Times of India
23 November 2010
By Umesh Isalkar
Pune, India

While battling their critical illness, patients in intensive care units (ICUs) also face the risk of acquiring hospital–acquired infection or nosocomial infection, said Victor Rosenthal, president of the International Nosocomial Infection Control Consortium (INICC), an international scientific community that works interactively through a network aiming at reducing healthcare associated infections.

According to Rosenthal, the most common hospitalacquired infection (HAI) in India is nosocomial pneumonia, which is associated with mechanical ventilation and is also called ventilator–associated pneumonia (VAP). The irony is that about one–third of all such cases are preventable, said Rosenthal while speaking to TOI on the rates and reasons for the nosocomial infections in India.

"Every year, thousands of patients die of hospital–acquired infections (HAI) in India. Death due to HAI is responsible for more mortality than any other form of accidental death in the country. The irony is about one–third of all such cases are preventable," Rosenthal said. "HAI are infections that patients receive after two days of admitting in the hospital."

Rosenthal on his current India tour has so far visited 17 hospitals and has met infection control teams of more 30 hospitals in Delhi, Mumbai, Kolkata, Hyderabad and Pune. The meeting in Pune – which took place on Thursday – was attended by more than seven hospitals.

The objective of Rosenthal’s tour is to spread awareness of HAI and get hospitals to become part of INICC to help government bodies formulate infection control guidelines.

"According to the report by the INICC in 2006, overall 1.4 million people worldwide are suffering from nosocomical infections and in India alone, the infection rate is at over 25 per cent," Rosenthal said.

Elaborating, he said, "HAI are mainly device–associated infections. Devices are invasive procedures and thus they cause infection due to contamination of devices. Similarly contamination during care of the devices also causes infection. Most common HAI is ventilator associated pneumonia (VAP). The incidence of VAP is 11 per 1,000 device days followed by catheter associated blood stream infection (BSI) which is 8 per 1000 device days and then by urinary tract infections."

What adds to the patients’ woes is the cost incurred due to HAI. "Data reveals that HAI increases the length of stay from 2 to 5 days and thereby increasing cost to patients. As per an estimate in Argentina, the increase in cost due to HAI is around $5000 and India could be about Rs 25,000 to 100,000 depending on severity and hospital," said Rosenthal, also the director of infectious diseases, infection control and hospital epidemiology department at Bernal Medical Center, Buenos Aires, Argentina.

Roesnthal advises mandatory surveillance of HAI in public and private hospitals in India. "The government should mandate creation of one infection control committee at each hospital. Hospitals should carve an infection control committee and the ICC should have an infection control nurse, an epidemiologist, one assistant and one good lab to detect microorganism and bacterial resistance," he said.

Hand hygiene, use of maximal sterile barrier during insertion of device, skin antisepsis with chlorhexidine (a chemical antiseptic), use of subclavian vein over jugular over femoral vein, use of closed system intravenous fluids (bags) over semi rigid containers (plastic bottles), use of sterile gauze at insertion site are some of the guidelines Rosenthal suggest for hospitals to reduce HAI.

Rosenthal plans another visit next year to conduct a two–day workshop in the city to help hospital infection–control committees.