Healthcare Associated Infection major risk; need urgent attention for quality care: Dilip Patil

Healthcare Associated Infection (HAI) is a major issue today which has bothered both patients as well as healthcare service providers. At a time when whole world is battling with COVID-19 pandemic, the issue holds huge significance. It causes lots of inconvenience to patients–at times out of pocket expenses goes up, patients have stay for longer period in hospital, and mental stress In ICU and OT, infection may cost patient his life. In this wake, healthcare providers needs to look into sustainable solutions to prevent the infection. Dilip Patil, Founder Director, Trivector Group & Baby Quest Cryobank highlights various aspects of the infection & hygiene and how Cold Plasma Air Sterilizer may prove to be a game-changer.

Infection posing risk to frontline workers amidst COVID-19 crisis

During the COVID-19 pandemic, all the hospitals and authorities are undertaking utmost care to follow infection control guidelines. They are doing their best–maintains physical distancing, surface hygiene, providing healthcare workers with sufficient PPE. But the hospital beds are full, overcrowded, makeshift beds in sports arena and exhibition grounds are being constructed. The hospital budget and revenue are under huge stress. As frontline workers are overworked, they are vulnerable for infection. They are increasingly getting infected. PPE shortage is unfortunate reality. Hand hygiene mechanism is inadequate. Cleaning staff can’t cope up with enormity of this pandemic. Patients of other issues like TB are getting neglected somehow as focus is on coronavirus mostly. We are in for a big challenge now. We have to augment infection control practices.

Importance of HAI–Economic and social impact

HAI stands for healthcare associated infection or hospital acquired infection. Patients acquire these infection during their stay in hospital or after they get discharged. It is also classified as occupational infection among healthcare staff. HAI is preventable.

Is HAI a serious issue?

7 percent of total patients in developed countries like America and 15 percent in India and Africa, they acquire at least one infection during their stay in hospitals. There are 1.4 million hospitalized patients at any point of time around the world who acquire at least on infection. 30 percent of this infection is acquired in ICU. For India, this statics is double or triple. 50 percent patients in ICU may get infection. The mortality rate or death rate is 10 percent. 6 million patients in Europe and United States get infected annually. One can gauge enormity of the issue. In developing countries, death rate of neonatal due to HAI is equivalent to like a plane crashing in every hour. In developing countries, patients spend 5-30 additional days because of infection. HAI patients are 5 times likely to be readmitted after discharge. In USA, total healthcare cost due to HAI is 45 billion dollar which can be avoided by precautions.

Social consequences

There are substantial extra cost for healthcare services, insurance companies, and administrators. As patients have to stay longer, there could be excess use of antibiotics which a patient has to bear in terms of out of pocket expense. Then quality of life is at risk—death, pain, discomfort, and psychological trauma. In addition, there is loss of productivity due to morbidity and mortality. In this light, HAI is big issue which needs urgent attention. It was before corona, with corona, and will remain after the pandemic.

What hospitals are doing?

We have WHO, CDC and our own guidelines on improving hand hygiene among hospitals’ staff and surface cleaning protocol. Most of the hospitals and all cross agencies they collaborate to follow anti microbial stewardship–limit the use of antibiotics.

Why hand hygiene and surface cleaning is not enough and airborne issue needs to be taken seriously?

Hands of healthcare workers are chief vehicles for these pathogens to transmit in the hospital. WHO has advised five golden moments for hand hygiene. These are following–Before you touch a patient, before you clean and aseptic procedure, risk of changing urine bags, after touching a patient anytime, and after touching patients’ surroundings like bed railings or IV stand. 76 percent of healthcare workers miss at least one event of hand hygiene while dealing patients.

What are the lapses?

Even when hand rub is readily available for the staff in the dispenser, and sink are in the working order, no leakage and blockage of water, and authorities have clear guidelines, still compliance on hand hygiene is very low. 60 percent people all over the world don’t follow hand hygiene properly. Either workers don’t rub the hands as required or don’t use enough soap, don’t clean bags. Average time spent on hand cleaning is 11 seconds contrary to 20 seconds. When workers wear gloves, they infect other surfaces. Surface cleaning is important. Meticulous surface cleaning is critical. All these infection outbreak is due to contaminated surfaces like bed railing, sink, door handle, stethoscope, glucometer, computer key board in the ICU. These are sources of surface contamination.

Failures of surface cleaning

Hospitals have limited budget. Cleaning staff often have very less time. As per WHO, between two patients there has to be 40-45 minutes gap for proper cleaning of the room which is not generally followed due to time constrain. Hospitals authorities can’t gauge quality cleaning as sometimes what appears to be clean in actually carry lots of germs. Generally corporate hospitals tend to outsource cleaning. But staff tend to be underpaid by the agency due to number of reasons.

The missing link: Airborne Transmission

Because of overuse of antibiotics, 70 percent of bacteria have developed resistance to all the available antibiotics. In the last 30 years, not a single new antibiotics has been developed by any company. We have to inactivate viable airborne particles before they settle on surfaces. WHO maintains SARS-CoV2 spreads mainly through respiratory droplets and contact routes.

Air cleaning technologies and solutions

There are two ways to kill air borne pathogens–one is trap method and other is deactivating(killing) pathogens. Most of the hospitals have trapping method–HEPA filter and carbon filter. HEPA filter has to be replaced periodically otherwise bacteria will get colonized and it will do more harms than benefits. Its performance decreases with humidity. Moreover maintenance cost of HEPA is huge. A sustainable solution is needed.

Cold Plasma Air Sterilizer

Ultra Low Energy Plasma Air Disinfection

It is a new to combat infection. Plasma is a fourth state of matter. When you apply heat to solid it becomes liquid and if the process continues end result is plasma. Plasma is an energized gas. Lightening is best example of plasma. Multiple physical and chemical processes occur simultaneously to produce a powerful medium that is uniquely hostile to microorganisms and organic chemical compounds.

Clinical Trials: Summary

75 percent reduction in surface bacterial count.
97 percent reduction in MRSA
82 percent drop in CFU rates
52 percent drop in infection rate in three months
100 percent reduction in C. difficult.

The article is on the basis of interaction with Dilip Patil in a webinar. Patil is a thought leader in Airborne Infection Control domain and Plasma Air Disinfection Technology.

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