Incidence and impact of nosocomial infections
IT HAS been widely recognised by national and international healthcare economists and policy planners that Kerala, in India, offers the best healthcare model worthy of emulation by states of other developing countries.
Therefore it is paradoxical that in recent times, in terms of the type, nature and intensity , many healthcare issues such as the incidence of spread of infectious diseases such as dengue, chikungunia, leptospirosis, malaria etc have surfaced in Kerala, some of them reaching epidemic proportions.
Vector borne
While these diseases are vector borne and hence can be controlled only through sustained improvement in public health, what has been alarming is the spurt in hospital originated infections resulting in high levels of infant mortality in some of the leading hospitals in the State.
Nosocomial infections, as they are referred to, are not uncommon even in the most advanced countries. In fact the Center for Disease Control (CDC) estimates that 4.5 per cent of all hospital admissions in the U.S. are due to infections acquired from hospital stays. Studies conducted in hospitals in Delhi and Mumbai report figures as high as 30 per cent. If such figures are representative, around 300,000 of the 1 million hospital beds would be occupied by people falling sick from hospital originated infections.
The main causative organisms leading to hospital infections are of bacterial, viral and fungal origin.
They include infections from gram positive, gram negative and anaerobic strains of Staphylococcus, E.coli, Proteus, Klebsiella, Pseudomonas and Clostridium in addition to viral infections from Hepatitis, A, B and C and HIV viruses and Candididiasis.
Causative factors
Their incidence have their aetiology from lack of hospital hygiene and proper housekeeping, human transmissions, surgical and other invasive interventions and airborne, water borne and food borne infections. While maternal transmissions of viral and bacterial infections are difficult to control in labour wards, all the other infections can be effectively controlled by appropriate measures of both preventive and curative nature. A major problem faced is that organisms present in the hospital environment are usually more virulent and even more importantly, resistant to most antibiotics including new generation cephalosporins, methicillin, amikacin or even vancomycin.
Bacterial resistance
Management of large number of patients including many immuno-compromised ones, emergence of newer organisms and increased bacterial resistance are additional impediments.
Both the World Health Organisation and CDC, U.S., have developed practical guidelines for prevention of hospital acquired infections; however they have not been adopted in India, let alone practised.
Assuming that the national average for nosocomial infections in India is anywhere near the estimates based on limited reports of 30 per cent of hospital admissions, Indian healthcare scene is facing an enormous challenge in terms of the need to prevent and control, if not eradicate, such infections.
It is imperative that all States take up a pro-active approach to solve this problem.
