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THE SILENT KILLER IN HOSPITALS

Dolcumentary Film Series on Hospital Acquired Infections

NOSOCOMIAL infectlions

• You go to the hospital to get better, but a ……………… investigation found that more than 100,000 deaths in the year 2000 were linked to infections that patients received ……………… hospitals".

• Infections often occur when hospital workers fail to wash their hands in between each procedure.

• The number of people needlessly killed is unbelievable, but the public doesn't know anything about it".

• Hospitals can be a hotbed of cross contamination opportunities.

• Drug-resistant germs adapt, thrive beyond hospital walls.

• In a special investigation, ……………… in 2000 nearly three-quarters of these deadly infections- or about 75,000 - were preventable. Strict adherence to clean-hand policies alone could save 20,000 lives …………..

• ………. deaths linked to hospital infections represent the fourth leading cause of mortality among Americans, behind heart disease, cancer and strokes. These infections kill more people each year than car accidents, fires and drowning combined………………..

• Dirty hospitals kill 75,000 patients a year. Unnecessarily.

• Operating rooms furniture can make or break a sterile field.

A hospital is a place for treatment of infections of various kinds ; to restore the sick and injured to health in the shortest possible time so as to ensure that they return to normal life routine. However, since the very nature of their functions of accepting al kinds of infections by patients, hospitals, by themselves, become a source of infection. This phenomena of nosocomial (hospital - acquired) Infection is worldwide and almost impossible to eradicate.

In this context, it is imperative for the hospital management to ensure proper efforts on a warfooting so that the probability of cross infections was kept to the barest minimum. Perhaps the most important, but invariably, the most neglected area of Infection control is disposal of Hospital waste. The persisting problem of waste disposal calls for a firm policy. It is heartening to note that the authorities in India are paying greater attention to this problem of late. Hospital workers are potential hazards and could transmit numerous diseases in the community and put those who handle waste or live in its proximity at risk.

Besides, the increasing number of disposables in health care system is also posing additional burden as waste management facilities. The most practical approach to the management of biomedical waste is to identify and segregate infectious waste for which some special precautions are needed to follow.

Right from the discovery of germ theory by Louis Pasteur and subsequent work done to kill germs on surgical equipment, the significance of the need for proper cleaning, disinfection and sterilization is understood well by the medical fraternity.

While advanced countries have studied on infection control as a science and have progressed rapidly with newer methods of sterilization and disinfection. India is still pursuing obsolete technology, equipment and lagged behind in the absence of a perfect infection control protocol. Besides, there is a dearth of qualified personnel to conduct this critical job. Most often, most illiterate person handles this key department and the doctors have also accepted this practice unmindful of the lurking danger. In a way the process is done more as a ritual than a science.

Hospital acquired infections can be caused by various factors which among others include personal hygiene of hospital workers and doctors.
Studies have revealed that the hospital staff including doctors and nurses shockingly lax about keeping their hands clean. In a nutshell, hospitals have become more potential area for breeding infections. An interesting study reveals that the lives of tens of thousands of people could have been saved if doctors and nurses wash their hands properly.

Hospital acquired infections are becoming a real persistent danger for pregnant women too. According to a study as many as 4000 women each year acquire infections as a result of having a caesarian. In the US, a recent study reveals, that between five and 10 per cent of all the US hospital patients become infected with new diseases while in hospital. Hospital acquired infections are killing 90,000 patients and sickened over 2 million every year.
HAI is the forth biggest cause of death in the US, next only to heart disease, stroke and cancer.

Infants, who have yet to develop immunity to infections, very old people, diabetes, leukemia patients, patients who have had their spleen removed (spleen is a major immune system) and AIDS patients are most vulnerable than other category of people to catch hospital acquired infections. Urinary tack infection and pneumonia account for almost 60% of infections. Surgical wounds accounted for another 20 per cent.
Orthopaedic infections could be devastating and could become chronic without prompt treatment leading to infections of bones and joints.

In most of the hospitals in India, the sterilization department is not identified as a separate unit but an extension of OT. The surgeon is not bothered about the sterility of the equipment at his Mayo (surgery) table and believes that everything is alright. There is no sterile storage and sterile handling. Ironically, even with the latest technical know-how and equipment the developed countries still find about one to two per cent post operative infections, whereas in India it is claimed to be nil !.
But, according to studies the percentage varied from 10 to 25.

(Compiled from various sources)

Some of the key points on silent killer in hospitals

A hospital is a place for treatment of infections of various kinds; to restore the sick and inured to health in the shortest possible time so as to return them to their earlier life routine. However, since the very nature of their functions of accepting all kinds of infected patients, hospitals themselves become a source of infection. This phenomena of nosocomial infection is a worldwide one, which is almost impossible to eradicate. All the same, it is imperative that the probability of cross infection is kept to the bare minimum; secondly that, all efforts are made on a war footing to control, if such an infection should start to spread amongst patients. This is where the role of the hospital management comes in.

The most important administrative function for control of HAI is monitoring constant vigilance and to take immediate corrective measures. What is required is to ensure that recommended methods are being followed everywhere. In one hospital, it was noted that the corridor being used to convey operated patients from OT to ICUs was being swept by broom instead of wet mopping. In another, that the new lot of Resident doctors did not resort to hand washing before touching each patient in critical care areas.

In a third place, 10% of OT staff were found to be positive for staphylococcus aureus in nasal swabs during monsoon. Fortunately, the majority turned out to e Methicillin Sensitive (MSS). Prompt treatment of 'healthy' staff averted passing it on to patients. In another case, delay in instituting counter-measures resulted in spread of infection amongst other patients of the world.

The decision to close a facility is a difficult one. Not only does it inconvenience the patients waiting for operation or admission to ICU, but the consultants are unhappy a the resultant 'drop in figures'. Hence the pros and cons of the decision have to be weighed carefully, keeping in mind uppermost the question of prevention of spread of infection. Such closure also means adverse publicity and affects the confidence level of the clients in the particular hospital, which takes a long time to rebuild.

INFECTION CONTROL IN INDIAN HOSPITALS DISINFECION, DE-CONTAMINATION & STERILIZATION OF MEDICAL EQUIPMENT.

Right from the discovery of germ theory by Louis Pasteur and subsequent work done by his disciples like Charles Chamberland, who designed the first Autoclave to kill the germs on Surgical Equipment, the significance of the need for proper cleaning, disinfection and sterilization is understood well by the Medical Fraternity. While the developing countries have studies infection control as a Science and have progressed rapidly with newer and newer methods of sterilization and Disinfection, in India, unfortunately we are still in the second world war age with obsolete technology, equipment and practices. We are yet to formulate an infection control protocol and recognize the need of a documented control over this critical aspect. Why haven't we developed on this front ?
1. Processed like Disinfection / Sterilization are all behind the scene matters and nobody including the surgeon and the technician is bothered about it seriously.
2. There is dearth of qualified personnel to conduct this critical job. Most often the most illiterate person handles this dept.

3. There is no knowledge about the intrinsics of the total removal of microbes. Thus practices observed from other places are being followed here.
4. The processes are done more as a ritual than a Science.

5. The hospitals also spend as little as possible on this critical aspect and considers this department as a revenue spending area.
6. The equipments are out dated and are not aimed to conduct "Sterilization of Medical Equipment".
7. The surgeons do have an option of resorting to a wide variety of Chemotherapeutics and believes that even if the instruments are non - sterile, the post op infections can be taken care of by prophylactic use of couple of antibiotics.

According to the most recent figures from US Centres of Disease Control, between 5 and 10 percent of all American hospital patients become infected with new diseases while in hospital. hospital acquired infections are killing 90,000 patients and sickening some 2 million every year.

This makes hospital acquired infection the fourth biggest cause of death in US, behind heart disease, stroke and cancer.

In the PHLS study above, six specialists, general medicine, general surgery, haematology, general ICU, geriatric medicine and nephrology accounted for 72 percent of all hospital acquired bacterial infections. Two thirds of all the infections were associated with an intravascular device or other devices such as urinary catheters.
What, potentially, does such information mean to birthing women In this country around 20 percent of women, some 160,000 each year, will have a caesarean operation. A woman who has a caesarean will have tow out of four of the most common risk factors - a surgical scar, a urinary catheter. Using the PHLS figures as basis for calculation, then as 4000 women each year will acquire infections as a result of having a caesarean.

Since it is estimated that around two-thirds of these caesareans are totally unnecessary, this means that 264o women each year may acquire bacterial infections which they did not need to get.

The Tribune report found that nearly three quarters of the deadly infections, or about 75,000, were preventable because they were caused by unsanitary facilities, germ -infected instruments, unwashed hands, or other lapses.

ABCNEWS' Dr. Nancy Snyderman gave the following tips for patients : Watch your doctor, before you're admitted. Does he wash his hands before he touches you, and then again after he writes in your chart ? it's an early indication of how you'll be treated in the hospital he's affiliated with, Snyderman said.

Check out the Hospital : Go to the Hospital and look around. If there are paper towels on the floor, and public bathrooms are dirty, these are good indications that cleanliness is not a priority.

Ask Staff to wash their hands : You are well within your rights to ask the people treating you to wash their hands. It won't make you popular, but it will help you stay healthy.

Remember : Most of the germs that are causing the deaths are the same ones that we all fight off everyday. But people in the hospital must be treated as a special - they are susceptible, and often unable to fight back.

Bacteria can hide anywhere, and they can collect on clothing, blankets, walls and medical equipment. Hospital workers can pass them on by hand and they can cling to tubes inserted into the body.

Hospital - Acquired Infection. A hospital by its very nature provides a large pool of sick people with increased vulnerability to infection. About 5 percent of patients who enter acute-care hospitals acquire infections from their hospitalization, and the incidence of drug-resistant strains of the most common of these so-called nosocomial infections. (e.g. Staphylococcus aureus and coagulase- negative)

HOSPITAL - ACQUIRED INFECTIONS AND ANTIBIOTIC RESISTANCE.HTM

Hospital - Acquired Infection. A hospital by its very nature provides a large pool of sick people with increased vulnerability to infection. About 5 percent of patients who enter acute-care hospitals acquire infections from their hospitalization, and the incidence of drug-resistant strains of the most common of these so-called nosocomial infections. (e.g. Staphylococcus aureus and coagulase- negative)

Staphylococci is on the rise (101) Infections can be transmitted from staff to patients, from visitors to patients, and from patients to other patients.

Many invasive procedures performed in hospitals, including surgeries such as hip replacements that involve inserting a foreign body, catherterization, transfusion, or even organ transplantation, create opportunities for nosocomial infections to develop.

Infection control programs in many long-term-care facilities such as nursing homes are also often ineffective and allow infections to be transmitted rapidly among a population whose immunity has already been compromised by age or chronic illness. Standards to control the spread of infection among children in schools and day-care facilities are also difficult to maintain.

 

Hospital acquired infections (HAIs) - The most common HAIs are urinary tract infections and infections at the site of surgical wounds. One of the most severe, albeit rare, HAIs, is a bloodstream infection caused by an antibiotic-resistant strain of the bacterium Staphylococcus aureus known as MRSA. A US study found that patients infected with MRSA had to stay in hospital three times longer than those who were not infected.

DANGER ON TAP IN HOSPITAL : Hospital water is one of the most frequently overlooked sources of nosocomial infection.

So, the bad news is :

‵ More than one-third of married Indian women have chronic energy deficiency ; mor them are anaemic.

‣  Forty-five percent of children under three are severely and chronically malnourish

‣ Only 42 percent of children between 14.4 percent have not received a single vaccin.

‣  Only 31 percent of the rural population has access to potable water supply and or cent enjoys basic sanitation.

‣ In 2001, people continue to die for the same reasons they did when India became in 1947 : infectious diseases.

‣ Babies continue to die every day of treatable respiratory infections, diarhoea and illness either preventable through clean water, nutritious food and cheap vaccine treatable with basic drugs.

‵  AIDS is one more infectious diseased in the landscape today.

‵  As the entire Indian population ages, many more people are being struck down by infectious ailments. Some people believe that cancers, diabetes and heart disease overtake infectious diseases as the number one killer.

DEALING WITH DUST : Keeping dust to a minimum is the concern of many in health care facilities. Dust can contain microorganisms such as Aspergillus, a mold that can cause infection in immune compromised patients. However, there are steps that can be taken to reduce the amount of dust present in patient rooms :

‵  Have a proper ventilation system.
‵  Increase the air exchange rate in rooms so dust is drawn through the ventilation and prevented from settling.
‵  Damp-dust surfaces while cleaning, using wet towels, cloth or mops.
‵  Limit the number of dust gathering items in rooms of patients who are susceptible to dust. Balloons and teddy bears are difficult to clean.

OR FURNITURE CAN MAKE OR BREAK A STERILE FIELD

Surgical team members go to great lengths to create and maintain a sterile field by following aseptic techniques, thus helping to reduce the patient's risk of surgical site infections (SSIs). However, a stool cushion with a slight hole, a poorly placed light pod or even traffic flow can compromise what would have otherwise been a successful surgical procedure.

The most common way bacteria spread in a hospital is from contamination of people's hands, or what is known as contact transmission. The remedy is simple wash your hands.

Health care workers are required to wash their hands before and after patient contact, after performing a procedure, and after removing their gloves. Wearing gloves does not replace the need for hand washing because small defects in gloves or the improper removal of dirty gloves can contaminate the health-care worker's hands. Failure to change gloves between patients is an infection control hazard.

If a patient has been placed in isolation, health-care workers must wash their hands in the patient's after they remove their gloves. In addition, visitors and family members of the patient are also expected to wash their hands before they leave the patient's room.

Patients have the right to ask health-care workers whether they have washed their hands. They should do so before the health-care worker touches them or their equipment.
In a special investigations, the newspaper found that in 2000 nearly three-quarters of these deadly infections-or about 75,000 were preventable. Strict adherence to clean-hand policies alone could save 20,000 lives, according to the federal government.

ORTHOPAEDIC INFECTIONS CAN BE DEVASTATING. Disease-carrying bacteria, viruses and parasites that get into the body can destroy healthy tissue, multiply and spread through blood. Infection of skin and other soft tissue can lead to infection of bones (osteomyelitis) and joints (septic arthritis). Without prompt treatment, orthopaedic infections can become chronic.

Thus, even a small scratch on the fingertip has the potential to permanently disable your hand, or worse. Fortunately, early diagnosis, appropriate antibiotic therapy and surgical intervention when required can cure most infections and prevent permanent problems.

Nurses and other health-care workers complain that it's virtually impossible to wash hands between every patient contact, which could number 150 times or more a day in a busy hospital. A recent study showed nurses would spend 1 ½ hours each day to wash hands thoroughly with disinfectant and water. Additionally, frequent washing causes the skin to dry out and crack.

Consequently, most hospitals have begun to use a waterless disinfectant that kills germs and instantly dries on hands. Nurses can squeeze the solution on their hands from wall dispensers and continue to the next patient as their hands are cleaned. Studies show the waterless system kills germs effectively as soap and water. However, many nurses fail to adopt even this simple measure, hospital inspection report's show.

HOSPITALS CAN BE A HOTBED OF CROSS CONTAMINATION OPPORTUNITIES.

The opportunities for bacterial cross-contamination are numerous in the healthcare environment. Both the expected and unexpected opportunities for cross contamination in a hospital's kitchen, operating room and central sterile department need attention.

IN THE KITCHEN : Many cases of foodborne illness are caused by the consumption of ready-to-eat foods contaminated by poor handling techniques and the cross contamination between raw and finished food products. Seventy-five million cases of foodborne illness occur each year in the United States ; of these cases 325,000 hospitalizations and 5,000 deaths resulted according to a 1999 study by the Centers for Diseases Control and Prevention (CDC). These statistics are particularly frightening, considering that food service in hospitals impacts a large group of immuno suppressed individuals who are open to opportunistic pathogens.

How infections are caught in hospital from bacteria passed from staff, including doctors who have not washed their hands from equipment such as catheters from bacteria such as staphylococcus aureus passed through surgical wounds and intravenous lines infectious diseases such as influenza, gastro-enteritis or Legionnaires Disease spread from patient to patient.

A hidden camera was installed outside operating room2, and the tapes revealed that up to half of doctors, primarily surgical residents …….. did not wash their hands before entering the operating room, according to hospital ……….

(Compiled from various sources)

News paper reports on 'Silent Killer in Hospitals'

FILM MAKER TO HIGHLIGHT DANGERS OF HAI

BANGALORE, APRIL 5, Is the hospital lyou go to clean enough, or is it a source of Hospital Acquired Infection (HAI)?

HAI is a 'silent killer' because patients and the public do not know about it. But in the United statees for example, HAI is the fourth largest cause of mortality, killing more people than accidents, fires, and drowning combined.

What then is the scene in Bangalore which has 240-250 large, small, private, and government hospitals? Moreover, the City is under Category A of the Ministry of Environment and Forests guidelines, i.e. its hospitals were to have set up bio-medical waste treatment facilities by 1999, Many still have not.

Yet, Health officials say HAI deaths are 'minimal'. The is why, to coincide with World Health Day April 7, a City-based documentary film-maker begins shooting an educative film on HAI titiled "The silent killer in hospitals".

B.N. Chandrakanth, who earlier made a film on Hampi, and his company Vasath Visuals, will make the 40-minute film in English and Kannada, Medical support is by Manipal Hospital i.e. it will be a 'model hospital' but Mr. Chandrakanth says he will film rural primary health centres and government hospitals, if he gets permission to do so.

Negligent hospital management is also a cause, Mr.Chandrakanth's research revealed that in one hospital, the corridor used to convey operated patients from OT to ICU was swept by brooms, not wet-mopped. In another, new resident docotors did not wash their hands before touching patients in critical care.

In a third, the operation theatre staff were themselves unhealthy.

"Government hospitals (rural and urban) will most certainly be worse." Mr. Chandrakanth points out. There, for instance, general wards have public. Toilets; burns waqrd patients lie close to each other, and wardboys often dress wounds.

Infants, very old people, diabetics, leukaemia patients, those with their spleens remoed and HIV/AIDs patients are among the most vulnerable to such infections. But that today's hospitals have more people who are sicker, older, and hospitalised longer, can also lead to more HAI.

But Mr. Chandrakanth, does not blame the hospitals alone, "Peole who visit relatives and friends in hospitals, must also have personal hygiene," he says.

The 40-minute film will have B.N.Vasanth Kumar as creative director of photography; and the medical script will be by Satish Kumar Amarnath, consultant microbiologist, Manipal Hospital. To know more, contact Mr.Chandrakanth on 2663 2833/98440 66328.

-THE HINDU, Sunday, April 6, 2003

Camera captures silent killer in hospitals

The film will focus on practices in hospitals that could lead to infections

Dr. Amarnath from Manipal Hospital will script the documentary. It will be directed by Chandra Kanth.

The director already claims to have footage of hospital waste being handled without gloves and dumped outside the city,


Many a times, hospitals can end up giving patients infections that they did not walk in with.

This is the focus of a health documentary, the shooting for which starts in Kolar on the World Health Day which falls on Monday. The shocking fact is being brought to light on a day the World Health Organization (WHO) seeks to brings the spotlight on health world-wide.

Silent Killer in Hospitals, a 40-minute Vasanth Visuals production, will try to create awareness among people on practices in hospitals that could potentially lead to infections. "If someone in an office catches cold, it spreads to many others in the establishment. Just like that, Infectious diseases spread within a hospital where patients are in close proximity,' says Dr. Satish Kumar Amarnath, chairman, Infection Control Committee, Manipal Hospital, who is writing the script for the film.

Unfortunately, no survey has yet been taken up in our country to assess the number of deaths that occur from infections - arising out of reused syringes, and other careless practices - in hospitals and primary health centres around the country.

According to the US National Nosocomial (or hospital acquired infection) survey for 2002, such infections lead to 75,000 deaths in the US on an average in an year.

"A simple practice like washing hands frequently could save so many lives, yet, you will be surprised that so many infections spread because of this negligence," says Amarnath.

Especially vulnerable to infections are cancer and transplant patients. Kidney transplant patients are administered drugs that suppress their immunity so that their body does not reject the transplanted organ. It makes them highly susceptible.

Newborns, AIDS patients and those suffering from diabetes are also at great risk.

"No hospitals has zero infection rate. It's prevalent in every single medical practice, from a small dispensary to a large hospital. The question is whether hospitals have any kind of verifiable clinical surveillance to monitor infection rates," says Amarnath.

The film will be shot in Manipal Hospital though it will take a look a the practices being following in 30-40 hospitals across the state.

"We will also look at primary health centres in rural areas that some times do not have good water supply. We are only looking at do's and don'ts, we are not exposing any practice," adds creative director of the film Chandra Kanth, who had earlier made a film on Hampi, a World Heritage Site.

The director already claims to have footage of hospital waste being handled without gloves and dumped outside the city, rather than incinerated.

"We want to see the Government set up a statutory body to ensure compliance of all sterilization norms and accountability of medical practitioners," says Amarnath, hoping that the film would bring some change.

The New Indian Express, Bangalore, April 7, 2003.

Film portrays story of silent killers in hospitals

Bangalore, April 20 : Concerned over the unknown number of possible cases of deaths owing to hospital acquired infections in Indian hospitals, film maker B.N. Chandrakanth has embarked on a 40-minute documentary on the subject, titled 'The silent killer in hospitals.'

His cause for concern stems from the intensive research he has done on the subject.

He points out that in America, deaths linked to hospital germs represent the fourth leading cause of mortality as per the federal centres for disease control and prevention of the U.S.

That is not a lone statement on the subject. According to Mr. Chandrakanth, research has found him coming across alarming statements like "The number of people needlessly killed by hospital infections (in America) is unbelievable, but the public doesn't know anything about it," as per a statement made in 2002 by a leading infection-control expert and president of the Society for healthcare epidemiology of America. Or "Strict adherence to clean-hand policies alone could prevent the deaths of upto 20,000 patients each year," as the US department of health and human services has said.

Mr. Chandrakanth's documentary on Hospital Acquired Infections or Nosocomial infections as it is scientifically known, will highlight various factors leading to infection in hospitals. His recent documentaries, Rhythm in silence and Whispering stones, on the World Heritage site Hampi, were screened n Margaret Mead film and Video festival, New York, Ojai film festival and Hollywood film festival, California and the Denver International Film Festival, Colorado.

The new project, the first of its kind to explore the subject, has as its prime objective, creating awareness, among hospital authorities and the general public on the subject, as Mr. Chandrakanth told The Asian Age.

Slated to be completed in 90 days, the film may also be screened at two film festivals in UK and USA, Mr Chandrakanth claims. According to him, festival authorities have already given in-principle agreement for the participation of the film based on the script submitted to them. The movie will showcase both the hygienic and unhygienic practices in hospitals, he said.

The Asian Age, 21 April 2003.

Film on danger of infections

Vasanth Visuals, a Bangalore based film producing unit, will produce a documentary on danger of infections in hospitals.

The shooting will start from tomorrow (April 7) to coincide with World Health Day.

The 40-minute titled "The Silent Killer in Hospitals" in English on hospital acquired -infections (Nosocomial) is being produced to highlight various factors leading to infections in hospitals. The film is directed by B.N. Chandra Kanth and script is written by Dr. Satish Kumar Amarnath.

Deccan Herald, Monday, April 7, 2003.

Film on 'silent killer'

" Vasanth Visuals, a documentary film producing unit, used the occasion to launch a venture to create a film, "The silent killer in hospitals".

The film in English, scripted by Manipal Hospital's consultant microbiologist Dr. Satish Kumar Amarnath and directed by B.N. Chandra Kanth, will highlight the hidden perils of hospitals-acquired infections.

The Times of India, Bangalore, Tuesday, April 8, 2003.

At Manipal Hospital, we clearly understand that Hospital Acquired Infections (HAI) can have significant effects, and in worst case scenarios cause morbidity, permanent disability and mortality. They always prolong patients stays in the hospital and exacerbate the accumulation of resistance. HAls also exert socio- economic pressure in terms of time and costs incurred on primary health-care sector, community care services, besides mental agony to the individual patient and his family and friends.

To address these critical issues, infection control at Manipal Hospital is an inherent component of our treatment policy. Besides control measures to reduce HAls, the broad goals of the infection control also aim for a coordinated approach to infection control and to enhance hospital structures and processes for managing them. A key part of our process is to identify international good practice, and practical solutions that can be applied more widely - steps that would lead to improved patient care and better value for money for them. These protocols are inadvertently followed in the background, without the patient knowing about it and apart from the treatment he undertakes!

We have implemented over 50 protocols and effective surveillance system over the last four years to bring down the overall rate significantly. To illustrate, its 0.59 percent for the Cardiac department, amongst the lowest in the world. By implementing these protocols we have made real improvements in the quality of care for patients and could free up significant resources for additional patient care.

-Manipal Hospital, Bangalore, India