Hospitals flout rules to prevent spread of infections

Last December, a 24-year-old pregnant woman from Sattur, who desperately needed a transfusion had approached a government hospital in the district. She was, however, infused with HIV positive blood.

In 2013, a 28-year-old man from Chennai was diagnosed with kidney failure and in need of a transplant to avoid a dialysis-dependent future. But, due to a few ailments, his transplant was postponed, forcing him to rely on dialysis at the Stanley Medical College and Hospital. It was not too long before he was diagnosed with Hepatitis C, acquired from the equipment used during dialysis. He was just one among 18 people who suffered the same fate that year.

Transfusion Transmitted Infections (TTI) and Hospital Acquired Infections (HAI) have both been growing to become a major cause of concern in Tamil Nadu and have been affecting the state’s reputation of being the hub for medical tourism. While the Government of India has five mandatory tests for the blood donated — namely HIV, Hepatitis B, Hepatitis C, Malaria and Syphilis — recent cases have been indicative of the lack of this protocol being followed. There are also other regulations that are not being taken as seriously as expected, say doctors.

Stating that both HIV and Hepatitis C have a window period during which identifying the virus in the body becomes difficult, Dr Shanthi R, a doctor and member of the Doctors’ Association for Social Equality (DASE), said, “In such cases, the nucleic acid test has proved to be useful as it can test the virus within five days of contraction. The Tamil Nadu government’s blood policy book says that we should conduct the nucleic acid test in a phased manner so as to prevent TTIs.”

But, despite the presence of such a policy, the number of cases of protocols not being followed is on the rise. “We have a blood safety policy in the state. Besides, we have the Nationalised Control Society, Blood Safety Administrator, as well as the Drug Control Department — all of which look after blood safety in Tamil Nadu. The problem, however, persists. The blood policy 2018, which the state government came out with on March 9, last year, continues to be in the draft phase even after almost a year. Though the policy has everything in terms of the protocols to be followed, it has not yet started functioning. Drafting a policy is not adequate; it has to be finalised and executed as well,” she said.

On the seriousness of such infections, Dr Vidya K, a general physician, said, “Nosocomial infections are the leading cause of death at any given time. About 1.4 million people suffer from HAIs and its complications, making it a matter of great concern.”

HAIs or nosocomial infections are caused because of the hospital environment or owing to the presence of an infection in neighbouring patients. “We have been trying to create awareness on the importance of sterilising the stethoscopes as it is a common tool that spreads infections. It is important that every hospital has an infection control protocol, an infection control committee and an antibiotic policy,” said Dr Shanthi.

While the government did come up with such a policy, it has also mandated that each institution has a policy based on its own statistics of prevalence of infections in the institution. “The policy must be drawn up by the infection control committee of each institution, especially the bigger hospitals. Also, the committee should be formed of different HODs and the experts from the microbiology department. They must take infection prevention seriously to prevent nosocomial infections,” Dr Shanthi added.

It may, however, be noted that less than 10 per cent of the hospitals in Tamil Nadu have formed such a committee. “The hospitals that do have the committee do not even meet on a regular basis, as is mandatory,” Dr KP Raman, a specialist in Infections.

“The committee is supposed to monitor the cases, be it in the post-operative ward or in the Intensive Care Unit (ICU). They also need to identify the reason for the infections. They need to carry out a swab test of the walls, beds, door handles and equipment in the ICUs and the operation theatres. If these regulations are followed, infections can be prevented,” the doctor added.

While one can acquire infections from unsterilised needles, other equipment like catheters, endoscopes and stents can also serve as carriers of a variety of infections. Stating that it is a challenge to control such infections, Dr Mohana K, a general doctor, said, “Poor medical infrastructure and the uncontrolled use of antibiotics have increased the risk of development of these infections. Unlike others, HAIs are resistant to antibiotics and are extremely difficult to manage and cure. It is therefore crucial for hospitals to ensure that they follow proper safety protocols to prevent such infections.” With the immune systems of persons admitted at the ICUs found to be compromised, patients there tend to be the most vulnerable to such infections, Dr Mohana said. “While it is mandatory for hospitals to ensure safety to the patients coming there for treatment, it is also important that the patients are aware of what are the parameters that each hospital must follow to assure them that them that they are in safe hands,” she added.

From washing hands to using disinfectants and sterilising hospital equipment, a few simple steps can help prevent such infections, said Dr Soundari R, a city-based doctor. “Today, HAIs are becoming a matter of global concern. It is therefore essential for preventive measures such as hand wash, use of disinfectants and wearing gloves and masks be adopted in hospitals.”

“Many infections are developed when babies from other hospitals get admitted here. There are respiratory-related infections and catheter infections. These are the common infections that affect foetuses. Chances of survival are based on the measures taken up by the medical institutions and the presence of hygienic practices such as hand washing and sanitising,” said Dr S Arun Kumar, a senior consultant of neonatology at Rainbow Children’s Hospital.

Stressing on barrier nursing — rigorous handwashing and educating patients and attenders about the risks of cross infection with other patients — Dr Mathurbootham Sridhar, a consultant paediatrician at Apollo Children’s Hospital, said, “Each hospital must have a strict infection control policy and ensure that it is put into practice.”

Stating that steps are being taken to check the prevalence of HAIs and TTIs, a health official, said, “What happened with the pregnant woman recently was a mishap and action has been taken to ensure it is not repeated. But, while HAIs are common, we are stressing on the importance on maintaining hygiene at the institutions to prevent cases.”