Vital to reduce hospital infections, antibiotic abuse

In medicine, we are at a crossroads. A patient who may contract an infection during treatment or after a surgery requires antibiotic treatment. Unfortunately, because of the abuse of antibiotics, globally, infection-causing organisms have developed resistance to antibiotics. As a result, available antibiotics do not work in curing the infection. So, we have come to use the most potent of antibiotics now.

There are no new antibiotics on the horizon as there are no incentives for the pharmaceutical industry to research and develop one because at the end of the day, infection control will require one to avoid excessive use of antibiotics The “crossroads” situation is caused by multi-drug resistant organisms causing infections. Doctors are not sure what to do.

Hospital-acquired infections (HAI) is a major safety concern for both healthcare providers and patients. Considering morbidity, mortality, increased length of stay and the cost involved, efforts should be made to make hospitals as safe as possible by preventing such infections. Guidelines have been developed for healthcare personnel involved in patient care at wards and areas of critical care, and for persons responsible for surveillance and control of infections in hospitals.

Therefore, doctors are making all efforts to prevent infections. Infection prevention and control is a major challenge for the healthcare system and it’s a team job. The team comprises an infection control committee, surgeons, critical care doctors, physicians, nurses, housekeeping, physiotherapy, quality departments of the hospital and medical administration.

There are international and Indian studies that show that if a person develops an infection in hospital, the cost of treatment escalates 150-250%. For example, if a particular operation costs Rs 1 lakh but a patient develops infection in the bloodstream or pneumonia due to ventilation, they will end up spending Rs 2.5 lakh. That’s how expensive infections can be. So, what should we do and what should our strategies be to prevent infection?

First of all, infections can be avoided by doctors taking precautions at the hospital. There are World Health Organisation (WHO) guidelines on infection control that directs that in the hospital, nobody wears a watch, ring, bangle or full-sleeved shirt so as to maintain hygiene. Also, at an individual level, one can keep a check on things like making sure to wash hands and sanitise them frequently when in the hospital or around the patient.

Spread of infection

Infections can spread in two ways: one, from the hands of the healthcare worker to the patient or from a patient’s body or his cavities or his fluids to the healthcare worker. An infected healthcare worker could then infect another patient if adequate precautions are not taken. Many hospitals have made efforts to put the practice of hand hygiene in place. Wearing gloves is another way to protect both parties — healthcare worker and patient.

While carrying out a regular check-up or blood pressure measurement, doctors may not wear gloves. However, if she has to insert an intravascular catheter in the neck (which goes all the way into the heart) or a catheter into an artery to measure blood pressure continuously or to put a tube into the windpipe to give artificial respiration, it is necessary for a doctor to wear gloves, gown, caps, mask, etc.

The government has come out with a directive that such equipment should not be reused as they are for single use. They may look clean, and they may look good, but it is not like industrial gloves which one can wear till they tear. These gloves and masks need to be untouched and sterilised before use and should be discarded after a single use. It is said that infection control personnel in the intensive care unit for a patient may have 40-50 instances of treating/physical contact with the patient.

Infection control committee members suggest that each of these situations be preceded by a hand hygiene process using hand rub solution. Sometimes, if you are likely to have blood, urine, sputum touching your hands or body, you have to protect the hand against them. So, even if we assume that in about 20 opportunities out of these 40-50 there is blood contact, then we might have to wear gloves. So, in one hour, for a patient, one healthcare worker will use about 20 pairs of gloves.

It may sound surprising, but you may require even up to 1,000 pairs of gloves for a patient who stays for 10 days in an intensive care unit. Such care has been recommended by international healthcare guiding bodies such as the Centre for Disease Control, US, and WHO. If any healthcare worker does not adhere to these strict and stringent precautions, they may contribute to infection in the patient or get infected themselves.

There are many reasons why we should avoid the abuse of antibiotics. You may be surprised to know that if I use a high-end antibiotic or combinations of them, say Mero-
penem and Colistin, then the everyday treatment would cost up to Rs 20,000-30,000
for a 15-day course. Hence, we can understand that the cost may escalate to about Rs 5 lakh because of antibiotics usage alone.

Therefore, at healthcare facilities, we stress and emphasise infection prevention rather than treatment. Every major hospital has an infection control committee which monitors the activity of each and every doctor, nurse and other healthcare workers. They also have periodic training to impart knowledge on the new developments in infection control to lower the infection rate at hospitals.

The relatives/attendants of patients are also asked to follow and practice infection prevention. If any infection occurs, it can escalate the cost of treatment by 150-200%. So, a holistic approach and cooperation is needed from patients’ attenders, too, to avoid spreading infection. If we adopt these practices, overall patient satisfaction will be high.

(The writer is Chairman, Central Infection Prevention & Control Committee, Fortis Hospitals, Bengaluru)