Objective: The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network. Setting: A 780-bed, tertiary-level, public teaching hospital in northern India. Methods: After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash. Results: Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified. Conclusions: Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.

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Objectives: To understand the perceptions of the private HIV physicians regarding HIV case management and reporting practices followed by the National AIDS Control Programme, India. Methods: We conducted this cross-sectional study among 142 private practitioners attending Chennai ART Symposium 2017, from five south Indian states. We used a pre-structured questionnaire to collect information on demography, qualification, the number of HIV patients treated, ART regimen, and the reporting practices. EpiInfo 7.2 was used for data analysis. Results: Out of the 142 private practitioners, 89 (63%) responded. All respondents had diagnosed and/or treated at least 10 HIV patients in the past 12 months. About 42% of respondents reported attending an orientation program on ART by the State AIDS Control Society (SACS). Seventy percent of respondents were aware of the National AIDS Control Organization’s (NACO) Public Private Partnership (PPP) initiative for private clinics, and 44% (39) reported sharing monthly reports with SACS. However, 77% of physicians were not interested to enroll due to increased paperwork and complicated reporting mechanisms. Conclusion: Private sector physicians treating People Living with HIV (PLHIV) are aware of NACO guidelines and reporting mechanisms. A simplified reporting process and an engaging platform are needed to facilitate reporting.

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