‘’Usage of a waterless scrub reduces the potential harm caused by microorganisms through infections’’

Indian hospitals are constantly faced with the problem of contaminated water supply. 3M India has introduced an innovation solution to this problem. Gautam Khanna – Executive Director, Healthcare Business, 3M India tells Raelene Kambli that clinical areas wihtin the hospital need to go waterless to resolve this issue

What are the challenges faced by hospitals in India concerning water quality? How does water quality in Indian hospitals impact infection control?

Gautam Khanna

Availability of abundant clean water is no more a given situation, and is becoming difficult and expensive to procure. According to the Ministry of Health and Family Welfare, a 100-bedded hospital should have at least 10,000 litres of potable water per day. Additionally, the average use of water per bed ranges from 400 to 450 litres per day. Most facilities today cannot provide so much water to a single patient due to the problem of water scarcity. The limited water used may be highly contaminated due to lack of proper treatment.

In critical environments of a hospital like the operation theatre, water is used in large quantities. While shortage of water may prevent surgeries from taking place, the poor quality of water may also lead to higher infections, considering the fact that all the surgical hand preparations done today need water. Additionally, the cost involved in purifying water in large quantities is quite high. (Average cost of RO water ranges from Rs 0.8-1.5 per litre)

Summarising the problems:

• Absence of strong guidelines and monitoring tools for hand hygiene.
• Acute shortage and/or poor quality of water leading to increasing ineffective hand hygiene
• High costs associated with purifying water for surgical settings
• Lack of appropriate hand antiseptic solutions in the Indian market to tackle these problems

Tell us about your study ‘Random Analysis of water quality in Indian hospitals and its impact’? What are its findings?

3M conducted an internal study to find out the levels of contamination in water in hospitals. For this, water samples were collected from six hospitals across cities, and a microbial analysis was conducted of the water being used. The results showed that a majority of the samples had a high level of contamination. Details of the results are as below:

You say that there is a need to go waterless in hospitals. What do you mean by this? Why is it so?

From the results of the study conducted, it was clear that there are issues in the availability of the right quality of water for critical areas of the hospital and costs of ensuring quality water seem to be underestimated. In such a situation, in a country where natural resources are depleting and becoming a scarcity, it is smart to ‘Go waterless’ sooner than later.

How does this help keep infections at bay?

Surgical site infections (SSI) have been one of the key reasons for increasing cost, morbidity and mortality related to surgical operations and continues to be a major problem.

While various reports claim that SSI rate in Indian hospitals ranges from nine per cent to 20 per cent, the costs of such high SSI is yet to be quantified. Increased hospital stay, higher morbidity and mortality, and higher consumption of antibiotics are some of the direct costs associated with increasing SSI- all leading to a significant cost of maintaining the healthcare infrastructure.

Usage of a waterless scrub reduces the potential harm caused by microorganisms through infections.

Sample	Results
	Total aerobic count	Pathogens
		E. coli	S.aureus	P.aeroginosa	Salmonella sp
1.	Greater than 300 CFU	Present	Present	Absent	Present
2.	Greater than 300 CFU	Absent	Present	Absent	Absent
3.	Greater than 300 CFU	NT	NT	NT	NT
4.	Greater than 300 CFU	NT	NT	NT	NT
5.	Less than 10CFU	Absent	Absent	Absent	Absent
6.	Less than 10CFU	Absent	Absent	Absent	Absent
7.	Greater than 300 CFU	Present	Present	Present	Present
* Not tested for pathogens due to limited available of sample

Tell us about 3M Healthcare’s new innovation – Avagard? What are its advantages?

One of the biggest innovations by 3M in hand-hygiene for healthcare practitioners is Avagard Waterless Surgical Hand Antiseptic- the only FDA-NDA approved waterless surgical hand antiseptic in the world today.

3M Avagard, developed on a patented liquid-crystal technology can help counter most of the problems related to hand-hygiene. Some of the unique benefits of the product include:

• Fast, highly effective and much better persistent antimicrobial protection when compared to conventional water-based PVP or CHG scrubs
• Significantly reduces or eliminates the use of water for surgical hand preparation
• Considerably reduces the amount of antimicrobial solution consumed for hand preparation
• Reduces material waste of sterile towels, scrub brushes and hand-rub, used in traditional methods of surgical hand preparation
• Cuts down the overall time spent in surgical scrubbing (from average five minutes to one minute), thereby increasing the OT productivity
• l Reduces overall costs for the hospital

Is it possible for any hospital to go completely waterless? And how?

We cannot eliminate water from a hospital. But we can drastically reduce the amount of water consumed with Avagard.

Will this add to the operating costs within hospitals?

This will actually reduce operating costs, not increase it. Since this waterless scrub leads to lesser material waste of sterile towels, scrub brushes and hand-rub which is a part of the traditional surgical hand preparation, the overall cost of going in for a waterless scrub is lesser by atleast Rs 12 per hand wash before surgeries.

How do you plan to market your product in India?

Avagard has a benefit for everyone in the ecosystem – it reduces chances of infection for patients, easier pre-operative preparation for surgeons and other healthcare providers, lower operating costs for the hospital management. So, with the right educational programmes and spreading the right message to each stakeholder, we can successfully launch this product. The educational programmes will be focused on the benefits of moving away from traditional practices. Sampling of the product is also a key technique for commercialisation. Further, conducting more studies on water quality in hospitals in India to further clinically validate our claims will help us tie up with surgeon societies in India eventually. Even hospitals are conducting studies to evaluate the efficacy of using Avagard.

Any set targets for this year?

Since the product is a disruptive innovation, commercialising the product will take time. We plan to create awareness in almost all hospitals with more than 50 beds across the country. Our focus will be on concept selling and changing the practice of healthcare professionals by creating awareness.

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