Healthcare Associated Infections are a major contributor to increased malaise, fatality and hospital costs, even though they are often preventable. Because of the dimension of associated infections and antibioticresistance in hospitals, many States now mandate hospitals to publicly disclose data about their performance and/or infection rates. However, how many hospitals have laid down systems to record associated infections is questionable.
The incidence of Hospital Acquired Infections (HAIs) or nosocomial infections which is largely due to pathogens that were existing or incubating at the time the patient’s admission to the healthcare facility. It takes over 48 hours or more following admission to get infected. However, it may not become clinically evident until after discharge. Hence, maintaining follow-up records of patients who get HAI post-discharge is a big challenge, especially in a highly populated country like India.
Given this scenario, Dr Mamtora and Dr Shah, explain the need , processand implementation of infection control in the following Q&A:
Are WHO guidelines applicable in India?
WHO guidelines are instructions about health interventions, whether clinical, public health or policy guidance. WHO have set many guidelines for cleanliness and hygiene in the healthcare facilities for infection control all over the world. But are the Indian hospitals following the protocol?
Dr Mamtora: Yes. The WHO guidelines are basic guidelines which mention about minimum essential requirements for hospital sanitation and are as follows:
- Water – quality, quantity, facilities and access to water,
- Excreta disposal
- Waste water disposal
- Healthcare waste disposal
- Cleaning and laundry
- Food storage and preparation
- Building design, construction and management
- Control of vector borne diseases
- Information and hygiene promotion
Each of the above requirements can be fulfilled if there is strong commitment and willingness for same. Many places including hospitals don’t get water in India so as there are hospital premises which get flooded in monsoon season. Our environmental conditions are variable across the country, so we must adopt such that what suits best for that locality.
Cleanliness in hospitals differs from area to area. High risk areas like OT, ICU, transplant unit, procedure labs, blood bank, laboratory, Dialysis and CSSD departments require deep cleaning or more thorough cleaning than other areas. Special training is required for staff if they are designated in these areas and if possible, the workforce for cleaning in these areas need to be designated and should not be rotated. If there is a replacement contract worker in case of staff absenteeism then he/she might not as well know what type of cleaning is done in that specialized area of hospital and since it is only for a day, he might not be trained for that duty. Empowering housekeeping managers is important in such scenarios.
One of the critical areas to maintain hygiene is the food preparation space, where controlling of vectors during the monsoon season is a challenge.
Information and hygiene promotion methods have been shared through the media but healthcare centres have failed to implement and provide training for improving skill or even improvising through proper equipment for cleanliness.
Does it ensure that infection prevention is taken care of completely?
Dr Mamtora: Partly it covers majority of t hings but still there are many day to day practices like microbiological surveillance, surgical safety and other clinical related practices e.g. safe injection and infusion practices, hand hygiene, biomedical waste management, prevention of device associated infections and isolation precautions which are ongoing activities on day to day which needs to be supervised by an expert. Also, if we see infection prevention and control, there is shortage of trained manpower. At many places traditional age-old practices are followed which are outdated and there is complete lack of awareness or too much of negligence with respect to infection control practices as it is a costly exercise and not a primary objective.
Dr Shah: It will be utopianto claim that any guidelines can completely eliminate all infections. WHO provides guidelines as a base upon which the program needs to be built.Even if the program does not take care of all infections, it will definitely reduce number of infections, associated morbidity,mortality and cost of treatment by a great extent.
Why is infection spreading in hospitals in spite of preventionand precautions?
Dr Mamtora: There are three primary things which are responsible for infection. It will depend upon agent, host and environment (triad of epidemiology). Agents these days are stronger than what used to be before. We are on verge of postantibiotic era as there are only few high-end antibiotics which are still effective and drug resistant bacteria which are resistant to almost all classes of antibiotics causing infections.
Our actions are slow and negligible to curb this manmade disaster. Also, there can be potential resistance to disinfectants which are commonly used. Appropriate disinfectants are either used in high dilution or cheaper poor-quality substitutes are used which are less effective or not effective at all.