Nosocomial Infection in the Neonatal Ward of a Tertiary Care Hospital: The Role of Active Surveillance in the Control of Klebsiella pneumoniae Outbreak.

Aim: To describe an outbreak which occurred in a neonatal ward and the role of active surveillance in the control of further outbreaks. Study Design: Cross Sectional Observational Study. Place and Duration of Study: Lady Hardinge Medical College and Associated Hospitals, between May 2013 and June 2014. Methodology: The Infection Control Team (ICT) conducts active surveillance in the neonatal ward (NNW) routinely every year. The data regarding the above mentioned period were analysed and infection rates were calculated on monthly basis and compared. Attack rate was calculated as number of patients who acquired hospital acquired infections/ total number of admissions during that month. Results: A sudden increase in bloodstream infection (BSI) from 2 cases to 16 cases were observed over a period of 2 months (November 2013, and December 2013). Therefore an outbreak was suspected. Sixteen cases of primary blood stream infections caused by ceftazidime/ amoxicillin – clavulanic acid -resistant Klebsiella pneumoniae were observed over a two month period. Case definition was made. Recommendations for Infection control practices with immediate effect were sent. The ICT visited NNW and main labour room. Relevant samples were collected and Klebsiella species was isolated from suction tubing, baby cot, feeding katori, fingertip of health care worker (HCW) and soap sludge. Bacterial identification and antimicrobial susceptibility testing was performed by using the automated Vitek 2 instrument. The antibiogram of Klebsiella species from the samples and cases was found to be similar. It was found that NNW staff was changed recently without any training in Infection control practices. There was breach in Infection control practices. Conclusion: Active surveillance plays a very important role in detection of early onset of outbreak. All the HCWs including resident doctors, nursing and subsidiary staff and others must be trained in Infection control practices before they are posted to high risk areas.

Seroprevalence of anti Helicobacter pylori IgG/IgA in asymptomatic population from Delhi.

Helicobacter pylori is recognised as the most important etiological agent for chronic antral gastritis in humans, the major predisposing factor in the pathogenesis of duodenal and gastric ulcers as well as probable cofactor in the development of gastric cancer. This study was undertaken to determine the seroprevalence of anti - H. pylori IgG/ IgA in asymptomatic population. Two hundred and fifty eight serum samples from various age groups (1-40 years) were collected from patients admitted to the wards for conditions other than gastrointestinal disorders and screened for anti H. pylori IgG/IgA antibodies. The prevalence of anti H. pylori IgG/IgA in the age group < 10 years, 10-19 years, 20-29 years, 30-39 years and anti 40 years were found to be 38.89%, 52.08%, 59.62%, 67.88% and 54.17% respectively. The prevalence of H. pylori increased markedly with age, being maximum in 30-39 year age group. Similar trend was observed in a study conducted in South India and Mumbai. Almost half the children acquire H. pylori infection early in life which increases slowly and steadily with a peak prevalence in the age group 30-39 years and then declines as the age advances. There was no significant difference in prevalence rate in males and females.