Indian Journal of Pathology and Microbiology

: 2011  |  Volume : 54  |  Issue : 2  |  Page : 419--420

Infection control practices need ingenuous processes beyond prescribed guidelines

Charu Agrawal, Anurag Mehta 
 Department of Lab Sciences, Rajiv Gandhi Cancer Institute and Research Centre, Rohini V, New Delhi - 110 085, India

Correspondence Address:
Charu Agrawal
Clinical Microbiologist, Rajiv Gandhi Cancer Hospital, Rohini V, New Delhi - 110 085

How to cite this article:
Agrawal C, Mehta A. Infection control practices need ingenuous processes beyond prescribed guidelines.Indian J Pathol Microbiol 2011;54:419-420

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Agrawal C, Mehta A. Infection control practices need ingenuous processes beyond prescribed guidelines. Indian J Pathol Microbiol [serial online] 2011 [cited 2021 Jan 18 ];54:419-420
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The widespread nature of preventable nosocomial infections due to multi drug-resistant (MDR) organisms across the globe is echoed by the fact that World Health Organization (WHO) intends to set its focus, for this year, on "Tackling Antimicrobial Resistance". [1] Despite the numerous guidelines available, some situations will require certain set of responses which are specific to the problem and can only be tackled by constant vigilance, detailed investigation to define root cause, and out of the box solution. The authors wish to substantiate this statement by the under- mentioned example.

A sudden clustering of cases was noticed in the intensive care unit (ICU) of our hospital where carbapenem-resistant Klebsiella species (CRK) was isolated from respiratory secretions of six patients over a period of 1.5 months (1 November 2009 to 15 December 2009). All these isolates were also resistant to other antibiotic classes including fluoroquinolones, beta lactams, cephalosporins, trimethoprim+ sulphamethoxazole, beta lactam+ beta lactam inhibitor combinations and demonstrated sensitivity to tigecycline and colistin only. During the same time period 5 isolates of multi-drug resistant (MDR) Acinetobacter species were also recovered from respiratory secretions of different patients from the ICU. These isolates were also resistant to all the aforementioned antimicrobial classes and sensitive only to tigecycline and colistin. To find out a common source of these pathogens, many surveillance samples were taken from oxygen flowmeter humidifiers, suction bottles, patient's beds, and hands of all cadres of ICU staff. CRKs and MDR Acinetobacter species were recovered from samples taken from suction bottles only. The staff responsible for disinfection of the ICU equipments was questioned for the exact procedure adopted by them and monitored whereby the step that went wrong was highlighted. As per the disinfection policy of the hospital, the reusable suction bottles were cleaned with detergent and hot water and disinfected by immersing in freshly prepared 1% sodium hypochlorite. But the level of the disinfectant was just enough to immerse only half of the length of the bottles, rest half remaining non-disinfected. Immediately the corrective measures were taken and the staff was re-trained on disinfection procedures of various items in the ICU. This proved to be effective and no similar isolates have been recovered from any clinical samples obtained from the ICU till the writing of this article. The antibiograms of the clinical and surveillance isolates were similar for both the organisms, although molecular typing could not be carried out to confirm their relatedness. Our experience highlights the importance of an early suspicion of an outbreak, detail investigation till the ground level, and the necessity of regular training on appropriate hospital infection control practices. After this incident the infection control committee of the hospital has proposed for autoclaving of the reusable suction bottles in the central sterile supply department after use, instead of chemical disinfection as mentioned in WHO guidelines. [2]

It is well known that MDR Acinetobacter species and CRKs are emerging nuisances as nosocomial pathogens. [3],[4] Limited options of effective antimicrobials and the risk of dissemination of MDR encoding genes into community strains calls for an urgent intervention into the matter by the entire healthcare community before the problem magnifies beyond the limit of any possible intervention.


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2Guidelines on Prevention and Control of Hospital Associated Infections. WHO Regional Office for South East Asia, New Delhi 2002. Available from: [Last accessed on 2010 Jun 29].
3Villegas MV, Hartstein AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol 2003;24:284-95.
4HPA. National Resistance Alert: Carbapenemases in Enterobacteriaceae. Health Protection Report news. Vol. 3. 2009. Available from: [Last accessed on 2009.