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Nayan Chanda

Nayan Chanda is the author of Bound Together: How Traders, Preachers, Adventurers and Warriors Shaped Globalization and is Consulting Editor of YaleGlobal Online, published by the MacMillan Center, Yale University.

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BW Businessworld

The Smart Way of Healing

Raising awareness about the high cost of poor hospital hygiene needs to be a major part of PM Modi’s cleanliness campaign

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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 in two-month time, two relatives and an acquaintance succumbed to hospital-acquired infections in Delhi, Kolkata and Mumbai. The treatments for which they were admitted to hospital went well, but in the course of their post-operative care, they succumbed to different hospital-bred pathogens. If hospitals, like doctors, are expected to follow the Hippocratic Oath ‘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 of entering the hospital.

According to the US Center for Disease Control, almost two million Americans are afflicted by hospital-acquired infections (HAI), resulting in 20,000 deaths per year. Very little data is available in India as hospitals are not mandated to report incidences. However, according to a 2014 study, WHO found figures from India “alarming, with an incidence rate varying from 11-83 per cent for different kinds of HAI”. A study, conducted at the J. P. Narayan Apex Trauma Centre in 2011-12 at AIIMS in New Delhi, was published in the Journal of Laboratory Physicians and it showed that the infection rate is 10.6 per cent. Of those infected, 83 died implying a mortality rate of 34.5 per cent. Seventy five per cent of the deaths were caused by blood stream 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 infected by HAI.

Secondary infections in hospitals have become an even bigger threat when caused by drug-resistant bacteria. The consequence of indiscriminate use of antibiotics by the Indian public and hospitals has been 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 virtually incurable.

Medical experts believe that India has become one of the world’s largest sources of drug-resistant bacteria, threatening not only Indian patients but foreign visitors as well. The growing costs — and tragic consequences — of the uncontrollable rise of resistant pathogens will be borne first by the public, but eventually the country’s exchequer will also feel the impact.

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? Raising awareness of the high cost of poor hospital hygiene needs to be a major part of Prime Minister Modi’s cleanliness campaign.

(This story was published in BW | Businessworld Issue Dated 25-01-2016)