Cases of hospital-acquired infections on the rise in TN

Despite the Union Ministry of Health and Family Welfare releasing National Infection Control Guidelines to prevent hospital-acquired infections (HAI) and healthcare associated infection (HCAI), the state has been witnessing an increase in the number of cases of people acquiring infections in government hospitals. While hospital authorities say that carrying out a larger number of medical procedures has increased the risk, experts blame the authorities’ non-adherence to safety protocols.

Government hospitals are home to a great variety of infections and acquiring these infections in such a set up often occurs within 48 hours of admission. Medical experts say that patients and their attendees have about a10 per cent risk of acquiring a new infection including respiratory infections, surgical wound infections, gastrointestinal infections, droplet transmission and airborne diseases.

The highest number of hospital acquired infections affecting the patients at Institute of Child Health is due to catheter associated urinary tract infection that have increased by 10 per cent in the last year. Fifteen ventilator associated pneumonia cases were reported in children at the hospital last year, while the total number of blood stream infections constitutes about five per cent of hospital acquired infections. Though surgical site infections are only about 1 per cent, their numbers continue to be higher than last year.

At Rajiv Gandhi Government General Hospital (RGGGH), more than 100 cases were reported due to catheter related infections in 2018 and till March about 43 cases have been registered. The ventilator associated infections and at dialysis units, there are more than 50 cases reported since 2018 to March 2019, which was only 32 in 2017. Influenza remains to be one of the commonly caught infections in RGGGH.

As per the WHO manual on prevention of hospital acquired infections, of every 100 hospitalised patients at any given time, seven in developed and 10 in developing countries acquire at least one health care-associated infection. Hospitalization or residing in an acute care hospital for two or more days can show symptoms associated with hospital-acquired infections in next 90 days.

“As the medical and healthcare services have advanced in the State, there are more number of medical tests and procedures conducted as part of diagnosis and treatment. There are various bacterial and viral infections that one is exposed to in a healthcare set up, while transmission of infections takes place due to contaminated medical devices, direct contact, vehicle transmission or exposure to infected person in the health care units,” said Dr S Azhagi, general medicine consultant, Rajiv Gandhi Government General Hospital.

“There is a high risk of infections from patients admitted to the intensive care unit, but attendee often insist to be allowed to the ICU and increase the risk of infections,” she added.

The use of catheters in the arteries, urinary catheter, injections and ventilators for a long period can serve as the major cause of infections as they are in direct contact with the internal organs or blood and can lead to HAI.

High risk among paediatrics- In paediatrics, prolonged and inappropriate use of invasive devices, immuno-therapy, and isolation precautions are some factors that increase the risk of infection in health-care settings. 

“Owing to less developed immune system, the risk of HAI is higher in children as they are often unaware of the personal hygiene and safety protocols. Opportunist infections attack an individual when the immunity gets affected post hospitalization. Low immunity of an individual is a major responsible factor for HAI, which makes them prone to infections in the hospital.,” said Dr Arasar Seeralar, director, Institute of Child Health. 

A large number of health workers are prone to HAI while working in healthcare settings as they are in contact with the patients almost every day. While protocols mandate use of gloves, masks and other infection control practices, nurses at government hospitals say that it is not possible to adhere to these round the clock.

Health workers play an important role in the prevention of HAI by following infection prevention protocol. As per the protocols to be observed while administering injections, during catheter insertions, cleaning surgical sites and preventing infections in dialysis units, the health workers have to be trained ininfection control practices, however, such training sessions are missing for the workers at government hospitals.

“We are not provided with any gloves or masks as we transport patients all throughout our eight hour shift at the hospital. There are no training sessions other than basic instructions to observe basic hygiene at the time of joining,” said K Tulasi, a staff worker at RGGGH.

Government hospitals should have a regular check of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients as they lead to most of the hospital acquired infections.

 “As per the manual for the prevention of HAI, an infection control committee is mandatory at all the government hospitals since 2017. However, not all government hospitals are having a functional infection control committee, sanitation committee or any supervising authority to oversee the cases of HAI. There is a need for a surveillance programme to check the spread of HAI and ensure prevention. However, there is no such effectively functional authority in all the government hospitals as there are no regular checks to check the preventive measures against HAI by these committees,” said Dr G R Rabindranath, member secretary, Doctors’ Association for Social Equality.

 A large section of HAI are mainly due to improper disposal and handling of bio-medical waste generated at the government hospitals. “Improper disposal of bio-medical waste also leads to an increase in the spread of infections, with patients and attendees who are in the hospital premises for a long time, being the primary victims. Not only solid waste management plants are lacking at most of the government hospitals, the liquid waste such as blood and laboratory waste is thrown without being treated,” said social activist Jawaharlal Shanmugam.

State health department officials say that most of the HAI cases are treated at the hospital itself, however, the authorities fail to produce statistics of prevalence of infections in the institution.

“A few government hospitals have an infection control committee and we are taking measures to identify HAI and report the outbreaks, if any. The infection control committee overviews the functioning of the hospital laboratories and wards to check if the safety protocols are being followed,” said public health director Dr K Kolandaisamy.