Did you know that you might be at risk of catching an entirely new infection at the hospital, while being treated for another condition?
Infections are common in critical care settings where a person’s immunity is already compromised and multiple tubes, medical devices are inserted into their body as part of treatment, say experts.
The US Centres for Disease Control and Prevention (CDC) says that on any given day, about one in 31 people admitted to hospitals develop at least one such infection, known as a healthcare-acquired infection or healthcare-associated infection (HAI).
A paper published in The Lancet in September 2022 found that HAIs in Intensive Care Units (ICUs) in India are not only common but have become a serious problem. The study, published as part of the first HAI surveillance network in India, comprising 26 public and private hospitals, showed high infection rates.
In 18 months, these hospitals reported 3,359 UTIs (Urinary Tract Infections) and bloodstream infections caused by bacteria entering the bloodstream through the central line (a tube that is inserted in the neck, chest, arm).
Dr Kamini Walia, one of the authors of the study, and head of India’s Antimicrobial Resistance Surveillance & Research Initiatives for the Indian Council of Medical Research (ICMR) tells Happiest Health that HAI data collection is now improving. This could be the reason it looks like the situation is worsening.
Dr Asima Banu, professor, microbiology, Bangalore Medical College and Research Institute (BMCRI), says that by the time she realised her aunt, who faced multiple medical complications for 16 years, suffered from surgical site infection, it was already too late.
Dr Banu recalls that it began with a simple surgical procedure – liposuction. “She never quite recovered from this surgery,” she adds.
“She underwent liposuction when she was around 30, after the birth of her second child. Post-surgery, she developed complications like fever, pus drainage and a non-healing wound. These symptoms kept coming on and off. One complication led to another. She developed renal complications, diabetes and cardiac issues. She died at 46,” Dr Banu says.
Dr Banu, who studied her aunt’s case as a microbiologist years later found that infection by an atypical microbacteria, known as Mycobacterium chelonae, commonly found in water, was the culprit.
Studies that investigated cases of wound infections caused by Mycobacterium chelonae post liposuction have identified that inadequately disinfecting the equipment with tap water is the source of contamination.
“Infection control practices in hospitals must be strengthened, there needs to be accountability,” says Dr Banu who is also the Infection Control Officer at Vanivilas hospital, Bengaluru.
How HAIs can be prevented
“It is important to have infection control committees and processes in place. The hospital must also have an adequate number of infection control nurses and hospital staff must be sensitised to reducing infections in hospitals. It is going to be a collective effort,” says Dr Walia.
Mary Elizabeth Job, the infection control nurse at Sagar Hospitals, Bengaluru, who goes on daily rounds around the hospital as part of HAI surveillance says that the golden rule is hand hygiene. “All the lines being inserted into the patient’s body must be properly sterilised. Aseptic precautions must be followed in all procedures,” says Job.
Job maintains a surveillance reporting form for each patient. “When a person is admitted, we test them for community-acquired infections. Later, if the person’s health worsens after showing signs of improvement, we look for HAIs.”
“After HAI diagnosis, the tubes inserted are immediately removed. If they need a new line – for instance, a urinary catheter may be required because they are still unconscious and are unable to pass urine – we must replace it,” says Dr Kavya Shree, Consultant Intensivist, Sagar Hospitals, Bengaluru.
Dr Jitendra Choudhary, consultant, intensive and critical care, Fortis Hiranandani Hospital, Vashi, Mumbai says that if someone in the hospital is harbouring a drug-resistant infection, contact precautions must be taken. “Resistant bugs will tend to linger longer on the body and cause more severe infections,” he says.
Hospital stays are often prolonged because of drug-resistant infections, says Dr Walia. The Lancet paper she co-authored also showed a worrying link between HAIs and antimicrobial resistance (AMR). This is a situation where pathogens evolve over time and become drug-resistant, which means antibiotics and antimicrobial medicines are no longer effective.
How are HAIs and antimicrobial resistance linked?
“As antimicrobial overuse in ICUs is high, there are ample opportunities for bugs to evolve and become multi-drug resistant,” says Dr Walia.
Explaining how this leads to AMR, she says, “The required number of infection control nurses and other measures to reduce infections are not in place because that is a very resource-intensive intervention. When we compromise on that, it is usually compensated by adding one or two more antimicrobials to what is already being prescribed. All this collectively increases antimicrobial pressure.”
The World Health Organisation (WHO) has also declared AMR as one of the top 10 global public health threats.
Takeaways
- A hospital-acquired infection is an entirely new infection you could catch at the hospital while being treated for something else.
- While you or your loved one is admitted at the hospital, make sure to maintain hand hygiene, allow people to disinfect your room and watch out for signs of an infection (sepsis or diarrhea).
