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When hospitals cause infections

Management attitude towards infection control

Hospital managements have come to realise that hospitalassociated infections can increase the length of stay of a patient, causing more burden on the hospital, which can also lead to increased resistance to antimicrobial drugs, and can prove catastrophic to the ‘image’ of the hospital. Accreditation agencies are also emphasising on infection control as an important component of patient safety. Hence, the importance of infection control is increasing in the management’s eyes, and from it percolates down from there.

Staff dedicated to hospital infection control

In my hospital, we have three dedicated nurses for infection control. We are three doctors who are involved with infection control along with our lab work or clinical work. We have also trained all our nursing incharges of wards and ICUs for infection control. This is useful as implementation of policies is smoother and more inclusive. Our management, nursing head and Quality head also work with us in close association to remove all the barriers.

Heads of department like Central Sterile Services Department, OT, Housekeeping Services and pharmacy are part of the infection control committee, which allows us to have a holistic and comprehensive program.

Processes for infection control

The laundry list is long and should be tailor-made for every hospital. A few salient points include:

• Hand hygiene program for all staff in clinical, para-clinical or non-clinical setting, patients themselves, and their relatives
• Cleaning and Disinfection of all the surfaces by correct disinfectant in correct dilution with correct equipment at correct intervals.
• Maintenance of air and water quality.
• Sterilisation of equipment
• Care of all invasive procedures while performing or when support lines/device are in situ.
• Appropriate Biomedical Waste Disposal
• Appropriate isolation of infectious patient or staff
• Appropriate health program for staff
• Antimicrobial stewardship
• Training for all
• Surveillance and Audit to monitor implementation

Latest techniques and machines used for infection control and monitoring

The infection control program has so far been people-driven, and is now moving towards automation. A few examples include:

• Automated hand antiseptic dispensers
• Automated disinfectant dilutor and automated fogging machine
• ATP counters are used for surveillance
• Chemicals are now becoming more environmental-friendly
• Macerators allow you to use disposable papier-mâché bedpans and urinals
• HEPA filters keep the air sterile in operative rooms and in transplant units
• Media and communication has made training easier and replicable.

Future trends in hospital infection control
These will include:

• Disinfection of surfaces and AC duct is becoming automated. Automated Foggers, UV light, robotic arm are making their way in, making hard labour less human-dependent and may provide more regulated and reproducible systems.
• Coated surfaces like door knobs, curtains, bed sheets and clothes promise to decrease transmission of bacteria via contact.
• Even catheters and dressing materials are being coated with silver or platinum to reduce bacterial burden or biofilm production.
• Chemical disinfectants are being replaced by negatively charged radicals like O- and OH- which do not allow bacteria to become resistant to disinfectants.
• Increasing support from imaging (radiology) services and laboratory services are crucial in diagnosing and treating patient sooner for better clinical outcomes.
• Use of Artificial Intelligence in predicting chances of patients acquiring infections while in hospital will allow concentrating the efforts on patients who are at higher risk.

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