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Reducing antibiotic abuse and controlling infection at hospital

Dr. Murali Chakravarthy
Wednesday, January 17, 2018, 08:00 Hrs  [IST]

In medicine, we are at the crossroads. A patient who may get infection during treatment or after a surgery, requires antibiotic treatment. But, unfortunately, because of the abuse of antibiotics, globally, infection-causing organisms have developed resistance to antibiotics. As a result, available antibiotics do not work in curing the infections. Therefore, we have come to use the most potent of antibiotic now.

There are no new antibiotics in the horizon as there are no incentives for the pharmaceutical industry to research and develop one because at the end of the day, infection control will require one to avoid excessive use of antibiotics The “cross roads” situation is caused by multi drug resistant organisms causing infections while no suitable antibiotic to control it. The doctors are not sure what to do.

Hospital-acquired infections (HAIs) is a major safety concern for both healthcare providers and patients. Considering morbidity, mortality, increased length of stay and the cost involved, efforts should be made to make hospitals as safe as possible by preventing occurrences such infections. These guidelines have been developed for healthcare personnel involved in patient care at wards and areas of critical care, and for persons responsible for surveillance and control of infections in hospitals, said NCBI (National Center for Biotechnology Information).

Therefore, doctors are making all efforts to prevent infections. Infection prevention and control is a major challenge for the healthcare system and it is a team job. The team is made of an infection control committee, surgeons, critical care doctors, physicians, nurses, housekeeping, physiotherapy, quality departments of the hospital and medical administration. There are international and Indian studies that show that if a person develops an infection, the cost of treatment escalates 150 per cent to 250 per cent. For example, if a particular operation costs about one lakh rupees, and a patient develops infection in the bloodstream or pneumonia due to ventilation, they will end up spending 2.5 lakh rupees, and that is how expensive infections can be. So what should we do and what should be our strategies to prevent infection?

First of all, infection can be avoided by doctors taking precautions at the hospital. There are guidelines of the World Health Organization on infection control that directs that in the hospital, nobody wears a watch, ring, bangle or full sleeved shirt, to maintain hygiene. Also, at an individual level, one can keep a check on things like hand hygiene, making sure to wash hands and sanitise them frequently when in the hospital or around the patient.

Infection can spread in 2 ways; one, from the hands of the healthcare worker to the patient or from patient’s body or his cavities or his fluids to the healthcare worker. An infected healthcare worker could then infected yet another patient if adequate precautions are not taken. Many hospitals have made efforts to put the practice of hand hygiene in place. Wearing gloves is another way of protection of both the parties – healthcare worker and the patient.  While carrying out a regular checkup or blood pressure measurement, the doctors may not wear gloves. However, if he has to insert an intravascular catheter in the neck (which goes all the way into the heart) or a catheter into an artery to measure blood pressure continuously or to put a tube into the wind pipe to give artificial respiration, it is necessary for a doctor to wear gloves, gown, caps, mask, etc.

The Government of India has come out with the directive that these equipment should not be reused as they are for single use. They may look clean, and they may look good. But, it is not like industrial gloves which one can wear till they tear. These gloves and other masks need to be untouched and sterilized before use. Although they look clean and good, yet they need to be discarded as they are for a single use. It is said that infection control personnel in the intensive care unit for a patient may have a 40 to 50 opportunities of touching/treating the patient. We, the infection control committee members suggest that each of these situations be preceded by a hand hygiene process using hand rub solution. Sometimes, if you are likely to have blood, urine, sputum touching your hands or body, you have to protect the hand against them. So even if we assume that about 20 opportunities out of these 40 there is blood contact, then we might have to wear gloves. So, in one hour for a patient, one healthcare worker uses about 20 gloves. It may sound surprising, but you may require even up to 1,000 gloves for a patient who stays for 10 days in an intensive care unit. Such care has been recommended by international healthcare guiding bodies such as the Centre for Disease Control, US and World Health Organization. If any healthcare worker does not adhere to these strict and stringent precautions, they may contribute to infection in the patient or get infected.

There are many reasons why we should avoid the abuse of antibiotics. You may be surprised to know that if i use a high-end antibiotic and combination of them, say Meropenem and Colistin, then the everyday treatment would cost up to Rs 20 to 30 thousand for about 15 day’s course. Hence, we can understand that the cost may escalate to about Rs 5 lakhs because of antibiotics usage alone.

Therefore, at healthcare facilities, we stress and emphasise infection prevention rather than treatment. Every major hospital has an infection control committee which monitors the activity of each and every doctor, nurse and other healthcare workers. They also have periodic training to impart knowledge on the new developments in infection control to lower the infection rate at hospitals.

The relatives/attendants of the patients are also asked to follow and practice infection prevention. If any infection occurs, it can escalate the cost of treatment by 150 per cent to 200 per cent. Therefore, a holistic approach and cooperation is needed from patients’ attenders to avoid spreading infection. If we adopt and execute these practices, the overall patient satisfaction will be high.

(Author is Director - Clinical Affairs, Dept of Anaesthesia and Chairman, Central Infection Prevention & Control Committee, Fortis Hospitals Bangalore)


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