OF NOSOCOMIAL INFECTIONS AND MALADIES

Millions of people all over the world regard hospitals as cathedrals hope, and cure of diseases, but it is gradually beginning to be realised that they could well prove to be houses of horror. They enter hospitals with some ailment but may acquire a new disease only as a result of having stayed in a hospital.

In one study in America, a team of doctors found that one out of every ten patients even in so called “first class ” hospitals which provide quality health care, developed a complication during their stay there as a result of a wrong diagnostic or therapeutic procedure. These complications may in many cases result in the death of the patients. While this is true of such an advanced country, one could imagine what the toll would be in developing countries like ours where standards of hygiene cleanliness of rooms and other facilities, etc are com­paratively much poorer.

It is estimated that lakhs of the medical malpractice suits are filed every year in the United States, alone. A huge percentage, involve infections allegedly acquired in hospitals.

Physicians recognise the risks of medical treatment. Ailments and complications that are by a wrong diagnostic or therapeutic procedure are described as iatrogenic illnesses. But to reduce the sting of the terminology and because so few of such illnesses are caused by the doctors themselves, they have come to prefer the rather euphemistic expression “nosocomial, infections” meaning hospital acquired.

The most common nosocomial illness is obviously an adverse reaction to a drug. It is thought to account for about half of all iatrogenic complication. Some of the more serious problems due to faulty drug therapy are heart problems, abnormal fluctuations of blood pressure and drastic changes in mental states. Injuries due to fall from hospital beds are much less common. Thus, a laboratory report wrongly interpreted may lead a doctor to prescribe a drug which a patient does not have to take. Patients are also injured in the operating room due to carelessness of anaesthetists, while administering anaesthesia or get electrocuted by some leakage in the electrical apparatus.

Surgical errors, though rare, usually prove fatal. They often involve one of the following factors:

1.surgeons are in a hurry to complete the operation

2. Surgeons are overconfident of their own ability,

3. Surgeons are too keen to use what they regarded as currently fashionable procedures rather than resort to time-tested ‘old- fashioned’ methods.

It is, however, universally recognised that of all the hazards a patient may encounter in a hospital, infections are the most frequent. Many patients die because of hospital acquired infections, rather than due to the disease for which they come to a hospital for treatment.

Nosocomial infection can increase the length of the hospital stay by weeks or months and add lakhs of rupees to the patient’s bill. These infections are responsible for more deaths than any other iatrogenic illness. Though the danger from hospital- acquired infections has not yet caught the public imagination, they are beginning to be viewed as a serious problem for the first time. It is felt that as many as half of all nosocomial infections are preventable and so a great deal of emphasis is now being laid on controlling infections rather than any other Iatrogenic complications.

By definition nosocomial infections are those that develop after the patient’s first three days or seventy-two hours in the hospital. Of these infections 90 per cent are bacterial in origin and the rest are primarily due to viruses. Parasites also represent a tiny faction of the problem. Most of the infections emanate from the medical devices that are used to treat patients. For instance, the same needles, etc., that deliver nutrients to the bloodstream can also be conduits for dangerous bacteria. Bloodstream infections can be very serious, leading to death .  The figure is likely to be of the order of millions, much more in developing countries, for obvious reasons. This would be almost twice or thrice the number of people killed in road accidents.

Researchers believe that patients undergoing surgical treatment run three times the risk of developing an infection than non-surgical patients. But the type of surgery being performed is a crucial factor. One is more likely to get infection from a colon operation when the bowel is full of organisms, than from a throat operation.

It is widely recognised that the most significant determinant factor in respect of risk of surgical-wound infection is the surgeon’s technique. There is evidence to show that if surgeons are told about their own surgical infection rates, these rates drop down significantly because of surgeons taking precautions after coming to know about their mistakes. However, in view of the sensitivity of such data, postoperative surgical wound surveillance and reporting systems are practically unknown, in developing countries like ours.

Poor hospital design and engineering may also contribute to the risk of infection in hospitals. Some areas such as the nursery, where highly susceptible young children are huddled close together arid wide open intensive care units which allow hospital staff to go from one patient to another without washing their hands at a convenient place, and dirty toilets (in Government hospitals) obviously play a big role in the transmission of diseases. Improper maintenance and house keeping also play major roles. The haemodialysis  machines, which are difficult to decontaminate expose susceptible patients to infection

Many of the troublesome bacteria that enter the hospital, enter on the patient’s own body. Patients may have become susceptible to these bacteria when taking steroid drugs which suppress the immune system or when the organisms are transmitted to the body through some wrong diagnostic or therapeutic procedure. Many patients pick up a new organism in the hospital- it is likely that some of these organisms are transmitted through the hands of medical personnel. For this reason the single most important procedure for the prevention of nosocomial infections is simply washing hands with soap or dettol and hot water. Sterilising medical equipment and use of disposable syringes are also important measures. A hospital which is full of sinks placed at convenient locations, and clean toilets would definitely cut down the infection rate to a great extent.