When Hospitals Infect

Indian healthcare providers need to get serious about infection control.

Written by Gauri Kamath | Updated: October 22, 2015 2:30 am
Delhi hospital, Safdarjung Hospital, RML Hospital, RML Hospital emergency, Dengue death, Avinash Rout, Parents suicide, Avinash Rout death, Kid death dengue, AIIMS, AIIMS emergency, Sanjay Gandhi Memorial Hospital, EWS, Delhi news, Indian express, nation news A doctor checks an X-ray in the ER of Sanjay Gandhi Memorial. (Source: Express photo by Oinam Anand)

A deadly strain of bacterium has doubled its resistance to last-resort antibiotics within a year, according to the report “State of the World’s Antibiotics, 2015”. By an estimate, antimicrobial resistance — the ability of bugs to outwit antibiotics — will claim two million lives in India by 2050, a fifth of the total.

India is under pressure to curb indiscriminate antibiotics use, the reason behind resistance. In parallel, it is vital that Indian hospitals, major users of last-resort drugs, minimise usage and don’t turn into hotbeds of drug-resistant infection. To do so, they have to avoid becoming purveyors of disease by following strict infection-control norms. Hospitals cater to the sick and are home to all sorts of bugs. Sometimes, these infect patients. For instance, a person recovering from heart surgery might contract pneumonia from a bug in the ventilator. Such hospital-acquired infections (HAIs) affect hundreds of millions of patients worldwide each year. While they can surely be contained, worryingly, they are not.

Insufficient hygiene and patient-isolation protocols in operating rooms (OTs) and intensive care units (ICUs), poorly maintained equipment, understaffing and overcrowding create a fertile breeding ground for bugs. Patients weakened by surgery or age are easy fodder. Doctors unleash increasingly potent antibiotics on the bugs, many of which are becoming drug-resistant. The frequency of ICU-acquired infection in low- and middle-income countries is two to three times higher than in rich ones. HAIs can double or quadruple the average length of hospital stay and jack up expenditure on drugs and diagnostics. Hospital staff are also at risk.

There are well-researched solutions. Studies support protocols of hand-washing/ sanitising by hospital staff to drastically alter the rate of transmission of deadly bacteria. Other measures include specialised air circulation systems in OTs, and methods to sterilise equipment. An infection-control department (or officer) and a microbiology lab can survey and respond to outbreaks. But even our richest cities are home to airless nursing homes, often run by a single doctor and manned by ignorant staff. States don’t mandate reporting of HAIs or HAI-linked deaths. Auditing infection control is voluntary.

True, India’s National Policy For Containment of Antimicrobial Resistance 2011 identifies “strengthening infection prevention and control measures” as an action point. Since 2012, the Indian Council of Medical Research (ICMR) holds workshops to train staff from private and public hospitals. But the lack of standardisation creates practical difficulties. A 2014 ICMR report cites a “high variability” in the presence of an infection-control team, quality-assured microbiology labs, and access to different groups of antibiotics among participating hospitals.

The rising popularity of accreditation programmes run by New Delhi’s National Accreditation Board for Hospitals and Healthcare Providers (NABH) or the US-based Joint Commission International (JCI) holds out hope as they have standards for infection control. But progress is slow. In Central Government Health Scheme hospitals, and those empanelled with a few states, NABH accreditation is mandatory. Among the rest, larger hospitals (typically over 100 beds) are more likely to opt in. But 90 per cent of Indian hospitals have under 100 beds.

Indian states, whose job it is to regulate healthcare, must require the reporting of HAIs. This would force hospitals to keep track even if they don’t opt for accreditation. States should also have uniform minimum standards for infection control that are compulsory and audited. Hospitals should be educated on the impact of infection control on healthcare costs, bed occupancy, staff health and clinical outcomes. Medical and nursing colleges should make basic HAI training compulsory. In Western countries, HAIs caused by staff action or hospital conditions are grounds for a medical malpractice lawsuit. In a rare case, a consumer redress forum in India asked a private hospital to pay damages to an HAI-afflicted patient in 2013.

Hospitals flaunt their roster of doctors and state-of-the-art technology as they believe this is what attracts customers.

We should hope for the day they seek to advertise better outcomes thanks to infection control.

The writer is a Mumbai-based commentator on the pharma and healthcare sectors

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  1. R
    Oct 22, 2015 at 10:22 pm
    My own mother was infected during a surgery at Max Saket hospital. She could barely survive with mive doses of very expensive antibiotic. Of course, it is impossible to sue the hospitals or doctors in India.
    1. S
      Oct 26, 2015 at 3:39 pm
      Dear Gauri , It is an extremely well researched article on a topic so often ignored by the medical fraternity. Here are some points I would like to add being a part of it:- 1- As you have rightly mentioned antibiotics are being used right, left and center in India.. You will be shocked to know that when a patient comes with a simple viral throat infection to specialists like us, he has already been purged with all sorts of higher antibiotics by GPs (in fact most of who are not qualified in allopathy medicines ) or shockingly even by the Pharmacists in medical stores. 2- Ideally for any surgical procedure if one has followed the aseptic & antiseptic precautions then in a clean surgical field you need you give maybe one shot of antibiotic an hour before the surgery and another about 6 hrs after the procedure. But most of our surgeons keep on giving antibiotics for a couple of weeks because they are not sure of the antiseptic precautions taken and do not want to take chances. The reasons given are we do not know how hygienic the patient or his living conditions are and this is India, there are bugs everywhere so better to be safe than sorry. 3- Now a days most of the surgical procedures are day care surgeries even the major ones so the patient can and should be discharged the moment he does not require injectables and is mobile. For some reasons the nursing homes and esp. multi-speciality hospitals keep them admitted for days and weeks together. Even mediclaim requires the patient to be admitted for more than 24 hrs even for a procedure like Tonsillectomy, endoscopic sinus surgery, ear surgery etc where the patient can be discharged in 6-8 hrs. Govt. of India's RSBY scheme req. the patient of Tonsillectomy to be admitted for 72 hrs absurd as it may seem but the rules have to be followed. I can go on and on but I do not want my comment to be bigger than the article. Keep penning such good work , informative and useful to the society.
      1. C
        citizen kane
        Oct 22, 2015 at 1:19 pm
        it is a fashion now days for every person to advise to medical fraternity what to do and not to do and critise them. These Jokers who may not worth of a dime comments on doctors and hospitals.These doctors are the best in their schools and colleges to get admission in to medical college, but finally they have to take advise , crsiticism from these worhtless peoples dr. eddu