Category: Professional Posters
Purpose: The objectives of the study were to: estimate the prevalence of health associated infections and the scope of antimicrobial use in a tertiary institution in Trinidad, describe the antimicrobial agents prescribed and their indications, and determine if prescribers followed evidence-based antimicrobial policies subsequent to diagnoses for patients in the selected wards.
Methods: This was a cross-sectional study consisting of three data collection instruments. Ward data were collected to identify the types of ward (ICU, Adult Medical, and/or Surgical), number of patients in each ward, presence of alcohol hand hygiene dispensers, type of medical personnel (consultants, house officers, nurses and nurse assistants, pharmacists), single room with individual toilet facilities or communal (multiple-bed) room and adjacent toilet facilities, and the number of occupied beds.Each ward surveyed was completed within one day. Data were also extracted from several sources available on the ward at the time of survey and documented on the data collection instruments. These included nursing notes, medical notes, temperature charts, drug charts, electronic prescribing systems, surgical notes, laboratory reports, e.g. microbiology results and other relevant charts. Patients were defined as receiving antimicrobials if they were prescribed at the time of survey for treatment or medical prophylaxis and received at least one dose of surgical prophylaxis in the 24 hours prior to 8:00 am on the morning of the survey. Data was recorded for each antimicrobial: the name of medication, route of administration, dosage per day, indication for prescribing and diagnosis. The prevalence of the health associated infection, device use and antimicrobial prescribed were determined using the software HELICSwin.Net 1.3.8. Both the prevalence and 95% Confidence Interval for the prevalence were calculated by the software.
Results: Of the 130 patients surveyed, 30 had an infection that occurred within 48 hours of admission. The most commonly reported infection type was urinary tract infections, evident in 9 (30.0%) patients, caused by Escherichia coli in 7 patients and Klebsiella pneumoniae in 2 patients. Out of the 30 patients, 10 (33.3%) were awaiting laboratory reports at the time of survey. Resistance was noted for Staphylococcus aureus and Escherichia coli, both of which were seen in 2 patients, and an Enterococcus species in 1 patient.
Conclusion: The results of the survey imply that public health surveillance and prevention activities should address hospital acquired infections. Recommendations to minimize the risk of resistance include: improving the availability of alcohol-based hand rub, the provision of single room and isolation capacity, antimicrobial guidelines for treatment of infection, judicious prescribing and proper surveillance of prescribed antimicrobials.