMS, Jodhpur as senior resident.
He has passed out MBBS from L. T. M. Medical College (Sion
Hospital) and done MD in microbiology from Government medical
college, Miraj. He has done his healthcare administration EPGDHA
from TISS, Mumbai and he is a New York state certified infection
control professional.
He is member of multiple professional bodies like IAMM, IATP,
IMA, HIS-MF (institutional), society of clinical microbiologists (SCM)
and ISID (international society of infectious diseases).
He has number of publications in peer reviewed journals both
national as well as international and he is also faculty and speaker
for various national and international conferences. He has also
organized many training activities and a national level conference
on “systemic approach to hospital hygiene and infection control” in
Mumbai in year 2018.
He is also a media subject expert on subjects like hospital
acquired infection, infection control and infectious diseases.
Dr. Dhruv Mamtora He is subject expert on infection control for clean India journal.
Consultant Microbiologist He has also guided as well as multiple projects related
and Infection Control Officer to healthcare which is in field of infection control and clinical
Email: dhruv_mamtora@yahoo.com microbiology namely national survey on infection control practices
in collaboration with Clean India journal and POCD in infection
control in collaboration with IITB.
He has been awarded multiple times in his organization and at
national level.
His topics of interest are implementing and improving quality
in healthcare, hospital and laboratory accreditation, clinical
microbiology, infection control, antimicrobial stewardship and
improving medical education to a minimum basic standard which
is suitable for current healthcare scenario in country and on
international level.
Sister Solbymol P S is a PICU Nurse with 19 years of experience.

She has worked as In-charge PICU Rainbow Children’s Hospital,
Hyderabad and Vikrampuri, senior staff at Ernakulam Medical
Centre Kochi. She is now working as Coordinator Quality and
Infection Control Nurse at Kinder Women’s Hospital and Fertility
Centre, Cherthala, Alappuzha.
Solbymol P S
GNM, ICCP
Email: solbyps@gmail.com
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INDEX
Editorial - Infection Prevention & Control Best Practices 06

For Attaining “Ayushman Bharat”
Dr. Ranga Reddy
Guest Editorial - Infection Control Trends: Helping with 07

Health for all, and Infection for none.
Professor Ramon Z. Shaban
Challenges Faced By Current Passing Out Microbiologists In The 08

Present Indian Scenario
Dr. H Srinivasa
Postgraduate Teaching Of Clinical Microbiology In India: 10

Let’s Take It From The Bench To Bedside
Dr. Prashant Purohit
Health Care Associated Parasitic Infections: Time To Rethink? 12

Dr. Abhijit Chaudhury
The Economic Impact Of Nosocomial Infections 13

Dr. R. Sukanya
“Effective Communication In Microbiology” Way To Save Lives, 14

Reduce Antimicrobial Resstiance
Dr. Samitha Nair
Antibiotic Resistance 15
Dr. Prabakar
From Desk Of Editor And Designer For Infection Control Trends- 18

National Survey On Infection Control Practices: Why And How?
Dr. Dhruv Mamtora
Namaskar: Smartness Out Of The Traditional Box 20

Dr. Sourav Maiti
India Antimicrobial Stewardship and Resistance [InTeRest Survey] 22

Dr. Aditya Shah
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EDITORIAL
INFECTION PREVENTION & CONTROL BEST PRACTICES
FOR ATTAINING “AYUSHMAN BHARAT”
Dr. Ranga Reddy

President IFCAI and Chief Editor
“Infection Control Trends”
Email: dr.rangareddy@ifcai.in
India is leading the world in economic progress with consistent GDP growth. As per voluntary national review
report on Social Development Goals (SDG), GOI has reported to UN that progress is made in 7 out of 17 SDG’s like
Ending poverty, Ending Hunger, Improving Nutrition etc.,
Progress is also reported in Health and Well-being through implementation of National Health Mission (Ayushman
Bharat), National Vector Borne Disease Control Program, National Program for Prevention of Non Communicable
Diseases.
Our medical fraternity and scientists are making significant progress in developing new techniques, pharmaceutical
products and medical procedures for addressing the disease burden and economical treatment.
While all this is laudable we are losing millions of lives and billions of rupees due to lack of education, coherent
policy and effective implementation on Hospital Acquired Infections. Despite several advances in healthcare and allied
fields of science, in terms of infection prevention and control (IPC), we have not arrived at best. Even if we are trying,
we are not yet achieving it.
World Health Organization’s (WHO’s) Report on the Burden of Endemic Health Care-Associated Infection
Worldwide shows that HAIs continue to be the most frequent adverse event in health care delivery worldwide. That
same study reports, for every 100 of the world’s hospitalized patients, somewhere between 7 and 10 will acquire at
least one HAI. A recent meta-analysis reported burden of endemic HAI’s in developing countries to be higher at 15.5
patients per 100 patients.
The time has come to strengthen infection prevention and control capacity and capability by embedding human
factors principles, methods, expertise and tools. Infection prevention measures could help develop interventions that
work safely within the healthcare system.
If the gains of recent years are to be maintained and if the defects in processes and adherence to protocols are
to be successfully overcome, it is first and foremost essential to achieve healthcare professional behavior change.
This is possible only through better awareness and education. Our challenge is to create a learning and performance
environment that turns healthcare into a high-reliability industry.
Ayushman Bharat is very ambitious project of Government of India. The success of this project will be dependent
on several factors, in our opinion IPC is one of the key factors in whether we succeed or fail in this work.
If we had to make “Healthy India” a reality we must make IPC better, much better. IPC is synonymous with
preventing all preventable deaths, shorter hospital stays, timely recuperation, avoid long-term disability and billions of
saved Rupees.
As our humble contribution in building “Capacity of Infection Preventionists”, we are bringing out this e-journal
called “Infection Control Trends”. A team of multidisciplinary healthcare specialists in collaboration with Infection
Control Academy will be working hard to make this journal a source of knowledge and practical advice on IPC matters.
With the cooperation of every member in” Infection control trends” we can reach to the narrow corners of world to
educate the Professionals who care life as we all believe and work with mission that TEAM WORK SAVES LIIVES.
We hope you will find this initiative helpful for your practice and enjoy the articles by leading clinicians, academia
and practitioners of IPC in India and worldwide.
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GUEST EDITORIAL
INFECTION CONTROL TRENDS: HELPING WITH HEALTH FOR ALL
AND INFECTION FOR NONE
Professor Ramon Z. Shaban

Immediate Past President, Australasian College for Infection Prevention
and Control
Clinical Chair, Infection Prevention and Control
Susan Wakil School of Nursing and Midwifery and Marie Bashir Institute
for Infectious Diseases and Biosecurity, Faculty of Medicine and Health
The University of Sydney and Western Sydney Local Health District, Australia.
Email: ramon.shaban@sydney.edu.au
It is the greatest of pleasures that I write to you today to launch the inaugural issue of the e-journal Infection
Control Trends.
In 2016 I had the greatest honor and privilege of visiting your most extraordinary country. It was my first time to
India. I visited my esteemed colleagues, Dr Ranga Reddy and Dr Mustafa Afzal, in Hyderabad. We toured many facilities
and places. I met lots of new people and made many, many new colleagues and friends. Most importantly, I was
fortunate enough experience first-hand the tremendous warmth and hospitality with my new colleagues and friends.
I am at a loss to find the words to adequately describe my experience of your glorious country, a land and people
abound with good will, culturally rich beyond measure and beauty in the land as far as the eye can see. And while
things it can feel that are a long way from perfect, the same of which is said and experienced in all countries world over,
there is so much the world has to learn and benefit from in India.
It is this very same sense of purpose and good will that drives us as infection control professionals. As infection
control practitioners we occupy privileged place in society. We are guardians of health and wellbeing for individuals,
their families and our community. Like Ayushman Bharat we serve to protect everyone from healthcare-associated
infections. Our purpose is for a Healthy India, and a Healthy World. Central to this goal is to have no poverty, zero
hunger, clean water and sanitation which are fundamental for good health and well-being. Helping our people to help
themselves through decent work and economic growth will both improve and be improved by gender equality and
reduced inequality, which will help industry, innovation and infrastructure to flourish where everyone can make the
best contribution they can. A policy of responsible consumption and production where we look after our water and our
land through climate action and the development of sustainable cities and communities are at the heart of the future
for all communities globally. Importantly, such goals can only be achieved in through peace and justice, and even more
important this success is partnerships and team work. These sustainable development goals are part and parcel of our
work to prevent, control and contain the spread of healthcare-associated infection.
As Dr Ranga wisely points out, the time has definitely come for us to do much more to galvanize our and advanced
our infection prevention and control capacity and capability, not only in India but around the world. The rise of
antimicrobial resistance threats the health and security of all people and all nations, and it threats our very existence.
Infection Control Trends is an important vehicle and tool in our pursuit for a Healthy India and a Health World. I
commend it to you most highly, and I look forward to watching it flourish in the years to come.
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CHALLENGES FACED BY CURRENT PASSING OUT

MICROBIOLOGISTS IN THE PRESENT INDIAN SCENARIO
Dr. H Srinivasa
Former Professor, SJMC Bangalore
Currently a free lance Clinical Microbiologist &Infection Control advisor
Email: dr.srinivasa.micro@gmail.com
Introduction
Microbiologists after acquiring post graduate course come to the professional platform for a career. During the
3 years of post graduation they are supposed to master topics prescribed by University. Get good marks in theory
and practical prescribed by University. No doubt many become successful teachers and mentors in big institutes and
colleges.
However when they enter professional career the job requirements command skills that needs good communication
skills, to take responsible decisions at individual level unlike in colleges where HOD/department Peers are there to takes
a call and be collectively responsible for decisions taken. The clinical microbiologists have to work with smart machines
and technicians of varied levels of expertise and experience. Sometimes a newly passed out clinical microbiologist has
to team with newly recruited technician and run all round Microbiology service. Decision has to be taken and clinical
microbiologist may or may not think of pros and cons of decision taken and its impact in clinical management. Though
there are talks of Reorientation in teaching UG/PG in microbiology by experts, there is still huge gap in what a post
graduate perceives as his job and what modern hospital expects out of him to deliver!
Challenges faced by freshly recruited clinical microbiologist and Infection control officers
Thus current young passed out microbiologists as well as those who in their mid career enter non college hospitals
is faced with many challenges. To list some of them
1. have to reorient their work culture to suit present day hospital care. Since lab is becoming hi-tech automated, the
clinical microbiologist s are in great Demand as infection disease specialists involved in assisting infection control, of
the whole hospital as a team. the clinicians of the present day having worked in corporate hospitals in India and abroad
though can handle clinical situations , depend on evidence based medicine and hence wants clinical microbiologist
to assist in Infectious disease diagnosis/cause of sepsis, long drawn fever etc besides, recognition ,management ,
prevention of nosocomial infections.
2. opinion on antibiotic selection, duration, handling drug resistance, to Suggest any synergy, escalation de-escalation,
interpretation of MIC values.
3. fungal etiology in unusual presentation, identification and antifungal sensitivity interpretation, when to start
antifungal etc.
4. need to pass on information on alert organisms, unusual organisms, exotic and strange organisms causing infections
how to manage.
5. guidelines and protocols are there for health care infection prevention and management but clinical microbiologist
needs to study existing standard international guidelines, adopt and customize based on local needs. This is where
real challenge Egs of some of the topics Use of disposables, reuse of items, waste management Diet and nutrition of
patient.... Anti microbial prophylaxis, vaccination policy, safe injection practice, lab diagnosis, counseling of HBV, HCV
patients, anti viral therapy management TB testing, prophylaxis.
6. To be actively involved in day to day hospital rounds, interact with hospital administrators and clinician.
7. Presentations of local Antibiogram and their interpretation in clinical forum.
8. CSSD, OT, dialysis units provide advice.
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9. Advice in management and containment of community outbreak, /epidemic of infections like cholera, H1N1, typhoid,
viral fevers etc. they are being involved in sending accurate data on notifiable diseases.
10. if a freshly microbiologist starts these services and works with different teams , for at least 5 years then only
they can acquire maturity in their day to day practice. In many hospitals the clinical microbiologists has to implement
national guidelines which is available but still may not be familiar to clinicians e.g. Antimicrobial therapy of infections
by ICMR, NABL,/NABH.JCI standards
Suggestions for shaping a successful Career
In modern day, however freshly joined clinical microbiologist need not be pessimistic. He should utilize the time
to acquire the above mentioned skills.
He can acquire these skills only by systematic self learning online, everyday; it is also a good practice to learn from
organisms isolated and clinical situations encountered. It is a good practice to write a daily notes detailing how the
clinical situations were resolved. Only by being available to clinicians and having dialogues and exchanging meaningful
information during daily rounds enriches the status of clinical microbiologist.
He may have to initiate new committees, e.g. infection control committee, hospital/lab accreditation committee,
quality team etc. He should be much sought and is expected to give expert advice on any problem of Infection posed
by clinicians/administrators on a day to day basis.. For this he should be up to date and a walking encyclopedia on all
aspects of infectious diseases.
I remember how much struggle we used to get access to a hardcopy of guideline or protocol or publication or case
report when asked by our teachers, now it is available at the click of a button. To that extent he can quickly analyze the
situation and give expert advice.
Also Thanks to online platforms like what’s up our expert colleagues are available instantly to share their knowledge
and experience.
What is most important to apply the acquired knowledge and customize to suit the local hospital?
Keeping in mind local prevalence of organisms, local antibiotic usage, more important is that are you working
in urban or rural scenario? Former is more problematic as difficult to identify is masked by prior therapy, migrant
population, lifestyle diseases However the latter situation is not easy, the rural area has limited resources, skilled
manpower you need to deal with serious cases of infection like cholera, meningitis, pneumonia, septic shock etc, issues
which may or may be text book like Recognition, quick diagnosis and prevention measures are important advisories
and all steps to be taken to prevent becoming an unmanageable outbreak.
In short though good salary is offered to Clinical microbiology/Infection control specialists, the early face of his
career, he is faced with many challenges. By dedication and hard work he can overcome the lacunae. Learn the required
skills. Those Clinical microbiologists will be gradually recognized and accepted by practicing clinicians as a part of their
clinical team. Which itself is a certificate that you are doing well!
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POSTGRADUATE TEACHING OF CLINICAL MICROBIOLOGY IN INDIA:

LET’S TAKE IT FROM THE BENCH TO BEDSIDE
Dr. Prashant Purohit

Senior Specialist,
Clinical Microbiology Unit, Sabah Hospital, Ministry of Health, Kuwait
Email: pphit1@gmail.com
The Preamble
The present postgraduate teaching of Medical/Clinical Microbiology in India is more focused on the bench work
in the laboratory rather than on the clinical aspects. This training churns out a good technologist but not a ‘clinical’
microbiologist. Medical science has become so vast and advanced, that one can only concentrate more on his/her
core specialty rather than infection prevention, control and treatment. Clinical microbiologist is the best person to be
entrusted upon these tasks. But impart him a level of proficiency in the subject; we need to overhaul our postgraduate
teaching. This article will try to have a bird’s eye view on the prevailing problems, and then will try to explore the
possible solutions.
The Problem(s)
The first one is lack of a countrywide standard, unified curriculum. This is appalling that Medical Microbiology
has no curriculum of its own, despite the presence of many eminent microbiologists of international repute. The
curriculum should include not only the text to be taught, but also the clear aims and objectives, work-schedule of
the resident (the postgraduate student), posting Rota, and the method of objective evaluation at multiple stages of
learning. The evaluation eventually shapes the teaching style. At the outset of the training the trainee should know
what is expected of him/her.
How To Go For It: A Couple of Examples
The Royal College of Physicians and Surgeons of Canada runs a postgraduate teaching program ‘CanMEDS’. It
describes seven ‘Roles’ the resident needs to show the efficiency in: Medical Expert, Communicator, Collaborator,
Leader, Health Advocate, Scholar, and Professional. Each of these roles comprises of key-concepts which give an
opportunity to evaluate the resident in each of the area by objective scoring system, deciding about the progression of
the resident further. These roles also encompass patient safety and quality issues.1
The Royal College of Pathologists (RCP), United Kingdom also has a very structured program for medical
microbiology teaching. Its website carries all the details regarding curriculum, training structure, evaluation methods,
examination sample papers, guidance for audits etc.2
Kuwait Institute for Medical Specialization (KIMS) is a regulatory body which is dedicated to the task of framing,
running and regulating the various postgraduate programs in Kuwait. Largely, KIMS follows the CanMEDS, but the day-
to-day, and end of rotation evaluations are done with the help of the RCP, UK evaluation templates. The evaluations are
based on the examinations, daily observations and feedback by the immediate supervisor, a 360 degree feedback from
laboratory and clinical colleagues, and patients. Apart from training in the bench work, the residents are taken for daily
rounds of intensive care units and wards under supervision. They are also trained in conducting audit and research.
They are given the tasks to follow the patients with positive cultures of blood, CSF and other body-fluids, accompany
the supervisor in different meetings with the Infection Control Committee, multidisciplinary teams (for quality and
safety, for patient management), and different management committees of the hospital, and are encouraged to
participate proactively. The residents are taught the critical appraisal of published articles, policy- development, usage
of laboratory-, and hospital-information systems. Overall, the resident is made to face the real life situations.
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The examples of these three countries have been cited just for getting an idea and to emphasize that a consolidated
and updated curriculum is the first and foremost requirement. The teaching methods may vary from country to country.
The advantage of such structured programs is that the resident knows that what is expected of him/her at the end of
the training, and also, as everything is being documented, passing or failing the candidate is maximally objective. Yet
efforts are always ongoing to improve the objectivity.
What we can do in India?
In India the system is closer to the British system. Unlike the US and Canada, there is no formal countrywide
training for the Infectious Diseases. Medical microbiologists are the most appropriate ones to take care of infectious
disease management in India, as they have the know-how of the organisms, their pathogenicity and the antimicrobials.
The most pragmatic approach would be to make the training in medical microbiology more clinical.
A dedicated body of teachers independent of MCI or NMC should be formed. Then that body first develops
a curriculum applicable across all the medical colleges. It should develop a unified evaluation system which would
encompass each of the training areas enlisted in the curriculum. It also describes an organized system of rotating the
residents in different sections of the subject, as well as in different medical colleges during their training (if required),
so that they may get the experience of all the types of infections and testing facilities, which vary in different colleges
of India. Patient/staff safety, laboratory quality, audits and research should be an integral part of the training and
evaluation. To make it more practicable, a few centers in each state may be identified as reference laboratories for
different sections of microbiology where all residents will have rotational postings. A system of sending the residents
to the appropriate hospitals/laboratories for short rotations should be set up.
Working towards making training more clinical would help the clinical colleagues, develop a team work and will
also increase the reputation of the Indian training globally which at present is not considered to be at par with other
countries.
References:
1. Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/rcsite/canmeds/framework/
canmeds-role-leader-e.
2. The Royal College of Pathologists, United Kingdom. https://www.rcpath.org/specialist-area/microbiology.
html?types=documents.
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HEALTH CARE ASSOCIATED PARASITIC INFECTIONS:

TIME TO RETHINK?
Dr. Abhijit Chaudhury

Professor, Microbiology
Sri Venkateswara Institute of Medical Sciences & Sri Padmavathi Medical
College (Women) Tirupati 517507, Andhra Pradesh.
Email: ach1964@rediffmail.com
Health care associated infections always conjure up an image of countless multidrug resistant bacteria, a few viruses,
and a couple of fungi. Parasites? Oh, you must be joking doctor! But, with such a response, we may be turning a blind
eye to a grossly under-reported and neglected scenario. The Extended Prevalence of Infection in Intensive Care (EPIC
II) study carried out in 2007 collected information of 14,414 patients in 1265 participating ICUs from 75 countries and
found that the proportion of parasites in nosocomial infections was 0.48%. 1 Apart from hospital associated diarrhoeal
diseases and transfusion/organ transplantation transmitted parasitic infections which are reported sporadically, not
much information is available regarding the others types of hospital infections.
Parasites have been found to cause diarrhoea in 12–17% of nosocomial epidemics and 1% of endemic outbreaks,
the agents responsible being Cryptosporidium spp., Entamoeba histolytica, Giardia lamblia and Blastocystis spp.2
Among the helminths, Enterobius vermicularis has been found to cause rapid outbreaks in paediatric wards.
Transplantation patients are at increased risk for any type of opportunistic infection and according to literature
parasitic infections affect around 5% of organ recipients 3 and most of the reports concern kidney transplants. The most
common parasites reported have been Entamoeba coli, Endolimax nana, and Strongyloides stercoralis. The majority
of the infections are helminthic infections commonly associated with water or food contamination with the added
possibility of transfer through infected organ.
Transfusion transmitted infection is given its due importance by Transfusion Medicine personnel with screening
for malaria parasite an integral part of donor counselling and blood testing in India. A recent systematic review has
revealed 100 cases of transfusion transmitted malaria reported worldwide beginning from 1911 with the following
species distribution: 45% Plasmodium falciparum, 30% P.malariae, 16% P. vivax, 4% P.ovale, 2% P. knowlesi, and 1%
mixed infection P. falciparum/P. malariae 4. Screening for American Trypanosomiasis is routine in many South American
countries, and since 2013, it has been approved by FDA in USA as well. Apart from these two parasites, post-transfusion
or post-transplant infections with Toxoplasma gondii and Leishmania spp. have also been reported.
The sanitary condition of hospitals plays a great role in harbouring and spread of hospital pathogens. A number
of studies have shown the importance of various arthropods in spreading the pathogens in hospital environment,
the most important being cockroaches, followed by flies, fleas and mites. Scabies infestation and myiasis in admitted
patients are also distinct entities not commonly clubbed under hospital associated infections.
References:
1. Vincent J.L., Rello J., Marshall J., Silva E., Anzueto A., Martin C.D, Moreno R., Lipman J., Gomersall C., Sakr Y., Reinhart K.
International study of the prevalence and outcomes of infection in intensive care units. Journal of American Medical Association;
2009, 302: 2323-2329.
2. Aygun G., Yilmaz M., Yasar H., Aslan M., Polat E., Midilli K., Ozturk R., Altas K. Parasites in nosocomial diarrhea: are they
underestimated? Journal of Hospital Infection; 2005, 60: 283-285.
3. Barsoum R.S. Parasitic infections in organ transplantation. Experimental and Clinical Transplantation; 2007, 2: 258-267.
4. Verra F, Angheben A, Martello E, Giorli G, Perandin F, Bisoffi Z. A systematic review of transfusion-transmitted malaria in non-
endemic areas. Malaria Journal; 2018 Jan 16;17(1):36.
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THE ECONOMIC IMPACT OF NOSOCOMIAL INFECTIONS
Dr. R. Sukanya
Consultant Clinical Microbiology, Infection Control and Infectious
Diseases, Bangalore
Email: sukanyar74@yahoo.co.in
Health care associated infections (HCAIs) destabilize the healthcare industry by causing an imbalance in economics.
Though the effects on quality of healthcare delivery, and human life are immeasurable, the various costs due to Health
Care Associated Infections (HCAI) is measurable. The burdens these infections place on our health care system can be
divided into three categories: the cost of quality, the cost of human lives and the financial impact 4.The measurable
variable is the cost due to infections.
Due to an increase in invasive procedures and a growing resistance to antibiotics, HCAIs have increased by 36% in
the last 20 years and are consuming more health care rupees each year.
At any one time about 1 in 10 patients in acute care hospitals have an HCAI, and an additional 10-60% of infections
may present after discharge 2. HCAI’s prolong hospital stay leading to loss of opportunity cost of bed occupancy for the
hospital .In addition, the patient suffers additional costs due to increased absence from work and relatives suffer costs
of time and travel to visit the patient; Thus, there is both physiological and psychological agony.
The alarming trend of increased Multidrug resistant organisms causing HCAI’s will be financially crippling to the
patient considering the exorbitant cost of high end antibiotics. Additionally, the healthcare in order to control the cross
transmission of such MDR organisms will have to shell out more manpower days, and implement stringent infection
control policies which increases the overall cost to the system. According to the Department of Health Expenditure,
National Institute of Health and Family Welfare, 10% above the expected mean cost is called the contingency medium
of expense which is a basic Thumb rule in any desired medical treatment expenses. Another 10% is treated as
unexpected contingency but not considered as an extreme over burden or that which leads to indebtedness. Costs
exceeding beyond 20% of expected mean cost are thus considered as expenditure which could lead to sale of assets on
indebtedness of individual or family. This will mean that patients will go into debt financially (beyond affordability) to
meet medical expenses. Therefore HCAIs are often the subject of litigation, the costs of which are huge and alarming.
Increased rates of HCAIs are associated with blocked beds and closed wards and theatres, results in increased unit
costs for admissions and procedures. HCAIs also affect the quality of care provided, negatively impacting the brand
image of the hospital. Patient morbidity and mortality resulting from HCAI have large community and society costs
that are difficult to quantify but may have considerable impact. Also difficult to measure in economic terms is loss of
reputation – either for the whole hospital or for individual units – which has significant impact on contracts and patient
referral, as HCAI is a quality indicator of a Health care facility.
The economic rationale for prevention of HCAI’s can be summarized as follows: hospital-acquired infections take
up scarce health sector resources by prolonging patients’ hospital stay; effective infection-control strategies release
these resources for appropriate alternative uses.3 For many HCAI’s, the costs of prevention are lower than the value
of the resources released, even when costs are estimated liberally and the benefits presented conservatively. Under
these circumstances, strict infection control should be pursued, since more stands to be gained than lost.5
References:
1. Haley RW, Culver DH, White JW, Morgan WM, Emori TG. The nationwide nosocomial infection rate: A new need for vital statistics.
Am J Epidemiol 1985; 121:159-67.
2. Plowman, R. P., Graves, N., Griffin, M., Roberts, J. A., Swan, A. V., Cookson, B. C.
and Taylor, L. (1999) The Socioecomic Burden of Hospital Acquired Infection, Public Health Laboratory Service, London.
3. Economics and Preventing Hospital-acquired Infection. Nicholas Graves,Emerging Infectious Diseases ,Vol. 10, No. 4, April 2004
4. Klevens RM, Edwards JR, Richards CL, Horan TC. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002.
Public Health Reports 2007; 122:160-166
5. Manual of Infection Control :Basic Concepts and Practices;2nd edition;International Federation Of Infection Control,Chapter:The
Costs of Hospital Infection
13
“EFFECTIVE COMMUNICATION IN MICROBIOLOGY”

SAVE LIVES, REDUCE ANTIMICROBIAL RESISTANCE
Dr. Samitha Nair

Consultant Microbiologist, DDRC SRL Laboratories, Trivandrum,
Kerala-695011
Email: dr.samithanair@gmail.com
The role of clinical microbiology has continued to evolve, apace with the rapid progress in medicine.
The hallmark of the bygone era was of bench work, more bench work and still more bench work, with little or no
communication with treating physicians.
But as with the scientific revolution in medicine that has translated into improved healthcare outcomes,
technological advances have shifted the onus from benchwork to the actual bedside. With current communication
facilities, a microbiologist can transform to a virtual bedside role, with guidance in deciding empirical therapy prior to
the final diagnostic report.
I would like to share following case scenarios where prompt communication altered the course and outcome of
treatment.
Case1
A 4 year old child with recurrent otitis, presented with high grade fever, confusion and features of meningitis.
Empirical administration of ceftriaxone and vancomycin was initiated. The subsequent work up revealed a brain
abscess. Neurosurgical aspiration was done and the samples were sent for culture in aerobic and anerobic bottles, but
clinical improvement remained elusive. Meanwhile, the anerobic bottles flagged positive and immediate microscopic
examination of the direct smear revealed minute streptococci morphologically resembling microaerophilic streptococci.
Surprisingly, no growth was observed on plates using conventional anerobic culture. However, this development was
communicated with the clinical team, who immediately started the patient on parenteral metronidazole. Clinical
response was dramatic with swift recovery from symptoms confirming the presence of an anaerobic pathogen. To this
day, the treating physician quotes this episode as a classic example of timely information being lifesaving information.
Case 2
A 54 year old diabetic male with a history of chronic alcoholic abuse presented with the clinical spectrum of
pulmonary tuberculosis. Prompt initiation of ATT regimen, however, failed to provide symptomatic relief. As a random
throw of the dice, BAL was done and the fluid sent for culture to out lab. To our surprise, it grew oxidase positive
NLF colonies with sheen. Smear showed “safety pin” appearance. Within 24 hours of sending the sample preliminary
communication was given to the physicians regarding the possibility of Burkholderia pseudomallei. Empirical treatment
was started immediately with ceftazidime and meropenem. Clinical response was once again, dramatic, and treatment
was continued for three months.
These episodes are just two illustrative examples among the multitude of clinical scenarios where effective
communication between the microbiologist and the clinician forms a crucial link in diagnostic – therapeutic chain,
Especially in this era of rising AMR.
We can effectively reduce the misuse and misinterpretation of our reports if we develop the habit of “talking” to
our treating physicians. I have personally experienced this during my short transgress in this field and find it extremely
rewarding and often, gratifying. I firmly believe that there is still more scope for improvement and we can reduce
the inappropriate use of antibiotics if a good rapport is established between lab and the physician. And from my
experience, this is eminently possible even in standalone labs too.
It is ultimately the passion for our work and improvement of patient care that keeps us going and by promptly
communicating what we know we can definitely help in improving the latter.
14
ANTIBIOTIC RESISTANCE
Dr. Prabakar
MD/HOD and professor of Medicine@SDUMC Deemed to be university
Kolar, Karnataka
Email: drprababhakar@yahoo.in
The use of antibiotics has always been and continues to be indispensable in managing bacterial infections. But,
the rampant and irrational use of antibiotics over the years has lead to widespread antimicrobial resistance, which is
now an important concern for health authorities globally. In India, where the burden of infectious diseases is huge,
recent hospital and community based data showed increase in burden of antimicrobial resistance.1 Antibiotic use is a
major driver of resistance. In 2010, India was the world’s largest consumer of antibiotics for human health at 12.9 x 109
units (10.7 units per person). The next largest consumers were China at 10.0 x109 units (7.5 units per person) and the
US at 6.8 x109 units (22.0 units per person).
Mechanism of antibiotic resistance is multivariate. Antibiotics target and inhibit the essential cellular processes,
retarding growth of bacteria and causing cell death. If bacteria are exposed to drugs below the dose required to kill
all bacteria the minimum bactericidal concentration (MBC), they can mutate and resist antibiotic action via natural
selection for resistance-conferring mutations. These genetic mutations can also be acquired at the same time.
Antibiotics and their spectrum:
The term antibiotic was coined by Selman Waksman, a Nobel– laureate soil microbiologist who discovered
streptomycin. Antibiotic is defined as a compound produced by a microbe which kill or inhibit the growth of another
microbe. The mechanism of action by these antimicrobial compounds is summarized in the figure.
Mechanism of resistance:
Antibiotic resistant organisms are known as superbugs. These microbes have become a global threat responsible
for high mortality and life-threatening sepsis. The different mechanisms of the common drug resistance are shown in
Table 1. 6
15
A common mechanism used by bacteria to minimize the effects is of antibiotics is by acquiring or by increase in
the expression of drug efflux pumps. These drug efflux pumps expel drugs from the cytoplasm, limiting the ability of
antibiotics to access their target 2. Studies have found that the multifaceted transcription regulator CpxR regulates the
expression of the major efflux pump in P. aeruginosa, and is involved in modulating resistance in clinical isolates.4
Methicillin-resistant Staphylococcus aureus (MRSA) is the most common antibiotic resistant infection in humans, and
the most frequent mechanism of resistance in MRSA is via the acquisition of mecA . mecA is a member of the penicillin-
binding protein family that does not bind β-lactams effectively and is thus immune to its effects 2
16
Studies on Mycobacterium smegmatist found that the mutations in genes encoding ribosome components cause
extensive changes in the transcriptome and proteome of the bacterium, including alterations to several proteins known
to impact resistance to drugs. These mutations promote further evolution of the bacteria in a multi-drug environment
in a drug-specific manner and lead to further development of resistance. 5
Development of resistance is likely to occur if patients fail to take their full course of prescribed antibiotic
treatment , but even this dogma is debatable . Despite how widespread and deeply this belief is held, there are no
data to support the idea that continuing antibiotics past resolution of signs and symptoms of infection reduces the
emergence of antibiotic resistance 6
The high economic burden in the healthcare sector is mainly attributed to emergent antibiotic resistance, due to
extended hospital stays, isolation wards, stringent infection control measures and treatment failures. Determination
of bacterial resistance to antibiotics of all classes (phenotypes) and mutations that are responsible for bacterial
resistance to antibiotics (genetic analysis) are helpful and is the way forward. Better understanding of the mechanisms
of antibiotic resistance, will facilitate clinicians to choose the right choice of antibiotic for their patients. Although
many International agencies like World Health Organization, European Centre for Disease Control and World Health
Assembly resolutions have highlighted antimicrobial resistance as a major public health issue, it will be a big challenge
to tackle the problem for the policy makers and health care providers.
References :
1. World Health Organization. Prevention and Containment of Antimicrobial resistance. [Last accessed on 2012 Mar 18].
2. Lauren A R. Understanding and overcoming antibiotic resistance Lauren. PLoS Biol. 2017; 15(8)
3. Pallavi S, Archana M, Shindhe G B.Emergence of drug resistance in bacteria: An insight into molecular mechanism. IJSER .2013;
4(9)
4. Tian ZX, Yi XX, Cho A, O’Gara F, Wang YP. CpxR Activates MexAB-OprM Efflux Pump Expression and Enhances Antibiotic Resistance
in Both Laboratory and Clinical nalB-Type Isolates of Pseudomonas aeruginosa. PLoS Pathog. 2016;12(10)
5. Gomez JE, Kaufmann-Malaga BB, Wivagg CN, Kim PB, Silvis MR, Renedo N, et al. Ribosomal mutations promote the evolution of
antibiotic resistance in a multidrug environment. Gilmore MS, ed. eLife. 2017;6
6. Spellberg B . The new antibiotic Mantra – “Shorter is better”. JAMA Intern Med 2016;176;1254-155
17
NATIONAL SURVEY ON INFECTION CONTROL PRACTICES:

WHY AND HOW?
Dr. Dhruv Mamtora

Consultant Microbiologist infection control officer
S. L. Raheja Hospital, A fortis associate, Mahim, Mumbai.
Co-editor and designer “Infection control trends”
Email: dhruv_mamtora@yahoo.com
Emerging and reemerging infections are threat to humankind. Understanding epidemiology of diseases helps us
to understand transmission of diseases from reservoir to susceptible hosts. Breaking chain of transmission of infection
is what is basic of infection control practices which are practiced worldwide.1 The fundamental basic principles which
are even though age old, yet is time tested multiple times during outbreaks like SARS, Ebola and recently during
Nipah virus outbreak. Infection prevention and control practices are also one of the keys to curb manmade disaster of
antimicrobial resistance. The major reason for this is the inappropriate use of antibiotics due to a lack of uniform policy
and disregard to hospital infection control practices.2 So this is right time we step out and understand community
scenario, we can empower secondary and primary healthcare level to fight against antimicrobial resistance. This is all
possible provided we understand need to understand complete situation.
When we look at guidelines related to infection control, there are multiple international guidelines can be referred.
It is up to individual institution that has to formulate their own policy and procedures for implementing minimum basic
requirements which are just enough to spread drug resistance and bugs which are responsible for diseases. There are
strong international surveillance networks in developed countries but there is certainly need for enriching surveillance
network in developing countries. Such surveys can definitely help in attaining same.
Hence, to know the status of baseline infection control practices throughout country is one of major objective
of this survey. Once we know the baseline, and then only will be possible to evaluate the need for planning. NABH
accreditation has already made drastic improvements in accreditated healthcare organizations.
With continuous research on infection control practices, one day I am sure with continuous and sustained efforts,
development will be seen at every healthcare organization of country up to primary healthcare centers.
There is an urgent need to start practicing and implementing our knowledge which is very vast in medical field
due to technological advancements for infection control practices advancement throughout nation. It is really hard
time to realize that we have to take firm steps to resolve issues of past which are still persistent in present. This
survey is one of the basic steps over which foundation of training and education can be laid for overall quality for
healthcare organizations. If we know our presence, we can definitely take steps and plan for our future of infection
control practices in this country.
The origin of this concept started when I visited small nursing homes which have minimum essential facilities. I
realized that reasons behind unresolved issues were doctors and staff was too busy with patients or perhaps routine
work was too much. As an expert I visited, observed as an expert in infection control and I realized that there was need.
Need was to start the training initiative, and yes simple training exercise followed by implementation of those technical
expertise made great changes in those facilities with respect to infection control practices. If change can be brought out
easily, why not expand our horizons for the whole of country? Thus I discussed idea with stakeholders at multiple levels
and in multiple meetings and this is how this survey is initiated. Next step will be how best we can utilize resources to
bring quality infection control practices even to the smallest of nursing home of this country is where we have to reach.
Another concept is of quality and standardization which can be placed in practice only if know what are issues and how
to address them with what is available with us.
Hence I appeal all healthcare organizations of India to participate wholeheartedly and support this survey. Alone I
can’t do this herculean task but yes I can introduce you the concept. Once you will have the concept, then only thought
process leading to ultimate desirable change can initiate. Yes, we all can do it together and shape our future for better
infection control practices in our own country.
18
Participation is purely voluntary and just two page forms which cover basics of facility, resources and policies.
The survey is available online https://form.jotform.me/82042752160448. Since it is a huge task to reach mass, I have
taken help from media people and clean India journal supported this initiative wholeheartedly and without any clauses
hence I am indebted to them.
Overall, I feel that change can never happen if we keep our hope alive. We have to be the change as quoted by
Mahatma Gandhi. So this is just a baby step for humanity to understand our practices and to know how the knowledge
of knowing practices can be utilized to change the practices by means of education, training and imparting skills.
References:
1. Morens DM, Fauci AS. Emerging infectious diseases: threats to human health and global stability. PLoS pathogens. 2013 Jul
4;9(7):e1003467.
2. Kapil A. The challenge of antibiotic resistance: need to contemplate. Indian J Med Res. 2005 Feb 1;121(2):83-91.
19
NAMASKAR: SMARTNESS OUT OF THE TRADITIONAL BOX
Dr. Sourav Maiti

Chief Consultant Clinical Microbiologist & In-Charge, Department of
Infection Prevention & Control, Institute of Neurosciences Kolkata.
Email: smaiti76@gmail.com
Strange are the ways of non-verbal human communications! Tibet will greet you with the tongue sticking out,
Maori in New Zealand by touching noses; men in Democratic Republic of Congo would touch foreheads. However, the
most common physical way to greet people globally is handshake. As we all know, it is a short ritual where two people
grasp on each other’s like hands with or without a brief up and down movement. Healthcare providers often offer or
accept handshakes for rapport development with the patient, patient’s relatives and associates. Being an industry in
itself, although many may disagree, the healthcare sector shares the industrial customs also where handshakes are
more or less mandatory for business deals. Could there be a cloud associated with this silver-lining?
Coming back to our ancient Indian tradition, Namaskar (or Namaste) is a respectful greeting in Hindu custom.
We press together our hands with palms touching, fingers
pointing upwards and putting thumbs close to the chest. Our
belief is “Atithi Devobhaba” (may the guest be god) as inscribed
in Taittiriya Upanishad and thus we bow to the divine only that
is present in all of us. In sharp contrast to handshake, it avoids
contact with a foreign touch and could be intended to many
at a single step. The same politeness, courtesy and honor we
express coupled with an inherent hospitality to the guest by a
non-touch (surgeons would appreciate) technique.
My medical graduation days introduced me to a strange
person, Dr. Edmond Locard. No, I did not meet personally with
the Sherlock Holmes of France but was amazed by his principle:
“Every contact leaves a trace”. He meant for forensic trace
evidences of criminal but scientifically each biological contact
should shed microorganisms unless they are sterile. This is
particularly true for the transient colonizers of our hand leaving
Dr. Sourav Maiti at Launch of Namskar Drive
aside the scope for disturbed resident microbial flora. Total
bacterial counts on hands of a healthcare provider ranges from 3.9x104 to 4.6x106 CFU/ cm2. Statistics reveals nurses
could contaminate hands with 100-1000 CFU of Klebsiella sp. during ‘clean’ activities like lifting patients, taking pulse,
blood pressure or touching patient’s hand/ shoulder/ groin (Casewell & Philips, 1977). And all these are the transient
colonizers waiting for the next touch. And we already know about scabies that inhabit webs of fingers and wrist.
When Stephen Potter in 1987 shook 19550 hands at St Albans Carnival and the longest handshake took place in 2011
for 33 hours and 3 minutes, I wonder what could have happened! Each one of us would shake about 15000 hands in
our lifetime. 1 in 5 of those hands would have wash missed after using toilet and only 5% wash correctly. And those
14250 of those handshakes will expose one to fecal matter! Pseudomonas aeruginosa and Burkholderia cepacia are
transmissible by handshaking for up to 30 minutes when suspended in saline but upto 3 hours when suspended in
sputum. The whole world knows the truth of hand wash in hospitals – could be as low as 20% only (even with the
Hawthorne effect)!
Barack Obama popularized fist bumps. One interesting article in American Journal of Infection Control (2014) used
a laboratory model and found that around two times bacteria were transferred during a handshake (mean 1.24x108
CFU) in comparison with a high five, whereas the fist bump consistently accounted for the lowest transmission. Contact
area of handshake being the largest (mean 157.4 cm2), coupled with strength of grip (politicians and businessmen
20
would probably prefer a firm one) facilitates efficient transfer of germs. One study at West Virginia University studied
10 subjects and found significant differences between open hands and fists. Considering the surface area of 30.206
sq in versus 7.867 sq in, contact time of 0.75 seconds versus 0.28 seconds resulted in total colonization of 187.5 CFU
versus
42.5 CFU at 72 hours incubation. Virology would probably magnify more if proper detection methods are employed
for virus transmission by the hands. But handshakes, fist bumps, hand hugs or giving dap all are contact-based greetings
whereas Namaskar is distinct with no risk of transferring germs to another, the purest in its kind.
Our hands touch various surfaces in a day explaining the variation in microbial composition. Like one busy
intersection, they connect one’s microbiome to the microbiome of other person or object. The beautiful Bayesian
network analysis by Lax et al describes the hands as the key vector for transferring microbes to various body sites, pets
and inanimate objects within homes. This explains the diverse biogeography of palms compared to other skin sites.
Palm skin typically contains 3 times more bacterial phenotypes per individual in comparison to skin over elbow or
forearm. Fungal species diversity was found to be intermediate on hands with the feet being the highest. Moist, warm
and nutritionally rich skin harbors a more stable microbiome whereas hands are dry and undergo continuous exposure
to various environments. This dryness favors predominance of citrate cycles among the palm microbiota. Hand hygiene
products if not chosen correctly, like one contains formaldehyde, can cause colonization by pathogenic bacteria more
easily and dangerously, too.
It is easy to shake our hands but hard to difficult to shake our
habits. But we need to revive our old traditions that are scientific.
With this thought one initiative has been started at Institute of
Neurosciences Kolkata, a premier tertiary care neuro-specialty
hospital in India catering patients all over from India and abroad.
This is “NAMASKAR” drive. All the staffs and healthcare providers
would avoid handshake and offer a Namaskar to the visitors,
vendors, patients and among themselves in case it is required.
We have devised a unique hand hygiene dance for its propagation
which is trendy and classy with smart moves depicting steps of hand
washing. Let’s hope that we become successful and others might
adopt this strategy to bring about big returns in terms of health and
wellness. Clean hands, clean minds – share the good things only,
Hand culture plate showing different not the germ!
bacterial colonies taken before a handshake
References:
1. http://info.debgroup.com/blog/how-many-hands-will-you-shake-in-your-lifetime
2. E. Grice, J. Segre. The human microbiome: our second genome. Annu. Rev. Genomics Hum. Genet. 13(2012) 151- 170.
3. J. Caporaso, C. Lauber, E. Costello, D. Berg-Lyons, A. Gonzalez, J. Stombourgh, R. Knight. Moving pictures of the human
microbiome. Genome Biol. 12(2011) R50.
4. J. Oh, A. Byrd, D. Denning, S. Conlan, H. Kong, J. Segre. Biogeography and individuality shape function in the human skin
metagenome. Nature 514(2014) 59-64.
5. S.L. Edmonds-Wilson, N.I. Nurinova, C.A. Zapka, N. Fierer, M. Wilson. Review of human hand microbiome research. Journal of
Dermatological Science 80 (2015) 3-12.
6. S. Mela, D.E. Whitworth. The fist bump: A more hygienic alternative to the handshake. American Journal of Infection Control
42(2014) 916-7.
7. W. Casewell, M & Phillips, I. (1977). Hands as route of transmission for Klebsiella species. British medical journal. 2. 1315-7.
10.1136/bmj.2.6098.1315.
21
INDIA ANTIMICROBIAL STEWARDSHIP AND RESISTANCE

[INTEREST SURVEY]
Dr. Aditya Shah

Fellow in Infectious Diseases, Mayo Clinic School
of Graduate Medical Education, Rochester, MN, USA.
Email:- shah.aditya@mayo.edu
Emergence and spread of antimicrobial resistance is a major problem in India. Significant knowledge gaps exist to
determine if this is a systems based, prescriber and patient characteristic based or diagnostic technologies based issue.
We would aim to conduct a survey to address these queries.
This survey will be done by physicians participating from the selected medical centers. The surveys will focus
on identifying where the problem lies in the larger issue of antimicrobial stewardship. Following this we will evaluate
feasibility of doing this study. We will first focus on retrospective review of charts from participating hospitals with
regards to identifying cultures with MDR pathogens and retrospectively looking at patient and physician variables
that might be leading to improper use of antibiotics. We would also look at diagnostic capabilities at participating
centers and identify the gaps that exist in the same. This would then help us evaluate where the problem lies in the
stewardship arena in India to propose future interventions, addressing these problems.
The primary aims and hypotheses are:
Hypothesis 1: Prescriber and patient characteristics are important determinants of antimicrobial use in the population.
Hypothesis 2: Poor diagnostic practices contribute to lack of guidance for physicians when treating patients with
infections.
Hypothesis 3: Antimicrobial use in patients with or without identified infections can be safely rationalized without
adversely affecting mortality, with improved stewardship and reduction in resistance.
Project specific aims:
1. To identify determinants for use of antibiotics in India.
2. To identify microbiological diagnostic practices which may influence antibiotic prescribing characteristics.
3. To implement effective strategies to promote rational antimicrobial use to limit over-use in patients with or without
identified infections.
STUDY OBJECTIVES
Primary Objectives:
1. To identify the major problems or determinants of antimicrobial resistance in India.
2. To identify knowledge gaps.
3. To devise strategies to address these knowledge gaps.
BACKGROUND AND RATIONALE
Prescriptions contribute to overuse, but so does the over-the-counter availability of many antibiotics until
recently. For example, India has had one of the highest over-the-counter sales of carbapenems, an antibiotic used to
treat multidrug-resistant bacteria.
In 2014, the government re-categorized many antibiotics, including carbapenems, to make them prescription-only.
But implementation of the regulation remains murky. Waste management treated with antibiotics/antiseptics along
with antibiotic use in animals for human consumption are also major contributors to this problem.In summary the
major reasons for increased prevalence of drug resistant bacteria isolated in cultures from relatively healthy patients,
might be due to 1. Systems based issues. 2. Prescriber and patient characteristics. 3. Existing diagnostic capabilities.
22
Our aim would be to start with a feasibility survey, addressing questions based on the above 3 points, filled by
providers from participating centers. This would ideally be followed by a retrospective review analyzing, which of the
above variables contributes most to the problem of antimicrobial resistance and the strategies that could be devised
against them.
Phase 1: In order to accomplish this we would start with a feasibility survey sent to the centers involved in this study. This
survey would focus on systems based, lab based and prescriber based characteristics which might impact antimicrobial
use. (Waiver has been applied via IRB wizard)
Phase 2: A retrospective review of data collected over a 1 year time frame between 1/1/17 and 12/31/17, with a focus
on patient characteristic, diagnostic facilities and provider variables. This data will be used to construct a statistical
model to identify the key determinants for antimicrobial use and antimicrobial resistance.
This will lay out the foundation to identify knowledge gaps that exist in India with regards to the issues that affect
antimicrobial stewardship and the problems that might be impacting rising and emerging antimicrobial resistance.
Survey Link -->https://bit.ly/2w4ey8F
References:
1. The threat of antimicrobial resistance in developing countries: causes and control strategies James A. Ayukekbong, 1,4 Michel
Ntemgwa,2 and Andrew N. Atabe3
2. https://www.huffingtonpost.com/entry/india-superbug_us_5949b329e4b0db570d3778cc
23
FUTURE THEMES AND RULES
Upcoming newsletters have following themes.
1. Jan 2019 issue – theme is dedicated to accreditation and its role in infection control.
2. April 2019 issue – theme is antibiotic stewardship program.
You can contribute your articles through email to doctortvrao@gmail.com and dhruv_mamtora@yahoo.com.
The rules and regulation for the Infection control trends newsletter are as follows:-
1. Article has to be written with scientific language and references are to be added in Vancouver style. Mention
all scientific names in italics. Follow font size of 11 with times new roman style with 1.15 line spacing. Article
submission to be done in MS word format only.
2. The high quality images of authors are to be submitted along with articles separately.
3. Article must be written by authors only. Articles submitted by students and secretaries of authors will not be
entertained.
4. If the articles are resent by editorial committee for necessary corrections, all necessary corrections shall be
done and resubmitted within 3 days after receipt of email. The only reason being the context and concept in
which the article is written is with author; hence editors can never judge or write in same manner.
5. Article should be sent one month in advance for themed newsletter.
6. We encourage reviewers for upcoming newsletter so you can submit your names along with CV to editorial
team.
7. Any verbal communication with editorial team members should be done in working hours only between
9:00 AM and 5:30 PM.
8. The purpose of newsletter is to promote scientific content and enhancing research and scientific approach
related to infection control and related topic and not publicity for person or product or services.
9. We appreciate Feedback and suggestions which should be conveyed only through official email.
10. Any queries related to newsletter will be addressed directly to editorial team members.
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INFECTION CONTROL TRENDS VOLUME 1 | ISSUE 1 | SEPT 2018

INFECTION CONTROL TRENDS

CHIEF EDITOR EDITOR EDITOR & CONCEPT TEAM MEMBER

Dr. Ranga Reddy Burri is Health policy enthusiast focused on

Dr. Dhruv Mamtora is a clinical microbiologist and infection

Sister Solbymol P S is a PICU Nurse with 19 years of experience.

Editorial - Infection Prevention & Control Best Practices 06

Guest Editorial - Infection Control Trends: Helping with 07

Challenges Faced By Current Passing Out Microbiologists In The 08

Postgraduate Teaching Of Clinical Microbiology In India: 10

Health Care Associated Parasitic Infections: Time To Rethink? 12

The Economic Impact Of Nosocomial Infections 13

“Effective Communication In Microbiology” Way To Save Lives, 14

From Desk Of Editor And Designer For Infection Control Trends- 18

Namaskar: Smartness Out Of The Traditional Box 20

India Antimicrobial Stewardship and Resistance [InTeRest Survey] 22

Dr. Ranga Reddy

Professor Ramon Z. Shaban

CHALLENGES FACED BY CURRENT PASSING OUT

POSTGRADUATE TEACHING OF CLINICAL MICROBIOLOGY IN INDIA:

Dr. Prashant Purohit

HEALTH CARE ASSOCIATED PARASITIC INFECTIONS:

Dr. Abhijit Chaudhury

THE ECONOMIC IMPACT OF NOSOCOMIAL INFECTIONS

“EFFECTIVE COMMUNICATION IN MICROBIOLOGY”

Dr. Samitha Nair

NATIONAL SURVEY ON INFECTION CONTROL PRACTICES:

Dr. Dhruv Mamtora

NAMASKAR: SMARTNESS OUT OF THE TRADITIONAL BOX

Dr. Sourav Maiti

INDIA ANTIMICROBIAL STEWARDSHIP AND RESISTANCE

Dr. Aditya Shah

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2. April 2019 issue – theme is antibiotic stewardship program.

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