Curing what ails Indian hospitals

Hospitals all over the world, especially in India, are becoming increasingly high-risk sites for contracting infections. This is not breaking news, but hit home dramatically for me when, over a period of two months, two relatives and an acquaintance succumbed to hospital-acquired infections in Delhi, Kolkata and Mumbai. The treatments for which they were admitted went well but, in the course of post-operative care, they succumbed to different hospital-bred pathogens.

If hospitals, like doctors, are expected to follow the Hippocratic Oath to "do no harm", they have failed.

Anecdotal evidence is easy to dismiss as mere coincidence, but a closer look at the issue shows that a serious threat is looming in the Indian healthcare system. If left unaddressed, the problem of hospital-acquired infections will damage prospects for medical tourism, which has been one of the brighter areas of India's economy.

Just as a spate of appalling rapes and lethal air pollution are driving away tourists, hospital deaths caused by poor hygiene and sanitation will surely dim the attraction of low-cost, high-quality medical treatment.

This problem is not a uniquely Indian one. Modern hospitals in the developed West are also struggling to cope with so-called nosocomial infections - the term used to describe infections that are not present in patients before admission but which occur within 48 hours afterwards.

According to the US Centre for Disease Control, almost two million Americans are afflicted by hospital-acquired infections (HAI), resulting in 20,000 deaths a year.

Preventing hospital-acquired infections is not rocket science. It requires the maintenance of rather basic standards of hygiene through, for example, frequent hand sanitisation and disinfecting devices.
Preventing hospital-acquired infections is not rocket science. It requires the maintenance of rather basic standards of hygiene through, for example, frequent hand sanitisation and disinfecting devices. PHOTO: REUTERS

FIGURES FOR INDIA 'ALARMING'

Little data is available in India as hospitals are not mandated to report incidences. However, according to a 2014 study, the World Health Organisation found figures from India "alarming, with an incidence rate varying from 11 to 83 per cent for different kinds of HAI". A study from 2011 to 2012 at the J. P. Narayan Apex Trauma Centre at the All-India Institute of Medical Sciences in New Delhi showed an infection rate of 10.6 per cent. Of those infected, 83 died - implying a mortality rate of 34.5 per cent.

  • 34.5% Of those with hospital-acquired infections died, according to a study from 2011 to 2012 at the J. P. Narayan Apex Trauma Centre at the All-India Institute of Medical Sciences in New Delhi .

    75% Of the deaths were caused by bloodstream infections from improper use of catheters or pneumonia bacteria transmitted from infected ventilators.

Seventy-five per cent of the deaths were caused by bloodstream infections from the improper use of intravascular catheters, or pneumonia bacteria transmitted from infected ventilators.

Another 10-month study of patients in a government-run intensive medical care unit in Karnataka showed 17.7 per cent struck down with HAI.

Secondary infections in hospitals have become an even bigger threat when caused by drug-resistant bacteria. The indiscriminate use of antibiotics by the Indian public and hospitals has seen the rise of resistant strains of super-bacteria. They not only entail high costs of treatment, lengthy hospital stays and often death, but certain strains are also virtually incurable.

Medical experts believe India has become one of the world's largest sources of drug-resistant bacteria, threatening not only Indian patients but foreign visitors as well.

Ironically, preventing such hospital-acquired infections is not rocket science. It requires the maintenance of rather basic standards of hygiene through, for example, frequent hand sanitisation and disinfecting devices. It is thus alarming to see empty or broken hand-sanitisation dispensers in India's elite hospitals.

If the premier healthcare institutions fail to adopt such widely recognised and inexpensive preventive measures, what hope is there for less developed parts of the country?

In October 2014, Prime Minister Narendra Modi launched a Clean India Mission, to modernise sanitation within five years. Raising awareness of the high cost of poor hospital hygiene needs to be a major part of that cleanliness campaign.

• The writer is consulting editor of  YaleGlobal Online, published by the MacMillan Centre, Yale University.

A version of this article appeared in the print edition of The Straits Times on January 29, 2016, with the headline 'Curing what ails Indian hospitals'. Print Edition | Subscribe