Thursday, March 20, 2003 08:00 IST

A recent phenomenon -
Prabodh Chandrasekhar 

Almost all the major private hospitals like Hinduja Hospital, Jaslok Hospital, Bombay Hospital, Breach Candy Hospital and Leelavati Hospital, had a well chosen and efficient committee. However, the mid-size and small hospitals did not have a formal committee to monitor the infection related cases in them. Most of the major hospitals have set up their ICC only after the mid-90s. It is thus a relatively recent phenomenon.

"Broadly, our ICC has got four functions, firstly to monitor sterility and asepsis on a daily basis, to check the infection rates, thirdly to monitor the outbreaks of epidemics, study the resistance patterns in the patients," said Dr. R.V. Shirhatti, medical director, Hinduja Hospital.

"Our hospital Prevention Committee performs functions of a watchdog, scientific advisory, prescribing antibiotics and training of the staff," said Dr. Vijay Kumar, Medical Director, Jaslok Hospital.

Very active in just the past five years - Rashida Bakait

"We at the Inlaks & Budhrani Hospital, Pune have a very active Hospital Infection Control Committee (HICC) since the past 5 years. It was because of sheer necessity to control Hospital Acquired Infections, and not set up after any major incident," said Dr. Nita Munshi, chief pathologist at Inlaks and Budhrani Hospital.

She is the chairperson, while other members are HOD Orthopaedics, who is also in charge of the Operation Theatre (O.T.) Dr Dudani, HOD Surgery, Dr Lokare, Chief of Critical Care and ICU, Dr Gupta, Matron, of the hospital -Jose, Sister in charge of the O.T., Sister Rita, and the Stores manager.

"Earlier, in the first 2 yrs, we had an administrator as the chairperson). Ideally, an administrator should be a part of the HICC," she added.

The Lokmanya Hospital in Chinchwad on the other hand, set up an HICC just about one year back. "The committee sets up certain protocols for every department so as to control infections. Presently we don't have any final statistics about the infection rates but we can confidently say that the protocols set up by the committee has brought more awareness amongst the in-house staff and thus has reduced the infection rates in general," said Dr.L. Pillai, Physician and a member of the committee.

In the Poona Hospital, too, the Infection Committee was set up in January this year. The eight member committee meets every fortnight and includes physicians, microbiologists, pathologist, surgeons, OT administrator, ICU in-charge and medical director. "We are still in infancy in this regard," said Dr Ina Ganguly, their OT administrator.
The Joshi Hospital, however, does not have a formal committee, but they are trying to set it up in the near future.

"We sit with the hospital's administrative committee once a month and discuss the protocol needs to be implemented in various departments to control infections. There is a need to set up such committees in the hospital as they help control infections to a greater extent but due to financial constraints the committees are not formed," said Dr. Rekha Khedekar, chief pathologist at Joshi Hospital.

With the increasing awareness about hospital acquired infections, Dr Munshi and others have come together to form a Hospital Infection Society in October 2001. "It is like a dream come true for me," she remarked.

Small hospitals have no need for a committee - Nandita Vijay

There are no Infection Control Committees and the heads of the hospitals are of the view that such a committee was more suited for large hospitals where there was a large turnover of people, which included patients and their relatives visiting the hospitals.

Dr. T Prabhu, director medical diagnostics and chairman Infection Control Committee, Sagar Apollo Hospital said the need for setting up an infection control cell was because organisms are multi resistant and checks have to be carried out to prevent hospital acquired infections, which are more dangerous than anything else that a person suffers from. 
In the case of Bangalore Hospital, which is a 160-bed facility, there are plans to set-up an infection control committee. Dr. C Munichoodappa, medical director Bangalore Hospital said that the process of infection control in the hospital was more for testing the presence ofbacteria by undertaking a study of the culture. 

"It is vital to ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces, and ensure that these procedures are being followed," he said.

Even Narayana Hrudayalaya set up the Infection Control Committee just two years ago when the hospital was established. The main objective is to undertake an on-going surveillance rate of the hospital infection. We use the data wisely to prevent any outbreak of infection. There is also an antibiotic policy to prevent the misuse of antibiotics. When we prescribe a higher dose of antibiotics, a study is conducted on the reasons for the failure of the earlier prescribed doses. An assessment of the anti-cycling sensitivity of the organisms is conducted all over the hospital as a first line defence mechanism, said Dr. Prem Anand Nagaraja head of the ICC and consultant microbiologist Narayana Hrudayalaya. 

Just putting a committee in place - K Santosh Nair

Since infection control is a recent phenomenon, many private hospitals, including corporate hospitals, in Tamil Nadu are just putting in place an Infection Control Committee.

"The awareness about infection control in hospitals is just picking up, the same being a recent phenomenon. There might have been infections in the past but no details have been recorded. Hospitals have just begun to tabulate the infections, rate of infections and the like. However there is now concerted efforts to have details about the infections and the measures to control the same, " says Dr. Ramasubramaniam, who head the Infection Control Committee at the Apollo Hospitals in Chennai.
Most private hospitals had begun the exercise of putting in place an Infection Control Committee only in late 1999 or 2000. But for hospitals, which have put in place the committee there are hospitals, mainly medium and small, which have yet to begin the exercise.

According to sources, corporate hospitals in Chennai had begun the exercise in late 1999 or early 2000. "Until then they have just been coping with the infections. As awareness began to pick up these hospitals began to put in an Infection Control Committee so as to be on guard. However, not all hospitals, especially in other cities of Tamil Nadu namely Madurai, Thanjavur, Trichy, Salem. Erode, have done the exercise. Coimbatore is an exception to some extent, almost on par with Chennai," says a hospital source.

Apollo Hospitals put in place a committee in late 1999. This committee consists of members from the Infectious Diseases department, house keeping, microbiologists, nurses, paramedical staff trained in the exercise, nurses in the Intensive Care Unit and the Intensive Coronary Care Unit. Similar is the case with Malar Hospital, another corporate hospital, which too put in place the committee in late 1999. The committee consists of the Administrative officer, House keeping, microbiologist, Incharge of the Intensive Care Unit and the Intensive Coronary Care Unit, nurses of the operation theatre and Cardio-thoracic department. So is the case with Balaji Hospital, a medium size hospital. It put in place the committee in early 2000, the committee comprising members from the house keeping, security, catering and administrative departments besides from the microbiology department. It has external controller too, an aspect which not many hospitals have looked into. 

Major hospitals have committee in place - Joe C Mathew

All major private hospitals in New Delhi have infection control systems in place. The hospitals approached were Escorts Heart Institute and Research Centre, St Stephens Hospital, Batra Hospital and Medical Research Centre, Gujarmal Modi Hospital & Research Centre and Kailash Hospital & Research Centre.

In the case of St Stephens' Dr Sudhir Mathew, deputy director is heading the committee. The members are drawn from all departments, represented by department heads. Nursing superintend, Chief Engineer, representatives from House Keeping, ICU nurses, nursing office, microbiologists are all members.

The committee meets once in every month. Every three months, the hospital observes "hospital infection prevention day" where all the staff would be asked to attend training programmes.

Lack of a professional approach is visible - Salil Mekaad

Though the concept of controlling hospital acquired infections is noticed in the different hospitals of Indore, lack of a professional approach in this direction is clearly visible. In majority of the hospitals, a sole doctor, mostly the medical superintendent or the director, carries out the function of policy making, controlling, investigating and auditing. Some of the hospitals have a committee in place, but its meets infrequently, only in case of emergency or a major incident.

The 350-bed Choithram Hospital and Research Centre (CHRC) is probably the only hospital that has a separate department of Infection Control to take care of the hospital-acquired infection.

According to CHRC Medical Director, Dr Ravikant, the hospital has a infection committee headed by the Hospital Superintendent, Dr Kamlakar Vaidya. The committee comprises a microbiologist, Dr Chitnis, Principal of Nursing School, Usha Ukand, Matron Ramola Rau and representatives of consultants from different departments.

"Why is there a need for infection control committee when I control it myself," said Dr Aslam Chara, Director of the 90-bed Lifeline Hospital. Though some emphasis has been given on controlling the water borne diseases - by installing a drinking water filteration plant - the hospital practically no control on hospital infections. However, the Director claims to have only one or two such infections in the hospital on a yearly basis.

When informed about the concept taking shape of a mandatory provision in the Madhya Pradesh Nursing Home Act, 1998, (the Act is not yet implemented due to legal hassles), Dr Chara said, "Operation theatres are fumigated on a regular basis. Even the rooms are nowadays being fumigated. After fumigation, the facility is not used for 12 hours."
Barbers with their shavers and a hospital director with a nail cutter - are the peculiarities of this 60-bed Bhandari Hospital and Research Centre. Like in schools, cleanliness among the para-medical is of prime importance at this hospital.

The reason - around six months back, even after a specialized infection control committee keeping a strict watch over the affairs, sudden spurt of infections were noticed in the neonatal ICCU, which could not be controlled even using higher antibiotics. The investigative wing of the BHRC swung into action and caught hold of a nurse and a ward boy having infection in their ears.

``The staff was thrown out, as they failed to report about their infections before attending the patients,'' said Dr Vinod Bhandari, Director, BHRC. He now keeps a nail cutter in the pocket and examines every para-medical staff he confronts during his regular rounds.

The 100-bed Gokuldas Hospital had no professionally managed system to control the hospital acquired infections. However, off late, the collection of bio-medical waste has improved greatly at the hospital, with the recent figures of collection touching around 365 kilograms, from 89 kilograms in January, 2002.

Infection control formed just six years ago - Sanjukta Roychowdhury

At the Kothari Medical Research Center, an Infection Control Committee formed just six years ago. Its members are: Chairman/President-Hospital Superintendent Dr. S. Sahay, Secretary- Dr. S.S. Jha(Deputy Medical Super), Technical Manager Dr Anuradha Agarwal (Microbiologist), Dr. M.L. Chatterjee (Biochemist), Nursing- Mrs. Gouri Dey (Deputy Nursing Super).

The Calcutta Medical Research Institute (CMRI) has also had a formal committee for the past three years. Currently, it is headed by Dr Amitava Chakraborty.