Creating awareness on HAIs

Dr Yatin Mehta, Chairman, Institute of Critical Care and Anaesthesiology, Medanta, chalks down strategies on ways to prevent HAIs

Healthcare-associated infections (HAIs) are a major patient safety issue in hospitals leading to morbidity, mortality and increased healthcare expenditure. India is one of the countries with maximum multi drug resistance organisms (MDRO) i.e. bacteria which do not respond to most bacteria with maximal use/misuse of antibiotics.

Prevention is the best cure!

The International Infection Prevention week was celebrated from October 14 to 20, 2018 this year. This year’s theme is ‘Protecting Patients Everywhere’. Improving our awareness on the role of infection prevention in patient safety is the need of the hour. We need to understand that each one of us have an important role to play in keeping patients safe from infection.

There are 2 basic strategies in preventing the transmission of infections in a hospital:

A) Standard precaution: Applicable for all the patient admitted to a healthcare facility. Implementation of Standard Precautions constitutes the primary strategy for the prevention of HAI among patients and healthcare personnel, must be applied to all patients. These include: adequate hand hygiene, use of personal protective equipment (PPE) when handling blood / body fluids, patient care equipment, soiled linen and appropriate handling of biomedical waste (BMW).

B) Transmission-based precaution: These precautions are implemented when the route of transmission is not completely interrupted using standard precautions alone. Isolation for the control of infection is used to prevent infected patients from infecting other patients or health care workers (source isolation), and / or prevent susceptible patients from being infected (protective isolation). Types of transmission based precautions are: contact precautions, droplet precautions, air borne precautions and reverse barrier nursing. At Medanta we test each patient admitted through emergency from other hospital is tested for MDRO so that they can be isolated immediately to prevent spread to other patients.

• Contact precautions are required for patients both infected and colonised with multi-drug resistant organisms (MRSA, CRO, VRE), enteric infections and skin infections. Patients should ideally be placed in a single room or cohorting can be done in patients with similar bugs. Clean gloves/ gowns are to be worn when entering the patient’s cubicle when substantial contact with the patient or patient environment is anticipated. The number of visitors and healthcare workers should be limited. PPE is to be discarded before leaving the room.
• Droplet precautions are required for microorganisms that are spread in tiny droplets (larger than 5 μm in size) triggered by coughing and sneezing eg, influenza (flue) and certain pneumonias. The patient should be placed in a single room/ cohort patients with same type of infections. A surgical mask should be worn when working within three feet of the patient. Mask to be worn before entering the room and should be after leaving the room.
• Airborne precautions are required to protect against airborne transmission of infectious agents (smaller than or equal to 5 μm in size) produced by coughing, sneezing & bronchoscopy e.g., pulmonary tuberculosis, measles, chickenpox, disseminated herpes. The patient should be placed in a negative pressure room. Anyone who enters the room must wear an N 95 mask before entering the room and discard it after leaving the room. A surgical mask should be put on the patient (if possible) while transferring to a different location.
• Protective or reverse – Barrier nursing is the physical separation of a patient at high risk from common organisms carried by others. This is used for diseases in which there is increased susceptibility to infection such as patients with neutropenia, on anti-cancer chemotherapy or severely immunocompromised patients (post-transplant recipients).

This way we may be able to check the spread of MDRO bacterial and reduce HAI’s.