Published: 2016-12-30

Epidemiology and risk factors of healthcare associated infections from intensive care unit of a tertiary care hospital

Sanjay Melville Masih, Shewtank Goel, Abhishek Singh, Sanjeev Kumar Khichi, Vasundhara ., Rakesh Tank


Background: Nosocomial infections (NIs) result in increased morbidity, mortality and length of hospital stay. The Incidence of NIs, their risk factors and the antibiogram patterns vary across and within countries. We assessed the rates, infection sites, pathogens and risk factors of health-care-associated infections in ICU of a tertiary care hospital.

Methods: In this retrospective study, all the patients admitted in Intensive Care Unit over a period of 6 months during August 2015 to January 2016 were included in the current study. Routine surveillance of various health-care-associated infections such as catheter-associated urinary tract infections (CAUTI), central-line-associated blood stream infections (CLABSI), and ventilator-associated pneumonias (VAP) was done by the Department of Microbiology through an Infection Surveillance Proforma. Patients’ records including Infection Surveillance Proforma served as study tools. Odd’s ratio was calculated to ascertain the strength of association of each risk factor.

Results: Incidence rates of health-care-associated infections were 9.06/1000 urinary catheter days, 13.35/1000 central venous pressure line days and 5.42/1000 ventilator days. Most common organisms isolated from urine were Pseudomonas aeruginosa (34.48%), Enterococcus species (13.79%), Klebsiella pneumonia (13.79%) and Candida species (13.79%). Similarly three topmost organisms isolated from blood were Klebsiella pneumoniae (32.26%), Acinetobacter species (29.03%) and Pseudomonas aeruginosa (16.13%). Acinetobacter spp. (40.0%), Pseudomonas aeruginosa (33.33%) and Klebsiella pneumonia (13.33%) were most commonly responsible for tracheal infections. Presence of diabetes and COPD as well as length of ICU stay ≥8 days was significantly associated with health-care-associated infections.

Conclusions: Diabetes, COPD and ICU stay for ≥8 days were found to be significantly associated with device-associated infections in our ICU. Data thus generated can be used to plan and modulate the potential intervention measures while managing device-associated infections.


Epidemiology, Risk factors, Device-associated infections, Intensive care unit

Full Text:



Niederman MS, Craven DE. Guidelines for the management of adults with hospital-acquired, ventilator- associated and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388-416.

Weinstein RA. Nosocomial infection update. Emerg Infect Dis. 1998;4:416-20.

Emori TG, Culver DH, Horan TC, Jarvis WR, White JW, Olson DR et al. National nosocomial infections surveillance system (NNIS): Description of surveillance methods. Am J Infect Contr. 1991;19:19-35.

Kollef MH, Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med. 2001;134:298-314.

Clinical and laboratory standards institute: performance standard for antimicrobial susceptibility testing; eighteenth informational supplement. CLSI document M100-S18. Clinical and Laboratory Standards Institute, Wayne, Pa, 9th ed. 2008.

Hughes JM. Study on the efficacy of nosocomial infection control (SENIC project): results and implications for the future. Chemotherapy. 1988;34;553-61.

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309-32.

Datta P, Rani H, Chauhan R, Gombar S, Chander J. Healthcare associated infections: Risk factors and epidemiology from an intensive care unit in Northern India. Indian J Anaesthesia. 2014;58(1):30-5.

Habibi S, Wig N, Agarwal S, Sharma SK, Lodha R, Pandey RM, et al. Epidemiology of nosocomial infections in medicine intensive care unit at a tertiary care hospital in northern India. Trop Doct. 2008;38:233-5.

Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N, et al. Device-associated nosocomial infection rates in intensive care units of seven Indian cities- Findings of the international nosocomial infection control consortium (INICC). J Hosp Infect. 2007;67:168-74.

Kamat US, Ferreira AMA, Savio R, Motghare DD. Antimicrobial resistance among nosocomial isolates in a teaching hospital in Goa. Indian J Comm Med 2008;33:89-92.

Agarwal R, Gupta D, Ray P, Aggarwal AN, Jindal SK. Epidemiology, risk factors and outcome of nosocomial infections in a respiratory intensive care unit in north India. J Infect. 2006;53:98-105.

Meric M, Willke A, Caglayan C, Toker K. Intensive Care Unit- Acquired infections: Incidence, risk factors and associated mortality in a Turkish University Hospital. Jpn J Infect Dis. 2005;58:297-302.

Pellizzer G, Mantoan P, Timillero L, Allegranzi B, Fedeli U, Schievano E, et al. Prevalence and risk factors for nosocomial infections in hospitals of the veneto region, North- Eastern Italy. Infection. 2008;36:112-9.