Infection Prevention in Hospitals

Infection is a disease caused by the attack of microorganisms (also called germs) like bacteria, viruses, or fungi.

A Hospital-Acquired Infection or Healthcare-Associated Infection (HAI), “also referred to as “nosocomial” infection, is an infection occurring in a patient during the process of care in a health-care facility that was not present or incubating at the time of admission.”

An HAI presents an ironic situation wherein a place of patient’s wellbeing can ultimately become a threat to their safety!

Amongst all pathogens, bacteria are the most prevalent in healthcare facilities that can lead to infections in admitted patients. We typically term an infection as HAI if it appears within two days of admission to the hospital, within 30 days of surgery, or after 2-3 days of discharge. 

What are the ‘added’ disadvantages of HAIs?

Being admitted to hospital premises is in itself disadvantageous; becoming a victim of HAI would be an ‘added disadvantage.’

• Prolonged illness for the patient
• Longer time to complete recovery
• More extended stay in the hospital
• Spread of infections to other patients 
• Associated financial burden for the patient and family (hospital costs)

Everyone in a hospital is vulnerable to HAIs – some more, some less. However, special care must be taken for the ‘most susceptible’ clan, including:

• Elderly people
• Newborns
• Sick children 
• People with low immunity
• People with diseases like diabetes 
• People who have undergone a surgery 
• People with wounds or injuries 

What are the chief key factors that can cause HAIs?

• Excessive use of antibiotics in the hospital

Prolonged use of antibiotics is one of the major factors that can cause antibiotic-resistant HAIs. Antibiotics have acted as our lifesavers from infections for ages. However, the present-day ‘updated’ and resistant bacteria pose a greater threat.

• Underdeveloped situations

While the first factor is technically controlled, another significant reason is the lack of necessities. That is the reason the occurrence of HAIs is more in developing and less-developed nations. The dearth of proper hygiene, sanitation, knowledge, equipment, infrastructure, nutrition, and excess of population and diseases are but obvious to result in such sad scenarios.

• Coming from the healthcare professionals

Our healthcare professionals (HCPs) treat us and help us recover; hence no words are required to express the cruciality of their roles. That said, even one small misstep by them, like missing basic hand hygiene, could have adverse impacts.

What are the basics of infection prevention in hospitals and healthcare facilities?

“Make your intention infection prevention”

• Educating the staff

In maximum cases, the cause of an HAI can be attributed to negligence or lack of the requisite precautions. Hence, it is imperative for the entire hospital staff to be meticulously educated about their roles and appropriate hospital conduct.
Needless to mention, the training must be provided during the induction. In addition, it is good to convene every six months (even annually would do) to keep a check and understand the current situation from the staff’s perspective.
Another crucial aspect is to ‘stay and keep updated.’ Whenever there is a change, an update, or something different from the usual, it must be discussed with the staff. To make it sound relatable, let me cite this – almost every healthcare facility around the world must have done it (though driven by a panic-based circumstance) on the outbreak of COVID-19. Processes, dealings (both in way and number), resources, and practically everything were new. It would have required absolute sync, coordination, caution, and patience from the healthcare professionals.

• Infection Control Procedures and Policies

Each hospital should have aptly formulated infection control procedures and policies. As a layman, we could think of the below basics to be covered:

✓ Cleanliness and sanitation of the hospital
✓ Hand hygiene by staff and patients
✓ Awareness around the handling of patients and equipment and sterile techniques during wound care, surgeries, use of medical devices like catheters and IV cannulas
✓ Ensuring there is no use of tobacco within the premises
✓ Taking specific care of weak patients like patients with diabetes, heart diseases, etc.
✓ Ensuring the use of gloves and face masks by the staff as and when appropriate

• Safety of healthcare professionals

PPE (personal protective equipment) is a term many of us would have heard for the first time and possibly excessively in the last 12-18 months. However, I am sure the term would not be new for professionals in the healthcare and medical fields.

Hence, it sounded strange when the availability, possession, keeping, and disposal of the same appeared like ‘mysterious’ tasks. Anyway, the presence of PPE and other safety requirements for the hospital staff at all times should be a mandate. Furthermore, there needs to be additional training provided to the team on the selection and usage of PPEs.

• Different precautions for different rooms

A hospital is a setup of many rooms, starting from a day room to dispensary to delivery room to the emergency department to an intensive care unit (ICU) to an operating room (OR). Each place demands its own set of ‘Do’s and Don’ts’ and safeguard measures. While all places of a hospital need to be carefully cleaned, sanitized, and disinfected, the level and frequency of such tasks become extremely critical in the case of ICUs and ORs.
The staff must be well-trained, and the process must be well-documented for the maintenance of hygiene, sanitizing, and disinfection of the entire facility, every room, and all equipment.

• Switch to oral therapy

The infections are likely to spread more through an intravenous (IV) therapeutic approach. Hence, it is advisable to switch to oral modes of medications as far as possible. It would prove to be effective, serving the required purpose and minimizing the risk of HAIs.

• As a patient or patient’s family

Safety is not the responsibility of one but a duty of all. Hence, as patients or visitors, we too have a checklist to follow. Let’s layout the basic ones (or, in other words, the ones I can think of 😔)

☐Follow hand hygiene (wash with soap and water and sanitize with an effective sanitizer)       protocols
☐Follow a healthy diet and try managing proper weight
☐Do not smoke
☐Keep blood sugar levels under control (especially if diabetic)
☐Inform about your medical history to the doctor
☐Follow the medical advice by your doctor and talk to the doctor/attending nurse if any discomfort
☐Cover your mouth while coughing or sneezing (if the visitor is suffering from such health  conditions, it would be good not to visit)
☐Confirm from the nursing staff if they have sanitized their hands before handling you

The blog aims to create and spread awareness (not infections ☺) of ‘hospital-appropriate’ behaviors to prevent infections in hospitals during the International Infection Prevention Week (IIPW) 2021. Though it would sound ‘too realistic’ to eliminate the possibility of any and all infections, we could at least do the very least from our end in this direction. 

Be aware. Stay cautious!

Avani Raj Arora