Hygiene in Healthcare – A Diagnosis

Walk down the narrow lanes of some of the government-run hospitals and it would be bustling with activity. Right from fruits to full fledged lunch plate would all be available at the doorstep of the hospital.

“Don’t quote me,” said a government official, while discussing about the illegal food stalls mushrooming outside government hospitals in Mumbai. “All these hospitals run on charity and the poor people coming from far off places get to buy food at affordable rates from these food stalls. They practically live out of the footpath. It’s disheartening and not so easy to vacate them or ban hawkers from setting stalls?”

Resultantly, the piling food garbage outside the hospital and the unclean ambience are what greet one at some of the leading government hospitals in India. If the entrance to a hospital is such, then how would the hygiene standards be inside? If people are getting treated in a government hospital, then they are doing so only under unavoidable circumstances rather than choice. In such cases, the cost of treatment is a deciding factor rather than the “clean” factor.

While government hospitals are charitable institutions and in many cases refrain from adopting “scientific cleaning practices” as it comes at a price, the private set ups claim a handsome price for both treatment and the clean factors.

Step into any of the washrooms at Tata Memorial Hospital and the next moment you would jump out with the suffocating smell of uric acid. Walk into the men’s toilet in the outpatient area of AIIMS Trauma Centre, New Delhi, you will be greeted with urine flowing out of the broken pot and people walking in and out of the same toilet, carrying uric acid in their shoes all over the place.

Are all government hospitals always dirty and unhygienic or for that matter are all private hospitals as clean as they look? On a rainy day, CIJ set out to ascertain the cleaning and hygiene practices at some of the leading private hospitals in Mumbai. People were walking in and out of the sliding glass door carrying their wet footmarks into the lobby/reception area of a hospital. Contaminants, microorganisms, dirt, road mud… all were neatly making way into the hospital and probably contaminating the already sick patients waiting to be treated. The entryway, just above a few flight of steps, only had a 3ft by 5ft common mat which was soaked in rainwater. A common man walking into a hospital with wet shoes, leaving a trail behind would not realise the results of his action. He wouldn’t know that he is carrying the germs in his shoes into the hospital because of improper matting at the entrance.

With more and more housekeeping service providers bidding for hospital cleaning contract, it is time to ponder if they are actually qualified to take up the job. Further, are hospital authorities well versed in cleaning practices? Hygiene definitely cannot be compromised either on the part of the housekeeping professionals or the hospital when it comes to dealing with lives.

But, shouldn’t a private hospital facility head know what kind of matting should be put at the entrance? Shouldn’t a janitor be stationed at the entrance to mop the floor? Shouldn’t there be a wet sign board to caution entrants?

Ideally, any premise with heavy traffic should have a 30ft matting at the entrance. In case of space constraint the matting can be laid outside-in. To ensure that the dirt and grime do not enter the premise, the entryway matting should be a combination of Z-web mat up to 10ft, loop mat up to 15ft and aqua mat up to 5ft. But, this private hospital had none of it. The janitor assigned to mop the entrance was multi-tasking and had been called elsewhere.

As much as the entryway to any hospital directly or indirectly affects the health of its inmates, so does the backyard, where all the waste gets stored before being disposed off.

“For single use only”

The SSKM Hospital in Lala Lajpat Rai Sarani, Kolkata, has suddenly woken up to the fact that the syringes with “For single use only” being supplied to the hospital are far from being fresh ones. Syringes, saline bottles, medical equipment and catheters reaching this hospital are actually recycled from clinical waste, largely resulting from the inefficient disposal system of the hospital. These recycled clinical accessories have been in use in this hospital for several years now and probably the ill-effects have already taken shape in the form of HIV cases.

This is not just a single case of a government hospital in Kolkata but a peek into the backyard of some of the leading government hospitals of Mumbai makes ground for a flourishing recycling business.

Five leading government hospitals are concentrated in Parel, Mumbai, where thousands of patients come each day to be treated. Loads of bio-medical waste packed in yellow and red garbage bags are dumped in the backyard to be collected by NGOs and municipal vans. What happens between the dumping and collection processes is a known fact. At one of these hospitals, CIJ spotted a woman ragpicker sorting and segregating syringes from the waste!!!

Even though there are separate compartments to store different wastes, it is so much easier to dump all the waste together, leaving it to the collecting agency to scuffle with the rubble. What, if a used needle jutting through the yellow bag pricks a poor safai karmchari? It’s sure death! Who should be held responsible for this death – the hospital authorities for their negligence in disposing off waste appropriately or the municipal corporation for not implementing proper waste collection regulations? Well, what has the ward officer/ assistant commissioner of Parel to say about this?

“Our primary aim is that we remove the waste that comes to the collection points which are strategically located. The hospitals must have an internal machinery to segregate or stack waste properly and bring it to the municipal collection point. What is done from the collection point to the dumping yard is the Municipal Corporation’s primary responsibility.
“For collection of bio-medical waste, we have separate vehicles which collect waste from individual hospitals. We have a schedule for collection of waste and our compactors go to these hospitals.”

Then where are things going wrong? “Probably between the time the waste is dumped by the hospitals and the time it is collected by the corporation vehicles? Or may be during the night.” The F-South ward of MCGM has prestigious hospitals like the TB hospital, KEM, Tata Memorial, MG hospital and Wadia hospital. Are all these hospitals oblivious about waste disposal and the frightening affects of malpractices?

If hospitals were using backyards to dump waste, one of them had a full fledged kitchen setup. The scene outside this hospital kitchen was frightening. Food waste was thrown mercilessly around with a stray dog feeding on it; a water pipe was lying close by and probably from this pipe was being used for cooking; and the food cooked out of this kitchen was being supplied to the hospital! No wonder, local food stalls are flourishing just outside these hospitals, as they seem more hygienic than what is served out of the backyard kitchen.

“Well, it is not that the people working in the hospital do not understand cleanliness, it is the lack of strict supervision or penalization of the designated officers when the norms are not followed. The infrastructure in most of these hospitals is over saturated. After a certain point, even the authorities are helpless,” said the municipal official.

One other critical area in a hospital that serves as a store house of germs is the washrooms.