Ph.D, MPhil, DCH, MBBS

Dr. Sanjeev K. Singh currently serves as Medical Superintendent at Amrita School of Medicine, Kochi.


Publication Type: Journal Article

Year of Publication Title


Dr. Sanjeev K. Singh, Charani, E., Wattal, C., Arora, A., Jenkins, A., and Nathwani, D., “The State of Education and Training for Antimicrobial Stewardship Programs in Indian Hospitals-A Qualitative and Quantitative Assessment.”, Antibiotics (Basel), vol. 8, no. 1, 2019.[Abstract]

: To understand the role of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in Indian healthcare organizations. : Mixed method approach using quantitative survey and qualitative interviews was applied. Through key informants, healthcare professionals from 69 hospitals (public & private) were invited to participate in online survey and follow up qualitative interviews. Thematic analysis was applied to identify the key emerging themes from the interviews. The survey data were analyzed using descriptive statistics. : 60 healthcare professionals from 51 hospitals responded to the survey. Eight doctors participated in semi-structured telephone interviews. 69% (27/39) of the respondents received E&T on AMS during undergraduate or postgraduate training. 88% (15/17) had not received any E&T at induction or during employment. In the qualitative interviews three key areas of concern were identified: (1) need for government level endorsement of AMS activities; (2) lack of AMS programs in hospitals; and, (3) lack of postgraduate E&T in AMS for staff. : No structured provision of E&T for AMS currently exists in India. Stakeholder engagement is essential to the sustainable design and implementation of bespoke E&T for hospital AMS in India.

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Dr. Sanjeev K. Singh, Menon, V. P., Zubair Umer Mohamed, Dr. Anil Kumar V., Nampoothiri, V., Sudhir, S., Merlin Moni, Dipu, T. S., Dutt, A., Fabia Edathadathil, Keerthivasan, G., Kaye, K. S., and Patel, P. K., “Implementation and Impact of an Antimicrobial Stewardship Program at a Tertiary Care Center in South India”, Open Forum Infect Dis, vol. 6, no. 4, p. ofy290, 2019.[Abstract]

Background: Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to antimicrobials. Implementing antimicrobial stewardship programs (ASPs) in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India.

Methods: An ASP was established in February 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The ASP tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with ASP recommendations. Defined daily dose (DDD) of drugs and cost of antimicrobials were compared between the pre-implementation phase (February 2015-January 2016) and post-implementation phase (February 2016-January 2017).

Results: Of 48 555 patients admitted during the post-implementation phase, 1020 received 1326 prescriptions for restricted antibiotics. Antibiotic therapy was appropriate in 56% (742) of the total patient prescriptions. A total of 2776 instances of "inappropriate" antimicrobial prescriptions were intervened upon by the ASP. Duration (806, 29%) was the most common reason for inappropriate therapy. Compliance with ASP recommendations was 54% (318). For all major restricted drugs, the DDD/1000 patient days declined, and there was a significant reduction in mean monthly cost by 14.4% in the post-implementation phase.

Conclusions: Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits.

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K. Baubie, Shaughnessy, C., Kostiuk, L., Joseph, M. Varsha, Safdar, N., Dr. Sanjeev K. Singh, Siraj, D., Sethi, A., and Keating, J., “Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study.”, BMJ Open, vol. 9, no. 5, p. e026193, 2019.[Abstract]

<p><b>OBJECTIVES: </b>To determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.</p>

<p><b>SETTING: </b>1300-bed tertiary care private hospital located in the state of Kerala, India.</p>

<p><b>PARTICIPANTS: </b>31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist.</p>

<p><b>RESULTS: </b>Key facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community.</p>

<p><b>CONCLUSIONS: </b>Opportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.</p>

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S. Kumar Gupta, Siddharth, V., Belagere, M. R., Stewardson, A. James, Kant, S., Dr. Sanjeev K. Singh, and Singh, N., “National survey of infection control programmes in South Asian association for Regional Cooperation countries in the era of patient safety.”, Indian J Med Microbiol, vol. 36, no. 4, pp. 577-581, 2018.[Abstract]

<p><b>Background: </b>The implementation of hospital infection prevention and control (IPC) in south Asia is not well described. We aimed to assess IPC programmes in hospitals in this region and explore opportunities for improvement.</p>

<p><b>Methods: </b>Attendees from hospitals in the South Asian Association for Regional Cooperation (SAARC) region who were at one of four National Initiative for Patient Safety workshops organised by All India Institute of Medical Sciences (New Delhi) from 2009 to 2012 were invited to complete a semi-structured questionnaire. The survey addressed six main components of IPC programmes.</p>

<p><b>Results: </b>We received responses from 306 participants from 82 hospitals. Five key opportunities for improvement emerged: (1) lack of healthcare epidemiologists, (2) relative infrequency of antibiotic guidelines (53%) and prescribing audits (33%) (3) lack of awareness of needle stick injury rates (84%) (4) only 47% of hospitals were prepared for surge capacity for patients with infectious diseases, and (5) limited coordination of hospital infection control personnel with other support services (55%-66%).</p>

<p><b>Conclusion: </b>These results outline IPC challenges in the SAARC region and may be useful to guide future quality improvement initiatives.</p>

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La Kumar, Dominic, Mb, Rajan, Sa, and Dr. Sanjeev K. Singh, “Impact of modified quality control checklist on protocol adherence and outcomes in a post-surgical intensive care unit”, Indian Journal of Anaesthesia, vol. 61, pp. 29-35, 2017.[Abstract]

Background and Aims: Quality improvement (QI) is the sum of all activities that create desired changes in the quality. An effective QI system results in a stepwise increase in quality of care. The efficiency of any health-care unit is judged by its quality indicators. We aimed to evaluate the impact of QI initiatives on outcomes in a surgical Intensive Care Unit (ICU). Methods: This was an observational study carried out using a compliance checklist, developed from the combination of the World Health Organization surgery checklist and Society for Healthcare Epidemiology of America guidelines for the prevention of infections. A total of 170 patients were prospectively evaluated for adherence to the checklist and occurrence of infections. This was compared with a random retrospective analysis of 170 patients who had undergone similar surgeries in the previous 3 months. Results: Introduction and supervised documentation of comprehensive checklist brought out significant improvement in the documentation of quality indicators (98% vs. 32%) in the prospective samples. There was no difference in mortality, health-care-related infection rates or length of ICU stay. Conclusion: The introduction of comprehensive surgical checklist improved documentation of parameters for quality control but did not decrease the rates of infection in comparison to the control sample. © 2017 Indian Journal of Anaesthesia.

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Sa Krishna, Dr. Sanjeev K. Singh, Dinesh, K. Ra, KP, Rc, Siyad, Id, and Karim, Sa, “Percutaneous endoscopic gastrostomy (PEG) site infections: a clinical and microbiological study from university teaching hospital, India”, Journal of Infection Prevention, vol. 16, pp. 113-116, 2015.[Abstract]

Percutaneous endoscopic gastrostomy (PEG) is used to provide enteral access in patients who are unable to swallow. Infection of the stoma is an important complication and there is little data from India on this problem, which can be used to inform infection prevention and prophylactic strategies.

The objective was to assess the prevalence and the role of contributory factors in PEG site infections.

A total of 173 patients underwent PEG insertion from January 2011 to May 2012. Clinical and microbiological data were collected for culture-positive cases. Insertion was performed using a standard sterile pull-through technique. Infections were defined as two of: peristomal erythema, induration, and purulent discharge.

A total of 54 PEG infections occurred in 43 patients (28.85%). Seventy-seven organisms were isolated. Pseudomonas aeruginosa was the most common (n=29) followed by coliforms (n=21) and meticillin resistant Staphylococcus aureus (MRSA) (n=6). Thirty-one (72%) received amoxicillin-clavulanic acid as prophylaxis and 12 (28%) were receiving concomitant antibiotics for their underlying conditions. The occurrence of PEG site infections was statistically independent of the administered prophylactic antibiotics (p=0.3).

This study has demonstrated the importance of PEG sites as a cause of healthcare associated infections. Educating patients on wound care practices would play a significant role in prevention of PEG site infections.

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