Thiruvananthapuram: It is common knowledge that hospitals, especially the ones that are overcrowded, could be harbouring a lot of super-bugs which get transmitted from hospital staff and equipment to patients.

While basic infection control practices are in place in most hospitals, wrong use of techniques, medicines and, often, poor hospital infrastructure could result in the transmission of bugs, as had happened in the SAT Hospital here.

Change in practices

Experts who led a training programme for all hospital staff in infection prevention and control, following the outbreak of infection in the newborn nursery, have pointed out that effecting some change in practices can make a world of difference in the level of hospital hygiene.

"Pathogenic germs are found everywhere in the hospital. But all errors are happening at the transmission point, when some objects exchange hands or leave one surface for another. We should be able to stop the infection at this point," says Amar Fettle, a senior paediatrician at General Hospital and one of the trainers.

Universal precautions

So far, the staff in hospitals have been following `universal precautions,' which are primarily the precautions that need to be adopted to protect oneself from infections that they may be exposed to while caring for a patient.

But what is advocated now is `standard precautions,' so that one is protected from infections while at the same time ensuring that no infection is transmitted unwittingly.

Asepsis protocol

The asepsis protocol now being implemented at the SAT Hospital has been prepared by Engender Health, a New Delhi-based NGO, which has been promoting safe and sustainable health services. The course that they have designed is intended to help health service providers, doctors, medical students and nurses strengthen infection prevention practices in low resources settings.

Disease transmission

The training focuses on disease transmission, hand-washing, use of gloves, aseptic techniques, surgical scrub and surgical attire, disposal of needles and sharps and processing of instruments such as cleaning and sterilisation

Hand-washing, using soap and water, can actually prevent more than half the infections. But there is a technique to it and while doctors and nurses are trained in this method, on an actual workday, it is rarely applied, it is pointed out.

Wrong use of anti-microbial agents for general cleaning is a mistake that most hospitals make.

"In our hospitals, antiseptics or branded cleaning agents are used for cleaning floors and other surfaces. These are expensive and less effective. But by using a 0.5 per cent concentration solution of bleaching powder - an easily available, cheap disinfectant, which is non-toxic and has one hundred per cent germ-killing efficiency - we can not only prevent infections but also cut the running costs," Dr. Fettle says.

Potential hazard

Hospital staff should be trained to treat every patient a potential hazard and use protective gloves, goggles and proper protective leggings. Hawaii chappals give little protection from infection to doctors or nurses who have to stand in a pool of blood and other body fluids in labour rooms. Cleaning staff should be given utility gloves and not the surgical ones.

The level of training imparted to medical students and nurses in infection control is quite poor and the situation is aggravated because of the infrastructural deficiencies in hospitals like SAT - non-availability of running water, acute space crunch and over crowding.

Latest reports now say that fumigation is not quite so effective in germ control as was thought to be. It is expensive, time-consuming and the chemicals used - formalin - is toxic. Swabbing floors several times a day using bleaching powder and detergent is more effective.

Washing down of operation theatres once a week is a regular practice at the SAT Hospital. However, humidity goes up in the room when it is left closed and the moisture is conducive for the growth of organisms like Klebsiella bacteria.

The trainers have suggested that wet mopping be done using disinfectants so that the water dries off quickly. Sweeping and dusting of hospital floors is also best avoided.

The training also focused on the scientific disposal of hospital wastes.

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