Early education and clinical exposure on hand hygiene: a key for better compliance

Background: India is underperforming when it comes to compliance to hand hygiene. Early education on followed by regular hand hygiene audits can bring positive changes in infection control practices.Methods: Group I included the 3rd Semester MBBS students who had early education and training on hand hygiene and Group II included the post graduate residents who were exposed to Hand Hygiene later in their carrier were followed up for compliance of WHO Hand Hygiene moments for four months. Compliance among students and residents were observed and compared.Results: Compliance rate was more (40.4%) among medical students as compared to residents (17%). The After moments had a better compliance than Before moments among both students and residents. The difference in the compliance rate was statistically significant.Conclusions: Early clinical exposure of the students to any problem, is the key for better compliance thus explaining the better compliance rate among medical students. Better HH practice can bring down prevalence of Healthcare associated infection by multidrug resistant organism which is a major concern today.

Principles Governing Damages in Trademark Infringement

374-379Award of damages as a relief in trademark infringement, has increasingly assumed importance in the modernized economies of the world; though grant of punitive damages is more recent. Initially, in order to restrain infringers, the courts usually granted injunction and in rare cases, granted damages. Damages are awarded to monetarily compensate the aggrieved party that has suffered injury. However, with increasing instances of piracy and growth of counterfeit goods, the courts have come to realize that awarding punitive damages may be a necessary deterrent to protect the interest of trademark holders. This article compares the principles governing damages in trademark infringement in United Kingdom, European Union, and United States of America while rendering an insight into the principle of damages as conceived under the Indian trademark law

Hand hygiene: An educational intervention targeting grass root level

Background: Hands are the most common vehicle for the transmission of pathogens within the healthcare environment. Hand hygiene is the leading measure for reducing healthcare-associated infections (HCAIs) and preventing the spread of antimicrobial resistance. Objective: An interventional study was carried out to evaluate the knowledge, attitude and practices of hand hygiene among third semester medical students. Materials and methods: A total of 152 medical students were evaluated using a pretest self-structured questionnaire to assess the knowledge, attitude and practices regarding hand hygiene. The students were trained by faculty of microbiology vigorously with the help of a lecture and demonstration on hand hygiene followed by hands-on training. The same group of students were then distributed the post-training questionnaire. The pre-training and post training data was analyzed and compared. Result: There was a significant improvement in knowledge, attitude and practice towards hand hygiene among students after intervention, as seen on comparison of results of post-test questionnaire from its pre-test counter-part because the doubts in the mind of the students got cleared in the education sessions. Conclusion: Targeting medical students and teaching them the good standard practices was fruitful as they were young, easy to mold and enthusiastic and above all they are the future doctors. Such educational intervention regarding hand hygiene will be carried out for each batch of medical students in future. Keywords: Hand hygiene, Medical students, Targeted educational interventio

Profile of infective microorganisms causing ventilator-associated pneumonia: A clinical study from resource limited intensive care unit

Background: Ventilator-associated pneumonia (VAP) is the most common cause of hospital acquired infection and death among patients admitted in ICU. Microorganisms responsible for VAP vary from place to place. Gram-negative bacteria (GNB) have emerged as a major group of pathogen causing VAP and over the years carbapenem group of antibiotics has emerged as one of the important antibiotics used in the critically ill patients. There have been reports of increased occurrence of infection by carbapenem-resistant bacteria in health care settings in recent times. Aim: The aim of the study was to assess the incidence of VAP, their microbiological profile with reference to carbapenemase producing GNB in the intensive care unit of a tertiary care hospital, their relation to initial emperical antibiotic therapy, sensitivity patterns, and outcome. Materials and Methods: This prospective study was carried out over the period of 1 year (July 2010-June 2011) on 100 randomly selected patients above the age of 18 years admitted in the emergency/ICU and requiring intubation and mechanical ventilation for more than 72 hours. The diagnosis of VAP was established on the basis of clinical and radiological parameters as per Centre of Disease Centres (CDC) guidelines. A baseline sample was obtained after initial endotracheal intubation. Thereafter, the culture sent on the first day of occurrence of clinical sign of VAP. Culture was done on blood agar and MacConkey agar. All imipenem-resistant strains were further confirmed by Modified Hodge test and combined disc for confirmation of respective carbapenemase. Results: Incidence of VAP was found to be 51%. GNB mainly Citrobacter 28 (52.83%) and Klebsiella pneumoniae 7 (13.21%), were the most commonly isolated pathogens. The prevalence of carbapenemase-producing GNB was alarmingly high 24/50 (48%). The entire carbapenemase producers showed high degree of cross resistance to antibiotics with some sensitivity to Polymyxin B (94 %) and Tigecycline (96%) Conclusion: High incidence of VAP and the potential carbapenemase-producing GNB are real threat in our ICU. The emergence of microorganisms known for its inherent resistance among most of the common first-line antibiotics calls for a alarm in all upcoming tertiary care hospitals

Evaluation of phenotypic tests for the detection of AmpC beta-lactamase in clinical isolates of Escherichia coli

Background: AmpC beta lactamases are cephalosporinases that confer resistance to a wide range of beta lactam drugs thereby causing serious therapeautic problem. As there are no CLSI guidelines for detection of AmpC mediated resistance in Gram negative clinical isolates and it may pose a problem due to misleading results, especially so in phenotypic tests. Although cefoxitin resistance is used as a screening test, it does not reliably indicate AmpC production. Materials and Methods: We planned a study to determine the occurrence of AmpC beta lactamase in hospital and community, clinical isolates of Escherichia coli and simultaneously evaluate different phenotypic methods for detection of AmpC beta lactamases. Results: It was observed that 82.76% isolates were ESBL positive and 59% were cefoxitin screen positive. Using phenotypic confirmatory tests the occurrence of Amp C beta lactamases was found to be 40% and 39% by inhibitor based method using boronic acid (IBM) and modified three dimensional test (M3D) respectively. Conclusion: Both the test showed concordant result. Co-production was observed in 84.62% isolates Screening of ESBL and Amp C can be done in routine clinical microbiology laboratory using aztreonam and IBM respectively as it is a simple, rapid and technically less demanding procedure which can be used in all clinical laboratories

Candida auris: Diagnostic challenges and outbreak control in paediatric and neonatal intensive care unit in a tertiary care hospital - the first of many in Eastern India

Problem considered: An emerging global threat, Candida auris infections have poor prognosis, high transmission rate, and potential for outbreaks. In India, prevalence of Candida auris invasive infection has been calculated to be 5.3 %. Strict surveillance and preventive measures must be implemented in intensive care units because of its propensity for rapid adaptation and potential for antifungal resistance. Methods: Outbreak investigational study was carried in paediatric and neonatal intensive care unit of a tertiary care hospital in eastern India. Clinical isolates from inpatients with candidemia were subjected to identification by microbiological tests. Deoxyribonucleic acid (DNA) sequencing done for molecular identification and determining clonal similarity of Candida auris isolates. Surveillance of intensive care units carried out to assess patient colonization, environmental contamination, and hand-carriage of yeast among healthcare workers following which strict infection control measures were implemented. Results: Blood isolates from four candidemia patients identified microbiologically as Candida auris. Environmental surfaces found contaminated with Candida auris by surveillance included Ultrasound guided (USG) Accu-probe and Blood-pressure (BP) cuff used for all patients admitted, molecular identification of which showed homology with patient isolates. However, patients and hospital environment no longer harboured Candida auris owing to stringent Infection Prevention and Control (IPC) measures taken. Conclusion: The article emphasises multidisciplinary approach towards investigation and containment of Candida auris outbreak and how prompt surveillance and simple preventive measures could eradicate Candida auris from patients and hospital setting

Fungal Keratitis Due to Fusarium lichenicola: A Case Report and Global Review of Fusarium lichenicola Keratitis

Fusarium species are among the most commonly isolated causes of fungal keratitis. Most species of the genus Fusarium belong to Fusarium solani species complex (FSSC). Fusarium lichenicola, a member of the FSSC complex, is a well-established plant and human pathogen. However, reports of fungal keratitis due to Fusarium lichenicola have not been frequently reported. To the best of our knowledge, only twelve cases of Fusarium lichenicola keratitis have been reported in the past fifty years. Clinical cases of Fusarium lichenicola may have most likely been misidentified because of the lack of clinical and microbiological suspicion, as well as inadequate diagnostic facilities in many tropical countries where the burden of the disease may be the highest. We report a case of fungal keratitis caused by Fusarium lichenicola and present a global review of the literature of all cases of fungal keratitis caused by this potentially blinding fungus

Spatial Analysis of Cadmium and Lead in Soils of Nagaon District of Assam, India

Aims: The study was carried out in order to find the hotspots of Cadmium and Lead accumulation in the soil due to the anthropogenic activities, so that proper management strategies can be taken on time for their remediation. Study Design: Different geospatial techniques as Normal Q-Q plot, histogram, trend analysis and semi-variogram cloud model is used. Place and Duration of Study: The study was conducted emphasizing basically in high agricultural chemicals dependent Nagaon District of Assam, India, from 2018 to 2021. Methodology: Heavy metals were assessed using a random sampling method with a 5 x 5 km2 grid, and a total of 160 samples were collected from a depth of 0 – 15 cm for soil. Choropleth maps were created to show the distribution and hotspots of pollution. Results: Geospatial analyses from different thematic maps of heavy metals revealed significant vulnerable points of elevated concentrations of Pb (>24.45 mg/kg) and Cd (>0.31 mg/kg) in soil which is presumed to be due to anthropogenic factors. The three-dimensional trend over the distribution of metals throughout the district best fitted the second-order polynomial for Cd, and Pb in soils. Significant numbers of pairs of heavy metal pairs to a certain extent were found to be spatially autocorrelated and all the pairs away from X-axis towards the extreme right corner and far above the axis reflected less influence of local characteristics of the heavy metal. Co-variance cloud with search direction from North to South revealed the existence of spatial autocorrelation and a wider spatial shift of correlation towards the southern direction. Conclusion: The current study provides baseline data to update the mitigation approaches to better manage the heavy metal contamination in soil in the entire district