Hospital Acquired Infection becoming a menace, claiming deaths too

By Vikas Vaidya

A man, aged over 80 years, went to a city hospital with a complaint of fever. A very senior doctor suspected a positive dengue and advised hospitalisation. The old man was admitted to the hospital. His tests for dengue came negative and he was discharged. But a new disease has afflicted him-- Cellulitis, a potentially dangerous bacterial infection that affects the deeper layers of skin. Cellulitis can develop anywhere on the body, but in adults, it most commonly affects the skin of the lower legs. In this old man’s case, Cellulitis proved to be very dangerous because he was already suffering from Varicose Veins. In patients of Varicose Veins, Cellulitis can be a fatal as Varicose Veins are enlarged, swollen, twisted blood vessels often caused by damaged or faulty valves that allow blood to travel in the wrong direction. This infection he carried came after his stay in hospital.
This is one of the several cases of Hospital Acquired Infection (HAI), people get admitted to get treated for common flu and get lung infection, for example. HAI is becoming a big menace in healthcare. Unfortunately everybody seems to neglect this aspect. The cases of HAI are 2 to 20 times more in developing countries like India than those in developed countries.
Taking serious cognizance of this menace, a big corporate hospital in Nagpur had oganised a symposium on HAI five years ago where all the stakeholders expressed their views. But the symposium yielded no result and the cases of HAI kept on rising. In Nagpur alone, more than 30 per cent people die and more than 40 per cent become bed-ridden due to HAI.
Several hospitals in Nagpur have general wards and various special rooms. The condition of both types is not very good. A senior citizen on condition of anonymity said that in one of the corporate hospitals what he experienced was not in a good taste. He hired a super deluxe room in that hospital for which he was supposed to pay higher charges. The room was not only in a shabby condition but also it was smelling foul. Even the bed sheet had blood stains from a previous case. The pillow cover was dirty. A part of mosquito net was broken and mosquitoes were menacing the room. His repeated requests to hospital administration were not attended to immediately and the old patient had to sleep in the room in that condition for the whole night. The conditions were dangerous and the patient could have become the victim of HAI.
What happened to the old patient is one part of the story, but the senior citizen who kept vigil came away with a serious bronchial infection that lasted for weeks.
The rate of cultures of patients coming to microbiologists has not only increased but also are coming positive. Most of the time the reason behind positive culture is HAI, which clearly means that the immunity of the patient would go down. The HAI is responsible for the rising resistivity of the organisms to antibiotics.
Dr Shrikant Ambalkar, Consultant, Clinical Microbiology and Infection, King's Mill Hospital, UK pointed out, “Every hospital should have its own infection control committee. Secondly The ratio of Methicillin-resistant Staphylococcus aureus (MRSA) needs to be checked. (MRSA is a bacterium that causes infections in different parts of the body). In fact, every hospital should keep on checking MRSA ratio. In Nagpur number of samples for MRSA testing and culture sensitivity reaching microbiologists have been increased. In a way it is good thing but it also means that it is worrisome. The Intensive Care Unit (ICU), a most sensitive part of hosptials is medically dirty.
One doctors from USA had been to Nagpur to perform a procedure on a woman, suffering from urinary incontenance. She was shocked to see the Operation Theater and ICU. It was not only dirty but also, the place was not fit to perform surgery as per medical standards. She demanded that she wanted to get cleaned everything where her patient would stay. She purchased all the equipment including gown, gloves, mask from her own pockets and performed the procedure.
What Dr Ambalkar pointed out about infection control committees at hospitals, 85% of the hospitals either don’t have such committees or are not functioning. Unfortunately, doctors and paramedical staff are a bit casual about HAI.
The mortality and morbidity rate of HAI is very high. One doctor on condition of anonymity told ‘The Hitavada’, “One can think if such a situation exists in hospitals in bigger cities then what would be the scene in smaller towns. Doctors are aware of deaths occuring due to HAI but they keep mum. This is very unfortunate when most of the deaths are taking place due to HAI, no one is giving serious thought to it.”