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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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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
High-Productivity Combinatorial PVD and ALD Workflows for Semiconductor Logic & Memory Applications
- Imran Hashim, Chi-I Lang, Hanhong Chen, Jinhong Tong, Monica Mathur, Prashant Phatak, Ronald Kuse, Sandra Malhotra, Sunil Shanker, Xiangxin Rui
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1159 / 2009
- Published online by Cambridge University Press:
- 31 January 2011, 1159-G01-02
- Print publication:
- 2009
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With materials innovation driving recent logic and memory scaling in the semiconductor industry, High-Productivity Combinatorial™ (HPC) technology can be a powerful tool for finding optimum materials solutions in a cost-effective and efficient manner. This paper will review unique HPC wet processing, physical vapor deposition (PVD), and atomic layer deposition (ALD) capabilities that were developed, enabling site-isolated testing of multiple conditions on a single 300mm wafer. These capabilities were utilized for exploration of new chalcogenide alloys for phase change memory, and for metal gate and high-K dielectric development for high-performance logic. Using an HPC PVD chamber, a workflow was developed in which up to 40 different precisely controlled GeSbTe alloy compositions can be deposited in discrete site-isolated areas on a single 300mm wafer and tested for electrical & material properties, using a custom in-situ high-throughput sheet-resistance measurement setup, to get very accurate measurements of the amorphous – crystalline transition temperature. We will review how resistivity as a function of temperature, crystallization temperature, final and intermediate (if any) crystalline phases were mapped for a section of the GeSbTe phase diagram, using only a few wafers. Another area where HPC can be very valuable is for finding optimum materials for high-k dielectrics and metal gates for high-performance logic transistors. Assessing the effective work-function (EWF) for a given high-k dielectric metal-gate stack for PFET and NFET transistors is a critical step for selecting the right materials before further integration. One way to obtain EWF is by using a terraced oxide wafer with different SiO2 thickness bands underneath the high-k dielectric. We report a HPC workflow using our wet, ALD & PVD capabilities, to quickly assess EWF for multiple different high-k dielectrics and metal gate stacks. This workflow starts with a HPC wet etch of thermal silicon oxide, creating different oxide thicknesses 1–10nm in select areas of the same substrate. This is followed by atomic layer deposition of a high-k dielectric film such as HfO2. Next, a metal e.g., TaN is deposited through a physical mask or patterned post-deposition to complete the formation of MOS capacitors. The final step is C-V measurements and C-V modeling to extract Vfb, high-k dielectric constant, EOT, and EWF from Vfb vs EOT plot. This workflow was used to extract EWF for a TaN metal gate with an ALD HfO2 high-k dielectric using a metal-organic precursor. We will discuss how EWF for this system was affected by annealing post-dielectric deposition & post-metallization, different annealing temperatures & ambients, Hf pre-cursors and interfacial cap layers e.g., La2O3 & Al2O3. Finally, we will also discuss more advanced versions of this workflow where the ALD high-k dielectric and PVD metal gate is also varied on the same wafer using HPC versions of ALD & PVD chambers.
Surgical repair of atrioventricular septal defect with common atrioventricular valve in early infancy
- François Lacour-Gayet, David N. Campbell, Max Mitchell, Sunil Malhotra, Robert H. Anderson
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- Journal:
- Cardiology in the Young / Volume 16 / Issue S3 / September 2006
- Published online by Cambridge University Press:
- 13 October 2006, pp. 52-58
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The repair of atrioventricular septal defect with a common atrioventricular valve is reconstructive surgery at its best, and hence one of the favourite operations performed by paediatric cardiac surgeons. In the past, the post-operative course from such patients was dominated by the occurrence of pulmonary hypertension crises, which were responsible for significant morbidity and mortality. Nowadays, repair is generally undertaken early in infancy, and this approach has mitigated the problems emanating from pulmonary hypertension. Coupled with a better understanding of the anatomy, and adaptation of the surgical techniques, repair can now be achieved safely at around 2 to 4 months of life, without increasing the risk of postoperative regurgitation across the reconstructed left atrioventricular valve. In this review, we discuss the surgical techniques required for, and clinical results of, such early repair.