A large number of patients who go to hospitals come back with something more serious. According to the World Health Organisation, at any given time over 1.4 million people across the globe suffer from a nosocomial or hospital-acquired infection (HAI). HAIs account for 2 million cases and about 80,000 deaths a year.
The first step to combat this situation is to improve hygiene practices and implement standard operating procedures at each step, according to the president of the International Nosocomial Infection Control Consortium (INICC), Victor D. Rosenthal, who has been studying the problem for several decades.
“Most HAIs are caused due to [a] lack of compliance with infection control guidelines, such as hand hygiene, [and] use of outdated technology,” he says. The most common types of HAIs are bloodstream infection, pneumonia, urinary tract infection and surgical site infections.
A study published in 2015 by the INICC led by Dr. Rosenthal, studied the rate of device-associated infection rates in 40 hospitals from 20 Indian cities over a 10-year period from 2004. The study, which collected data from 236,700 intensive care unit (ICU) patients for 970,713 bed-days, found that rates of HAIs and antimicrobial resistance were markedly higher in India than the rates reported by the Centers for Disease Control and Prevention, the leading national public health institute in the United States.
The study found an incidence rate of 7.92 central line-associated bloodstream infections per 1,000 central line-days, 10.6 catheter-associated urinary tract infections per 1,000 urinary catheter-days and a ventilator-associated pneumonia rate of 10.4 per 1,000 mechanical ventilator-days in adult ICUs. The study reports that these high rates could reflect “the typical ICU situation in hospitals in India”.
“In India, adherence to practice bundles is irregular, hospital accreditation is not mandatory, and some of the technology applied is different from that of high-income countries. This situation is further emphasised by the fact that administrative and financial support in public hospitals is insufficient to fund full infection control programmes, which invariably results in extremely low nurse-to-patient staffing ratios — which have proved to be highly connected to high HAI rates in ICUs — and hospital overcrowding,” reads the study.
Issue of overcrowding
Acknowledging India’s serious problem of overcrowding of hospitals which leads to many basic hygiene processes being given the go by, Dr. Rosenthal says limited manpower is an important risk factor. “Having one nurse for three beds in an ICU is an important risk factor. With limited resources, there are limitations on providing a good enough manpower, proper guidelines, proper training, proper education, good behaviour, and right technology,” he explains.
Today more than ever, pathologists are constantly in “catching up” mode trying to counter microorganisms rapidly mutating and adapting to existing known methods of treatment. And the persons most susceptible to infection are those whose immune system is already compromised, say after a surgery or a prolonged visit to the hospital. Referring to the overuse of antibiotic drugs, Dr. Rodenthal sounds a sharp warning to the overuse of antibiotics: “The misuse and excess use of antibiotics increase resistance. The approach should be to prevent infections and in the process bring down the HAI rate together with bacterial resistance, rather than waiting for infections and then treating them with antibiotics.”