At no point in living memory has there been more focus on hospital infection control than during this Pandemic. Hospitals across the world are battling Covid on two fronts – fighting the virus in hospitalised patients, and preventing it from being transmitted from an infected patient to an uninfected person. However, the battle against hospital acquired infection is far from new; for decades now, microbiologists and infection control experts have been fighting a long, weary battle with their own medical and surgical colleagues, as well as hospital administration, to integrate infection control measures in every aspect of hospital operation and design, as well as the personal and professional behaviour of hospital personnel. While everyone pays token attention to guidelines, few have adopted these measures as a part of their daily hospital routine. While it may not be a losing battle, this stalemate has existed for too long, and half measures can no longer be condoned, particularly during a pandemic. Beginning a new series of articles on hospital infection control, Dr R Sukanya, MBBS, MD, PGDID, CIC, Consultant – Clinical Microbiology, Infection Control and Prevention, Infectious Diseases, Quality Accreditation & Training has penned a stark, brutally honest picture of the state of infection control in hospitals, and what needs to be done to remedy this disease of apathy:
Compliance with hand hygiene, personal hygiene and attitude towards certain healthcare practices are extremely pathetic in India. The reasons for this are multifactorial and complex. The basic culture of hygiene such as clean hands, clothes and environment (personal
and professional) dates back to our rich Indian cultural practices, which have been forgotten and disregarded as old, obscure, irrational and non-applicable in the modern world. Simple practices such as washing hands, feet and face before entering the house, not carrying anything used at the workplace into the personal areas of the house such as the dining room and bedrooms, leaving footwear outside the house, taking a complete bath if anyone has visited the hospital, slaughterhouse or a house where someone has passed away – were strict, stringent practices followed by all Indians, regardless of caste or creed.
However, with so-called bmodernisation and aping of western cultural practices – which cannot be applied or even extrapolated to Indian
environmental and healthcare conditions – many of these simple yet effective strategies to prevent infections have become obliterated and have slowly effaced out of the system.
In particular, the Indian medical fraternity has undergone a complete changeover in terms of position in society, practices followed and ethical and moral issues. With the onslaught of a variety of PPE flooding the healthcare markets and many more innovative disinfectants and chemicals available for cleaning, a false sense of security and carelessness dominates the attitude among medical professionals.
Knowledge is definitely not a barrier in the present times, but what is sadly lacking is the will and discipline to follow recommendations. We still work best with the whip and not the carrot approach. Several approaches to ensure compliance among healthcare professionals have been and are still being used by Infection Control, Quality and Administration in Healthcare.
This includes the role model approach, awards and recognition, motivation and encouragement activities, along with continuous ongoing
training, updation of practices and real-time auditing and feedback. However, there seems to be a lack of will to incorporate changes. There is a dearth of proactive initiatives, learning skills and interest to know and practise the latest best practices.
Scarcity of resources such as manpower, equipment and infrastructure further widen this gap and plummet compliance. Another very important and impactful factor is the culture of the healthcare organisation towards patient safety, quality healthcare and occupational safety. This is governed to a large extent by medicolegal issues, which in the Indian judicial system has got many loopholes through which the organisation can slip through. Thus, we are still very far from attaining a decent compliance to basic safety and quality practices in Indian healthcare.
There should be stringent cross-audit processes which are random, unbiased and educational, conducted by the government or accreditation bodies or even industries. Noncompliance should be seriously addressed and analysed, root cause analysis should be done and gaps identified and closed within stipulated deadlines. Non-compliance related to individual attitude should be handled by the HR department in a well-formatted manner as per SOPs, and appropriate action should be taken against repeat offenders. Such actions should be discussed in a general forum, so that awareness and the gravity of such actions are crystal clear to all healthcare professionals. Compliance percentages should be included in the appraisal and promotion criteria.
Thus, innovative, motivational, creative and positive approaches and methods is the dictum for achieving sustainable compliance in healthcare.