DOCUMENTATION AND AUDITING OF INFECTIONS IN INTENSIVE CARE UNITS
A postgraduate topic for Microbiologists , Critical care specialists
Dr.T.V.Rao MD
Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs). The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome..Today there is growing awareness on Multidrug resistance in bacterial and fungal isolates, in Critical care patients, and many times the cause of death is multiorgan failure can be mostly due drug resistant pneumonia, the situation no different in developing and developed world, We in India even in Teaching Hospitals have few resources, Nosocomial infections due to intensive care unit (ICU) microbes only include secondary endogenous and exogenous infections. Infection control targets the three types of infection mainly due to potential pathogens. For tertiary care/referral hospitals, a substantial percentage of patients are transferred from community hospitals outside the local area and many primary treating physicians exhaust all the new generation antibiotics and referred when matters go wrong . Under these circumstances, resistance surveillance data from these areas would help select presumptive therapy or change existing therapy.I fought for many reasons with the system, that we cannot take appropriate faster decisions without automation and cooperation of clinicians and Microbiologists, It is most important to know every patient referred from periphery is at threat with failed antibiotic treatments, The most important happening in our country,. Need of the hour continues that we should save the antibiotics with rationalistic reasons and truly missing link as the use of antimicrobial drugs in day-to-day practice is sub optimal and directly responsible for multidrug resistance in a number of common pathogens. The factor that converts antimicrobial therapy from "empirical" to "rational" is in vitro susceptibility testing and reporting. However, if these tests are either not conducted or conducted poorly, they are not useful clinically and may create a false sense that therapy is rationally guided, I certain that 90% of the laboratories lack the standard protocols and advance technologies and many times im appropriately done Antibiograms, The teaching medical colleges and institutions can help the matters in many helping and training the local population on consequences of irrational use of Antibiotics We hope that the concept of "empiric antimicrobial therapy" would be changed to that of "presumptive antimicrobial therapy" based on host factors, common pathogens, and known susceptibility patterns in any given region.
TRULY HYGIENE MATTERS -An increase in the number of hospitalized patients who are infected with or colonized by gram-negative non fermenting bacilli that display multidrug resistance characteristics has been observed over recent decades. This issue has received attention, particularly from personnel within infection control committees and health services that consider patients' clinical conditions and the variety of therapeutic approaches applied within health units

NEED FOR AUDIT - Audit and Research Details of the numbers of cases treated, illness severity, age, outcome and treatments, must be recorded. and discussed to reduce mortality and morbidity The figures should be analysed at regular intervals both as an indication of therapeutic achievement and for administrative purposes. In-house audit must be a regular feature and incorporated in Hospital Infection control .discussions Ref Evaluating Antibiograms To Monitor Drug Resistance Mohamed El-Azizi, etal Emerg Infect Dis. 2005 Aug; 11(8): 1301–1302.
Dr.T.V.Rao MD Freelance reporter on Infectious diseases Pan African resources