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 Dealing with Infections 

One of the major concerns regarding hospital care that patients and doctors alike have is the concern about infections. The infections that we are exposed to in daily life can be controlled by steps that we take on our own, but infections that occur within hospitals are the responsibility of the concerned hospital or nursing home and needs to be a high priority for them. This is especially true as of today, with the rising number of new and more resistant infective agents being identified.  

Hospital Associated Infections (HAIs), also known as Hospital Acquired Infections or Nosocomial Infections, are those which occur in hospitalized patients and which were not present or incubating at the time of admission. Guidelines on Prevention and Control of Hospital Associated Infections that were published after a WHO Meeting held at Bangkok, Thailand in June 2001 are discussed below. 

It is also interesting to note that HAIs constitute 10 per cent of all hospital admissions worldwide. This has made even more imperative the need for infection control in hospitals and nursing homes.  

Required practices

A hospital / nursing home can effectively implement infection control by ensuring the following:

?        Supply of adequately sterilized instruments and dressings

?        Implementing standards of operation theatre design, discipline and procedures

?        General application of aseptic techniques

?        Good environment cleaning, safe food, effective laundry processes, waste disposal procedures

?        Standard procedures for intubation, catheterization, venous access, invasive procedures

?        Peri-operative surgical chemoprophylaxis 

In large hospitals, such procedures are followed under the guidance of an infection control committee. The hospital environment is monitored continuously, which includes the cleanliness in wards, operation theatres, water supply, kitchen and food handling, laundry and handling of bio-medical waste. However, such controls need to be in place in all hospitals and nursing homes, irrespective of size, in order to ensure quality of service to patients and to reassure doctors that their services will not be adversely affected due to a lack of infection control.

Operation theatre discipline

This is a very important aspect in infection control. Broadly, the practices for operation theatre infection control need to ensure that:

?        Airborne bacteria be minimized

?        Surfaces kept thoroughly clean

?        Recommended schedule for cleaning and disinfection of the operation theatre is followed

?        Air borne contamination is measured regularly by scientific methods 

Quality of air

Airborne contamination is usually affected by the following factors:

-        Type of surgery

-        Quality of air provided

-        Rate of air exchange

-        Number of persons present in Operation Theatre

-        Movement of Operation Theatre personnel

-        Level of compliance with infection control

-        Quality of staff clothing

-        Quality cleaning process 

All these factors need to be taken into consideration while planning the infection control process. A well-ventilated operation theatre is an essential requirement in any hospital or nursing home and this can be achieved by the following: 

-        Clean A/c filters

-        Positive air pressure in high risk areas

-        Negative air pressure in contaminated areas

-        AHU / HEPA filters

-        Uni-directional laminar airflow

-        Minimum 15 air changes per hour

-        Temperature: 20-22 deg C; Humidity: 30-60 per cent 

The sterilization process

Sterilization involves the destruction of all microorganisms including bacterial spores. On the other hand, disinfection is the process by which all growing forms of pathogenic organisms are killed. Biological Indicators are used to monitor the ability of the sterilization process to kill the microbial spores inside the sterilizer. Since it is only these indicators, which actually give information about the adequacy of sterilization, their importance cannot be undermined.  

Water decontamination

The water should be safe for oral intake and the water tanks should be cleaned periodically. Water should be boiled for at least 5 minutes before usage, water purification units should be used, water should be hygienically stored and the use of distilled water should be emphasized in the operation theatres.  

Bio-medical waste

The handling of biomedical waste needs to be approached with a ‘cradle to grave’ concept. This is because the hospital / nursing home is involved and responsible for the generation, segregation, collection, transportation, storage, treatment and the final disposal of biomedical waste.  

Role of the microbiologist in infection control

The microbiologist plays the major role in infection control and is responsible for:

?        Handling patient and staff specimens to maximize the likelihood of a microbiological diagnosis

?        Developing guidelines for appropriate collection, transport, and handling of specimens

?        Ensuring laboratory practices meet appropriate standards

?        Ensuring safe laboratory practice to prevent infections in staff

?        Performing antimicrobial susceptibility testing following internationally recognized methods, and providing summary reports of prevalence of resistance

?        Monitoring sterilization, disinfection and the environment where necessary

?        Timely communication of results to the Infection Control Committee or the hygiene officer

?        Epidemiological typing of hospital microorganisms where necessary 

A typical microbiology report of the operation theatre environment would include the following details: 

• Site of collection
• Date of collection
• Name of the person collecting the samples
• The colony count of the aerial flora
• Predominant organisms isolated along with their colony counts
• Water potability and coliform count
• Autoclave efficiency

 The case for infection control

Precautions need to be practiced with all patients and lab specimens regardless of the diagnosis since it is presumed that every patient / specimen could be potentially infected with blood borne pathogens.  

The need of the hour is for all operation theatres to follow the above guidelines laid out by the WHO to maintain a clean surgical environment and processes set in place to ensure that the environment sterility is maintained regularly through testing and checks.  

Disha Pathology Services, housed in the Shroff Eye Hospital situated in Bandra (W), provides a service for the microbiological surveillance of operation theatres for all nursing homes and private hospitals that may not have the infrastructure to be able to monitor the operation theatre environment. 

Our well-trained and qualified staff will assess the requirements of the operation theatre and give guidelines based on international standards as regards disinfection and sterilization procedures that should be followed. A monthly surveillance is usually recommended. If you aim to provide quality service, which addresses the patient’s concerns on safety, then make sure that you have an infection control mechanism in place at your hospital today.

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