Hospital acquired infections are increasing all over the world and particularly in the developing world. Patients admitted to intensive care unit are the very sick ones which lead to diminished immunity and more susceptibility to hospital acquired infections as it is called today inspite of hospitals adopting infection control measures. A large amount of antibiotics are being consumed in fighting these infections, some of them saving lives, but every use adding to antibiotic resistance in bacteria.
A Nosocomial infection or hospital acquired infection is commonly found in Intensive Care Unit (ICU) patients, these are associated with morbidity and mortality. This occurs due to the severity of the primary illness and the use of life support systems like mechanical ventilation and devices like central venous catheters as well as urinarycatheters which may disrupt the normal defence mechanisms of the body. Those who require these devices, are malnourished or bed ridden are more susceptible to multi drug resistant organism (MDR).Of note is the fact that in our country self-medication with antibiotics and over the counter sale of the same has been a factor for resistant infections even in the community.
The hands of the health care workers and visitors arethe main vehicles which carry these infecting organisms in between patients. Ventilator associated pneumonias and urinary tract infections are the commonest nosocomial infections.
DR A. Shobhana, Consultant in Critical and Stroke in the Institute of Neurosciences Kolkata, says “There are various sources of infections, which can be transmitted from other patients, health care workers or visitors. Inanimate objects like the patient’s bed surface, equipment or other devices or objects used in the ICU if becomes contaminated, can lead to infections. Endogenous flora from the skin, mucus membrane, GI tract or respiratory tract can cause a spread of infections. Intrinsic risk factors include immunocompromised state, severity of illness, extremes of age, inadequate nutrition, and immobilization make ICU patient more susceptible. Patients suffering from neurological disorders or malignancies are especially susceptible. Extrinsic risk factors include invasive procedure, catheters, mechanical ventilation & other therapeutic interventions in ICU.There are other modes of transmission; airborne transmission, droplet transmission.”
“ Implementation of recommended steps, such as the adoption of antibiotic stewardship programs including rational antibiotic therapy, isolation protocol, antibiotic regulation including stopping over the counter availability, improving diagnosis, optimizing therapeutic regimens; and preventing infection transmission through frequent hand washing practices are expected to be effective in managing this crisis.”, Said Dr. Dip Narayan Mukherjee Consultant Physician at Woodlands/Bhagirathi Neotia Hospital, Kolkata
Hospitals have adopted infection control strategies to overcome this looming problem. The most important aspect is good hand hygiene protocols including monitoring of hand hygiene. Other important policies include protocols for new methods on environmental cleaning and prevention of device related infection. Maintaining air purity and maintenance of air conditioning system of hospitals is important.An antibiotic policy for each based on the microbiological flora of the particular hospital will go a long way in preventing the emergence of MDR organisms and effective and successful management of the afflicted patients. This will also decrease the length of stay in hospital and cost of care.