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HEALTHCARE acquired infection (HAI) is on the rise worldwide. This is an infection acquired by a patient in a hospital or other healthcare facility, meaning that the HAI was not present at the time of admission. The term also includes infections appearing after discharge from the healthcare facility, as well as occupational infection among healthcare staff. HAIs occur in both developed and developing countries. Aside from hospitals, people are also central to HAIs as carriers, reservoirs and transmitters of new organisms.
As such, HAI constitutes a major cause of mortality and morbidity. One survey conducted by the World Health Organisation in 14 countries, representing four WHO regions, showed that 8.7pc of patients had HAIs. Worldwide, 1.4 million hospital patients contract infections during their stay. The exponential rise in HAI can be traced to a number of factors: decreased immunity among patients, increasing range and variety of medical procedures, the transmission of drug-resistant bacteria, poor infection control regimes and prolonged hospital stays.
HAIs are set to increase further because of rising anti-microbial resistance, overcrowding and population increase, new microorganisms, and reduced and compressed immunity due to old age.
Hospital patients risk acquiring infections during their stay.
As in the rest of the world, HAIs are widespread in healthcare settings and hospitals in Pakistan. Yet this issue has not been given due attention. A single visit to our public hospitals is enough to convince anyone of the possibility of picking up infections given the unhygienic environment. Yet there is no data available to show the incidence of HAI in the country. Limited studies conducted on the subject by various Pakistani researchers have, however, shown HAIs to be consistently present across all types of health settings and all departments.
Patients in intensive care units (ICUs) are generally at more risk of contracting HAIs. Most common infections are related to the respiratory system, followed closely by urinary tract and bloodstream infections. The higher incidence of HAI in ICUs is due to acute severity of the original illness, prolonged hospital stays, increased use of antibiotics and therapeutic procedures such as endotracheal tube insertion and urinary catheterisation.
With very few well-equipped ICUs in government healthcare establishments and a discernible lack of robust infection control measures, HAIs are more than likely to occur in public-sector hospitals. I have seen this up close: my father died of HAI in one of the largest public-sector hospitals in the country. This led me to look into the host of issues around HAIs, their management and the state of government hospitals. Part of the problem in these hospitals is on account of low funding and overcrowding.
Another study, this one focussing on children in the cancer wards of one hospital in Karachi, determined an equally high risk of HAI. The study found HAIs in 32 of the 70 patients admitted, with a mortality rate of 12.5pc. Increased mortality was strongly associated with parental nutritional status and length of stay longer than 30 days in the hospital.
The few studies cited here point to a deep-seated HAI problem, but it is neither acknowledged nor talked about. HAI-related mortality is often hushed up and not tabulated nor discussed for fear of attracting the ire of patients’ families. This approach does not lend itself to the formulation of strategies to address the issue. As a result, there is no coordinated strategy.
A beginning is necessary. A starting point can be the setting up of infection control programmes at national, regional and hospital levels. At the hospital level, setting up a collaborative infection control committee and team can be a first step. These must include members from the hospital management, doctors, pharmacists, biologists and hospital sterilisation personnel.
As well as infection control measures, HAI surveillance systems must be set up at both national and local levels with robust data collection, data sharing and data dissemination protocols in place. If properly designed, such systems should be capable of dealing with an HAI outbreak.
Above all, the most important element of prevention is person-to-person hygiene. One of the simplest, most cost-effective preventive acts available is regular handwashing. This message is being hammered home in recent years, yet it is more honoured in the breach than in observance. In addition, personal hygiene, sterilisation of equipment, use of gloves, masks and heated water can play a large part in preventing infection. Moreover, strenuous training of healthcare staff at all levels in the detection and prevention of HAI is a must. This is a much ignored aspect of our healthcare policy, and the need to remedy this fatal oversight is urgent.
The writer is a consultant and policy analyst.
Twitter: @arifazad5
Published in Dawn February 2nd, 2017
