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The Gorakhpur Tragedy of 84 children dying in BRD medical college followed by various similar incidents has raised serious concerns regarding India’s healthcare infrastructure and hospital acquired infections (HAI).
What are Hospital Acquired Infections? • Also called nosocomial infections, HAI are passed onto the patients after being admitted at the hospital facility. • It usually goes by unacknowledged unless an epidemic situation such as Gorakhpur tragedy happens.
Current Status in India • Despite being unacknowledged by the healthcare system in India, it is very much a reality according to a report published by the International Nosocomial Infection Control Consortium in 2015. • Another study published in the British Medical Journal indicates that that the burden of healthcare associated infections in countries like India is high, with an estimated pooled prevalence of 15.5 per 100 patients, more than double the prevalence in Europe and the US. • Inability to improve health outcomes is one of the reasons that India was not able to achieve the millennium development goal of “Good well being and Health”. • India does have guidelines for patient safety, waste disposal or other standard hospitals procedures. However, they are seldom followed.
Causes of HAI • Lack of proper Equipment: This includes both clinical and non-clinical equipments such as oxygen cylinders in the case of Gorakhpur Tragedy. This leads to inappropriate methods of treatments such as putting two infants in the same incubators. According to a CAG (Comptroller and Auditor General), there is 27.21% shortage for clinical equipment and 56.33% for non-clinical equipment,. • Poor knowledge and application of basic infection control measures: This includes absence of sanitisation of the hospital premises such as visitor chair as well as strict rules regarding visitation especially in intensive care units (ICUs). • Poor Infrastructure: Poor infrastructure in general includes proper beddings for patients, separate and disinfected lavatories for visitors and patients. • Understaffing and Overcrowding: This is one of the root causes of non-compliance of the most basic hygiene standards by hospitals. • Lack of Procedure: Lack of standard procedure for dealing with communicable disease patients increases the risk of HAI exponentially. • Lack of knowledge of injection and blood transfusion safety: Lack of proper training for such procedures increases risk of contracting infection such as HIV and Hepatitis B. Moreover, with quackery highly prevalent in India (especially in rural areas), this becomes all the more relevant. • Inadequate environmental hygienic and waste disposal mechanisms: There have been numerous cases of aborted fetuses and hospitals waste being thrown in nearby water bodies. Inadequate waste disposal not only increases chances of HAI but also puts the environment at risk. • Absence of local and national guidelines: Absence of proper guidelines for hospital maintenance, accreditation and laws puts patients at risk. • Prolonged and inappropriate use of invasive devices and antibiotics: Resistant strains have been found in India even for third- and fourth-generation antibiotics like cephalosporin and carbapenem making it difficult to treat patients. • Immune-suppression and other severe underlying patient conditions • Insufficient application of standard and isolation procedures
Implications • Creates additional suffering for patients and comes at a high cost for their families. • It increases hospital stays and creates long-term disability • Increases resistance to antimicrobials • Increases cost burden for healthcare systems and causes unnecessary deaths.
Way Forward • Identification of local determinants – Hospitals should have a set protocol in order to identify HAI and curb them. • Improving reporting and surveillance systems: Health is a state subject but the government must come forward with a national surveillance plan for HAI. • Standard procedures for infection control must be adhered at both private and public health care centres. Although ICMR (Indian Council for Medical Research) does holds workshops for the same but the lack of standardization creates practical difficulties. • Strict Adherence to standard precautions such as hand hygiene by hospital staff • Improving staff education and accountability: Training for dealing with critical care patients must be provided for all hospital staff especially informal healthcare providers such as nurses as quacks. This can help improve case management. • Quacks must be surveyed and laws must be put in place to avert them from providing treatment that they are not trained for. • Awareness campaigns must be held for patients and their families for timely reportage of HAIs. • Immunization and vaccination of staff must be made mandatory for influenza and other communicable diseases. • Antibiotics must be sold as prescription drugs only. India’s Red Line campaign is a step in this direction • India has done ample work on the policy front when it comes to tackle antimicrobial resistance. However, what we need to do is to buck up the administrative setup to implement those policies. • This could be done through public-private partnerships. This will also solve the problem of insufficient funding and human resources. • Hospitals not following standard treatment procedures, waste disposal methods and other protocols must be held accountable and duly fined. • The Indian Medical Association has proposed that all government hospitals too must be accredited from NABH in line with the private hospitals. • All blood samples collected for blood transfusion must be tested. Nucleic Acid Test (NAT) must be mandatory in order to reduce HIV infections. NAT detects HIV infections of 11 days to two weeks while the currently prevalent ELISA detects the infections of 30 to 40 days of six weeks.
By: Arpit Gupta ProfileResourcesReport error
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