Hospital acquired infections (HAI) are far more common in India than in western countries. This occurs at the alarming rate of one infection per four hospital visits compared to one in ten for a European country and one in twenty for the United States. At a rate this high, and due to the potential infection for immunocompromised patients, this could be a large contributing factor to the spread of disease in India.
Hygiene routines are already in place for Indian hospitals. Standards have been set and there are rules to follow. Many of these HAIs are common despite this. This implies that infections are occurring not through absence of set rules, but through non-compliance to the rules that are already in place.
This viewpoint has been acknowledged by the World Health Organization (WHO). Knowledge of the pathophysiology of infectious diseases has been enhanced by world leading research stemming from many countries. The spreading of antimicrobial resistance amongst many diseases has become a top priority in recent years. Yet still infections occur through what amounts to negligence of hygiene rules. To combat this the WHO has focused on the “Clean Care is Safer Care” campaign, focusing on the basics of hand hygiene.
A re-assessment of hygiene strategy and the means to enforce standards from the ground up may be the best potential strategy to address the situation. It has been found that a large number of the infections stem from medical devices such as mechanical ventilators and catheters. Again this relates to a lack of hygiene associated with the device, with suggestions that different, potentially outdated, devices are often used in Indian hospitals and so often will not adhere to modern standards.
A study conducted by Dr Victor Rosenthal published by the International Nosocomial Infection Control Consortium (INICC) assessed the rates of device associated infections across 40 Indian hospitals compared to a number of other countries. These studies were conducted on patients in intensive care units (ICUs). The findings indicate that 7.92 central line-associated bloodstream infections occurred per 1,000 central line-days, 10.6 catheter-associated urinary tract infections per 1,000 urinary catheter-days and a ventilator-associated pneumonia rate of 10.4 per 1,000 mechanical ventilator-days.
Many of those in intensive care will be in severely weakened states, potentially on antibiotics for other conditions. Conditions such as pneumonia may be life threatening under these circumstances . Also of concern is the fact that many of the HAIs are immune to antibiotics, this contributes to the spread of antibiotic immunity, with the potential to transfer the associated genes to other, potentially more lethal diseases if co-infection occurs.
Dr Rosenthal warns against the overuse of antibiotics to address the problem “The misuse and excess use of antibiotics increase resistance. The approach should be to prevent infections and in the process bring down the HAI rate together with bacterial resistance, rather than waiting for infections and then treating them with antibiotics.”. It is perhaps this “catch up” mentality that allows the infections to flourish.
The WHO present a strong case for an overhaul of the hygiene system from the ground up, preventing the spread of infection rather than treating it when it occurs.