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Surveillance of Healthcare-Associated Bloodstream and Urinary Tract Infections in a National Level Network of Indian Hospitals
- Purva Mathur, Paul Malpiedi, Kamini Walia, Rajesh Malhotra, Padmini Srikantiah, Omika Katoch, Sonal Katyal, Surbhi Khurana, Mahesh Chandra Misra, Sunil Gupta, Subodh Kumar, Sushma Sagar, Naveet Vig, Pramod Garg, Arti Kapil, Manoj Sahu, Arunaloke Chakrabarti, Pallab Ray, Manisha Biswal, Neelam Taneja, Priscilla Rupali, Vellore Binila Chacko, Joy Sarojini Michael, Veeraraghavan Balaji, Camilla Rodrigues, Vijaya Lakshmi Nag, Vibhor Tak, Vimala Venkatesh, Chiranjay Mukhopadhyay, KE Vandana, Muralidhar Varma, Vijayshri Deotale, Ruchita Attal, Kanne Padmaja, Chand Wattal, Neeraj Goel, Sanjay Bhattacharya, Tadepalli Karuna, Saurabh Saigal, Bijayini Behera, Sanjeev Singh, MA Thirunarayan, Reema Nath, Raja Ray, Sujata Baveja, Mammen Chandy, Sudipta Mukherjee, Manas Roy, Gaurav Goel, Swagata Tripathy, Satyajeet Misra, Anupam Dey, Tushar Mishra, Hirak Raj, Bashir Fomda, Gulnaz Bashir, Shaista Nazir, Sulochana Devi, Khuraijam Ranjana Devi, Langpoklakpam Chaoba Singh, Padma Das, Anudita Bhargava, Ujjwala Gaikwad, Neeta Khandelwal, Geeta Vaghela, Tanvi Sukharamwala, Prachi Verma, Mamta Lamba, Shristi Jain, Prithwis Bhattacharyya, Anil Phukan, Clarissa Lyngdoh, Rajeev Sharma, Rajni Gaind, Rushika Saksena, Lata Kapoor, Neil Gupta, Aditya Sharma, Daniel VanderEnde, Anoop Velayudhan, Valan Siromany, Kayla Laserson, Randeep Guleria
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s398-s399
- Print publication:
- October 2020
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- Article
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Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.
Funding: None
Disclosures: None
7 - Show Me the Cash: Direct Benefits Transfer in India
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- By Rajesh Chakrabarti, University of Alberta
- Edited by Supriyo De
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- Book:
- India's Fiscal Policy
- Published online:
- 23 July 2017
- Print publication:
- 21 November 2016, pp 182-210
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Summary
Two things seem clear. First, if the objective is to alleviate poverty, we should have a program directed at helping the poor. … Second, so far as possible the program should, while operating through the market, not distort the market or impede its functioning. This is a defect of price supports, minimum-wage laws, tariffs and the like.
The arrangement that recommends itself on purely mechanical grounds is a negative income tax. … The advantages of this arrangement are clear. It is directed specifically at the problem of poverty. It gives help in the form most useful to the individual, namely, cash. It is general and could be substituted for the host of special measures now in effect. It makes explicit the cost borne by society. It operates outside the market. Like any other measures to alleviate poverty, it reduces the incentives of those helped to help themselves, but it does not eliminate that incentive entirely, as a system of supplementing incomes up to some fixed minimum would. An extra dollar earned always means more money available for expenditure.
–Milton Friedman in Capitalism and Freedom, 1962Introduction
India, according to the World Bank, accounts for one third of the poor in the world (Olinto and Uematsu, 2013). Delivering benefits to the deserving recipients have been an old and major problem as well as a source of much corruption in India, since decades before former Prime Minister Rajiv Gandhi's famous observation of only 15 per cent of government outlay actually reaching the poor. India is not unique in this respect; most developing countries have struggled with such distributional issues. In recent years, direct cash transfer schemes have become a much experimented vehicle of distribution of benefits in much of the developing world, mostly with encouraging results. India has also embarked upon this path with characteristic hesitation and arguments. Both the idea of DBT and the delivery mechanism, essentially a unique ID-based transfer system, have generated much debate and skepticism. This chapter seeks to understand the nature and implications of the direct cash transfer programmes being considered and experimented within India, particularly in light of the experience elsewhere.
2 - Commodity Market Policy for Food Security – The Road Ahead for G20
- from Section 2 - The Development Agenda
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- By Rajesh Chakrabarti, Associate Professor at the Indian School, Francis Xavier Rathinam, International Initiative for Impact Evaluation (3ie), New Delhi, Vijay Kumar Varadi, Data Scientist, Global Analytics, Bengaluru
- Edited by Parthasarathi Shome
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- Book:
- The G20 Development Agenda
- Published online:
- 05 May 2015
- Print publication:
- 03 February 2015, pp 23-72
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