Dr Ratna Rao, Convenor, Infection Prevention and Control Committee, Apollo Hospital, Hyderabad
Healthcare in India is intervention driven and there is no emphasis on outcome analysis or review. Infection control programmes are difficult to sustain due to multiple factors like lack or shortage of basic requirement (e.g. gloves, hand washing facility), negligible administrative support, limited resources, overcrowding, under staffing and low levels of staff knowledge of infection control practices. In the days to come, there are going to be aging patients with high co-morbidity especially diabetes added to that is the drug resistance infections. The sacny data published show that in Indian hospitals there is high Gram-negative resistance infections, with very high prence of ESBL (Extended Spectrum Beta Lactamases) producers and also high carbapenem resistance rates.
We need to come to ground realities that Healthcare Associated Infections (HAI) with super bug is a medical challenge and in days to come it is going to be pan drug resistant infection. Apart from lapses in evidence based practices (hand hygiene, sterilization methods, standard precautions, and aseptic techniques) the biggest threat is sub optimal doses of antibiotics. Raising awareness and implementing evidence based IC measures apart from judicious use of quality antibiotics will be crucial to combat HAI..
Safety practices across healthcare centres / hospitals are extremely important but a herculean task. Many a times prime areas like the operation theatre, intensive care units receive the best attention.
Aseptic measures are specific practices to ensure delivery of safe surgical care and are ideal deterrents to HAI. One of the important yet neglected areas in hospitals is the Central Sterile Supply Department. Up-gradation of technology with new cutting edge STERRAD NX, a new low-temperature hydrogen peroxide gas plasma sterilizer with computerised record-keeping is essential to keep pace with changing times. Introduction of STERRAD technology has improved the adherence to the Standard Sterilization Protocols because of its ensuring sterility with speed, safety, cost-saving and simplicity. It enables sterilization of all delicate instruments including advanced Robotics surgical instruments and offers the benefits of terminal sterilization over disinfection.
The need to follow basic infection control measures have been taken for granted. As there is no regulatory authority or a notifying agency for HAI, there is no accountability. There is a dire need for introspection and change in mindset in the way we deliver healthcare. Certification of compliance to set standards by a third party (accreditation) has been one of the ways to ensure patient safety.Accreditation of healthcare setup by national (NABH) and international bodies (JCI) has raised the quality of healthcare delivery over the past decade in India. There are 21 JCI and 209 NABH-accredited hospitals across the country today.
Patient benefits the most through this process as quality of care from trained medical staff is ensured. Staff is satisfied as they play a major role in defining and implementing clear clinical processes apart from creating an environment of continuous learning, better working conditions. Healthcare, in turn, is able to benchmark with the best and gain the community confidence in providing quality care.
Compliance, in practice, is poor in spite of written policy and procedures especially antibiotic policy. Management support, staff behavioural change, sustenance of the efforts, continuous monitoring are some of the factors responsible for this. Fortunately, Apollo Hyderabad has had a very productive and favourable injunefection prevention programme over two decades. Innumerable policies and procedures are in place and its implementation has been continuously monitored resulting in infection rates being comparable to best of the hospitals abroad. Highly-motivated staff, team work, sustained monitoring by an extremely proactive infection control team has been instrumental in this endeavour. JCI accreditation, since 2006, has been a stimulus for this positive environment for the staff resulting in lowest attrition rates, continuous updating of technology and the best favourable patient outcome.