Infection control Committee (ICC) has to put the ring in order by arranging the beads.
Although much noise has been made already, in regard to setting up an Infection Control Committee (ICC) in every hospital, very little progress has been made in this line and many are still waiting to respond to the call. Health Pundits hope that this system will be accepted by all and the beads in the missing chain will be connected in the near future.
In one of the main ambitions of any hospital now a day’s Quality appears to play an increasingly important role not only from a clinical perspective, but also from a business perspective. In reality, hospitals are a setting where cutting-edge medical advances relieve suffering, and bring healing as well as provide a new life for patients who need absolute care. Focusing on the value of the service provided to patients, hospitals these days are coming up with value-enhancing strategies that include providing a rich patient experience, meeting infrastructural needs, working out on best interior designs, staying technological abreast, adopting systematic waste management strategies, reducing process variation so on and so forth. The list will go on. Indian hospitals especially, the elite institutes have been able to achieve the important components of the value chain in the Indian healthcare industry, producing services and recognised delivery segments, which are growing at an annual rate of 14 per cent. However, in all these positive endeavours to become a place of excellent healthcare delivery, the most important aspect that needs the highest priority- Infection Control level within a hospital is ignored perhaps always. Much has been highlighted and spoken about the unmet needs related to Infection Controls; nevertheless we still remain where we were ten years back.
Even after investing too much money and ho halla the studies prove that the cost of antibiotics to patients has not comedown rather has increased with a rapid pace. On one hand hospitals are claming that they are making huge % contribution in Infection control and on other hand patients are paying more and more for antibiotics.
Hospital Acquired Infections (HAI), Nosocomial
Many deaths or prolonged hospital stay are caused by unsanitary facilities, germ-laden instruments and unwashed hands. Recent reports indicate that at any time about 1.4 million people worldwide suffer from HAI. According to estimates the risk of HAI is nearly two to 20 times higher in developing countries where the overall incidence of HAI is about 10 per cent of hospitalized patients.
Experts say “Majority of infections are endogenous in origin, i.e. from the patient’s own micro-organisms. However, infection can spread to other patients through contact or hands of healthcare professionals, visitors and attendants. Some infections like measles, mumps, chicken pox, sputum positive lung tuberculosis etc. can spread through air. Other infections can spread through certain improperly disinfected or sterilised material or through water. Experts say the most high risk areas are ICU, OT, Nursery, Cancer ward, burn ward, kitchen etc.”
HAI and Infection Control
“Historically, infection control practices, in one form or another, have existed since great surgeons, like Lister, recognised the significance of bacteria in producing postoperative wound infections. John Bell, in 1801, remarked that hospital infection exists in every type of hospital. In the early 1970's, the first infection control nurse was appointed in the UK - this marked the beginning of an era: the recognition of infection control as a speciality in its own right.”
In today’s scenario “Statistics state, that in the developed nations the HAI rate is less than five per cent. Though few authentic studies have been conducted in India, and results of those studies reveal that in our country the HAI rate is more than 15 – 20 per cent.“In developing countries, the infection control programmes are nonexistent or, at best, in their infancy. Individual hospitals and physicians struggle to establish programmes despite financial constraints.”
India today is grappling with the emergence of diseases. Based on this evidence, several infection control policies are being constantly developed and revised, yet this issue remains a continuous process. Blame it on the great Indian divide, wherein, the country provides high quality medical care to elite and middle class Indians as well as to the medical tourists, or the country whose residents have limited or no access to quality care or the poor healthcare policies or blame it on the lack of awareness among healthcare providers. The fact is that HAIs are a serious cause of concern. “Lack of awareness about infection prevention and control practices amongst healthcare practitioners and absence of a formal education programme in Infection Prevention and Control in the country has contributed towards adding on the burden of HAIs.
Infection Control Committee (ICC)
The ICC is a team whose core responsibility is to make protocols to fight infections that can spread within the hospital set-up and to conduct surveillance subsequently. Every hospital should have an efficient ICC consisting of a member of a hospital staff preferably a senior medical microbiologist, epidemiologist or infectious disease physician, personnel from medical and nursing staff, support services like engineering and biomedical engineering, operations, housekeeping, F&B, operation theatre and sterile supply departments as well as the hospital administrator having an experience and training in infection control. The clinical microbiologists form the core Infection Control Practitioner in an ICC and generally chair or are member secretaries, by virtue of their closest involvement with micro-organisms and patients.
Role of ICC
The ICC acts as an advisory body to advice on the following subjects:
• Taking appropriate safety measures and making protocols in patient care so as to prevent infection in the patients and health care staff
• Conducting surveillance of healthcare associated infections, seeking trends and reviewing measures and changing them if required
• Educating the hospital staff on efficient and standardised use of antiseptics, disinfectants and products used for washing and disinfecting the hands
• Inspecting aspects such as quality control of the techniques used to sterilise equipment in the hospital; monitoring of sterilisation/disinfection cycle
• Recommending antimicrobial policy for the organisation
• Setting guidelines for training of different categories of staff in prevention of infection and control
Functions of the Committee
“Ideally, the infection control committee should meet monthly. For greater success, the meeting should be held on the same day and time each month. The meeting agenda should be well planned and circulated to committee members before the meeting,” informs Dr Pandey. Furthermore, the committee performs three principal functions:
• The first is to gather data. Each institution needs to know the microflora of its high risk areas such as operating theatres, adult- and neonatal- ICUs, dialysis units and oncology services. A good microbiology laboratory is essential to isolate organisms, to plot antibiotic resistance patterns and to indicate to clinicians' trends and changes in hospital flora. The laboratory is also best suited to identify outbreaks (three or more cases of infection with the same organism and antibiograms) and to alert clinicians accordingly.
• The second function is to carry out surveillance. Whole hospital surveillance is impractical and largely meaningless. Most hospitals should generally go for target surveillance to areas of the hospital where the highest rates of infection and antibiotic resistance are likely to be found.
• The third function of the committee is to enforce good infection control practices. For this certain concepts must be ingrained. Nosocomial pathogens have reservoirs and are transmitted by predictable routes to susceptible hosts.
Infection Control Programme
The most important objective of an ICC is to successfully plan and execute an infection control programme. The success of which facilitates to reduce the spread infection levels within patients, visitors and the hospital staff as well. “Infection Control Programme is conducted to prevent the infection occurring from the hospital environment by training health worker, patients and patient relatives and taking effective measures for proper use of antibiotics"
“An infection control programme is directed towards realisation of twin desired outcomes- decreasing preventable infections to minimum in patients and healthcare staff and decreasing antimicrobial resistance.” He further mentions that an ICC is incorporated to represent the Infection Control programme. ICC team looks after implementation of the programme and depiction of well defined roles and responsibilities of each component. It prepares an annual action plan with set targets, budgeting and review mechanisms. The team further creates a document in the form of a working infection control manual detailing policies, recommendations and guidelines including antimicrobial policy, infection control practices and protocols, activities carried out by infection control team with an infection control officer and infection control nurse(s), surveillance and monitoring activities, periodicity of ICC meetings and its occurrence at regular intervals to seek and review trends, deliberate on measures for implementation , a component of daily as and when required interaction between different departments of the organisation or healthcare institution, teaching training and awareness of all staff engaged in healthcare delivery in that institution- whether permanent or on contract and also patients and attendants.
Attention needed to control communicable disease by ICC
Experts are of the opinion that general monitoring of patients for development of HAIs and tracking these to improve upon processes associated in patient and staff health, specifically where devices are regularly used have to be conducted on a weekly basis. Monitoring for infections such as Ventilator Associated Pneumonia (VAP), central line associated blood stream infections and Catheter Related Urinary Tract Infections (CR-UTI) is vital. Antimicrobial usage monitoring with emphasis on certain restricted antimicrobials, antimicrobial susceptibility monitoring, monitoring of patients for development of surgical site infections, monitoring compliance of hand hygiene, monitoring of disinfectants and their usage, monitoring of
Sterile supply and Central Sterile Supply Department (CSSD) including bacteriological monitoring of -autoclaves, other sterilisation/disinfection processes etc is also of high priority. To look after safety of the staff members, needle stick and exposure inoculation injury monitoring, screening of food handlers , bacteriological analysis of water, monitoring specific infections in the staff, biomedical waste mangement should be also be conducted.
ICC and Indian Scenario
Microbiologists across the country believe that setting up an ICC within the hospital setting is a must for every hospital to provide quality care. However, in India very few hospitals have a complete and a functioning ICC. Stressing on the importance of an ICC Dr Sardana states, “Infection control programme which is effectively implemented and monitored with continuous improvement would grossly minimise the risk of development of healthcare associated infections. ICC is an integral part of infection control programme. However, heathcare associated infections cannot be totally eliminated. They would be there in one form or the other as micro-organisms (bacteria, viruses, fungi etc., as they are intimately present in and on human body and around us.” Moreover, studies show that nearly one-third of nosocomial infections can be prevented by a well- organised infection control programme.
Playing the Watch Dog
There are no specific polices that posses a compulsory binding on hospitals to set up a ICC within the hospital. This leads to a laid back attitude among caregivers on the respect of following stringent norms. Though statutory bodies such as ISO, NABH, HISI and JCI have set guidelines for formulation of ICC in every hospital, the success received is minimal.
NABH Norms
“According to the NABH standards, every hospital that seeks accreditation is bound to form an ICC within the hospital. These standards provide framework for quality assurance and quality improvement for hospitals. Chapter five of the NABH standards focus on Hospital Infection Control.
Challenges
Since we live in a country with limited resources, healthcare delivery providers are faced with umpteen numbers of challenges that restrict the successful implementation of an Infection Control programme. Heads of various hospitals are of the opinion that these challenges are a hindrance to the success of the ICC. “Ours is a country with vastly differing health care systems, hence the challenges are many. High bed occupancy, over worked staff, lack of sufficient funds to procure gloves, disposable syringes etc are some serious impediments to developing an adequate infection control programme in hospitals across the country. Hospitals need to perform antibiotic surveillance and develop antibiotic policies on a regular basis. Regular staff education is necessary. These activities need constant supervision by well trained infection control nurses,” says Dr Anjali Shetty, Consultant Microbiologist, P D Hinduja Hospital and Research Centre. Moreover, lack of coherent policies is the biggest set-back to the progress of infection control. Hospital infections are increased by invasive devices, and there must be a conscious effort to remove these at the earliest opportunity. Bacteraemia, pneumonias, urinary tract infections, line infections and surgical site infections are the major causes of morbidity and mortality. In India, this cost is more than what the Government spends on total healthcare.
Lastly...
There’s a lot to be done. Hospital administrators, microbiologists and policy makers need to gear-up together to develop various strategies to improve the quality of hospital care in the future. Formulation of stringent policies that will be binding on every hospital will also help reduce a decent amount of infection levels within the hospital. Moreover, infection control is a never ending struggle as medicine become more invasive and the proportion of ageing and immuno-compromised patients in our population continues to increase. Hospitals should come up with an in-house awareness programme where staff members, patients and their relatives can be educated on maintaining hygiene. All in all, experts believe creating a hygiene conscience society is the solution to reduce the infection menace.