prensa

[February 11, 2006]

Hospitals, a hub for HAIs; a route to AIDS

Spare a thought. Across the world, patients in treatment centres and the healthcare fraternity are increasingly confronted with the rising numbers of hospital-acquired infections (HAIs), also referred to as nosocomial infections.

Of course, it's not a new phenomenon. But the recent increase in HAIs in hospitalised patients is alarming and demands for concerted action as they challenge the delivery of state-of-the-art healthcare services in both the developed and developing world.

A look at the stats confirms the concern: Over one million people across the globe are affected by infections they did not have when entering the hospital.

Globally, there is a growing concern over nosocomial infections and the number of deaths attributed to such infections, which are potentially preventable. There is a need for stern action and stringent measures in developing countries like India if the mortality rate attributed to avoidable casualties has to come down, says Dr Victor Rosenthal, director and coordinator of the International Nosocomial Infection Control Consortium (INICC), Argentina.

Interestingly, an increase in HAIs has been registered not only in the developing world, where poor quality health service are more frequent, but also in highly industrialised countries. The World Health Organisation (WHO), which has made 2006 the year for nosocomial infections, calls HAIs a major cause of death and disability for patients.

A survey on HAIs reveals that at any time, over 1.4 million people worldwide are suffering from infections acquired in treatment centres. The actual rates vary from 5% to 10% of all patients admitted to modern healthcare centres in the industrialised world to up to 25% in developing countries like India.

For the uninitiated, the term hospital-acquired infections refers to infections developing in patients in healthcare centres, not present at the time of their admission. Broadly, it includes infections that manifest 48 hours after admission in hospital or immediately after discharge.

The common types of HAIs include those that occur in blood (bloodstream infections), at the site of surgery (surgical site infections), urinary tract infections and pneumonia. Amongst these, blood-stream infections are of particular concern because of their growing numbers, longer recovery time, the resistant nature of causative bacteria and the high mortality and high costs associated with them. The most common portal for organism entry in case of bloodstream infections is the venous route, through ever increasing use of intravascular catheters and devices.

Explains Dr Anupam Sibal, group medical director, Apollo Hospitals: HAIs occur with more frequency in newborns, infants and the elderly. Other factors associated with higher risks are serious underlying illnesses, major surgeries, length of hospital stay, immune deficiency and, stay in intensive care units (ICUs). It is estimated that approximately one-quarter of nosocomial infections occur in ICUs and that one-third of all such episodes are potentially preventable.

What's worse, HAIs complicate the treatment and care of millions of patients worldwide every year. In fact, a combination of factors, intrinsic to the environment of treatment centre, facilitates the spreading of micro-organisms - exposing patients to increased risk of infections.

The major reasons, but not the sole, for the higher risk exposure are congregation of infected persons and persons at high risk of infection, treatment of patients in a closed, small and crowded area with frequent transfer of patients between units and wards, transmission of microbes through healthcare professionals and usage of common equipment.

Also, the fact that many patients undergo procedures that bypass the natural protective mechanisms, ie. more frequent impaired immunity and resistance to antibiotics, contribute to the HAIs cases and diffusions of microbes in healthcare premises.

The case in India is no different and many studies conducted by private hospitals conclude the rate of HAIs at 20-25%, in agreement with WHO figures. However, the issue, which wasn't much in focus earlier, is now being given priority and most of the big hospitals have set up elaborate protocols to check the infection rate. This has also become important ever since Indian hospitals have started getting international accreditation for best practices and protocols.

Says Dr Ashok Seth, chairman and chief cardiologist, Max Devki Devi Heart & Vascular Institute, New Delhi: Adherence to good hand hygiene practices is the most important factor in preventing hospital acquired infections. We keep alcohol hand rubs at each patient bed-side and at entrances in critical care units to ensure compliance among healthcare staff and visitors.

We conduct monthly audits and random checks in OT and Cath Lab for doctors and nurses. We also adhere to guidelines for care of in-dwelling devices in patients, like IV lines, urinary catheters, etc, besides adherence to Infectious Disease Society of America & British Society of Anitimicrobial Chemotherapy guidelines on treatment of community acquired as well as hospital acquired infections to limit the spread of antimicrobial resistance.

In fact, most of the big hospital chains like the Apollo group and Fortis have in place multi-disciplinary task teams comprising microbiologists, nurses, doctors and members from waste management and house-keeping who meet regularly to keep the hospital environment as clean as possible.

We have set procedures and systems to measure infection rates and very strong antibiotic policy to prevent its abuse. Fortis has an elaborate policy on assessing the risk level of patients and applies strict standards in the premises, says Dr Manoj Rai Mehta, medical superintendent, Fortis Healthcare Ltd, Noida.

Max Devki Devi, for one, carries out active surveillance by clinical microbiologist and infection control nurse in all ICUs for VAP, bloodstream infection and catheter associated UTI. This data is collated for comparisons with data from developed countries like US & the developing world. This initiative has been started for the past four months and we will soon enter into an international collaboration with the International Nosocomial Infection Control Consortium (INICC) to compare our rates with the rest of the globe, says Dr Seth.

And the reason is not far to explore. Besides contributing to excess morbidity, mortality and costs, such incidences have the potential to tarnish a hospital's image in the eyes of the public and undermine its credibility and reputation - no matter how advanced it is in terms of medical expertise and performance or technological excellence and standards.

This also assumes importance ever since the concept of medical tourism has come to India. Says Dr Sibal: The three most important questions in the mind of a foreign patients are: how safe is the blood at the hospital, what's the state of nursing and post-operative care and what's the rate of infection. The fact that we are scoring very well on medical tourism in itself speaks volumes on how much attention we give to such issues.

Clearly, the key is to ensure proper sterilisation practices, with strict monitoring, and regular training of healthcare staff in best infection control practices. We feel that regular CMEs on nosocomial infection, antibiotic resistance and infection control for clinicians and nurses will go a long way in reducing the morbidity and mortality among hospital patients, says Dr Seth.

[ Back To TMCnet.com's Homepage ]

Copyright 2006 Technology Marketing Corporation (TMC) - All rights reserved