Page 51 - Clean India Journal Magazine June 2019 Issue

HOSPITAL HYGIENE

here is universal urgency for addressing optimal use of antibiotics
which is possible only through an antimicrobial stewardship program.
TThis is a simple solution for addressing the massive problem of
antimicrobial resistance, a man-made disaster of the 21st century. There are
multiple mechanisms of drug resistance in bacteria. The biggest challenge
for any healthcare practitioner today is to treat multidrug-resistant organism-
associated infections, especially in acute care settings and that too in
resource-poor settings.
Some of the biggest medical problems in the history of medicine have been
tackled with simple solutions like vaccination for smallpox. Similar tactics
can also be applied for addressing antibiotic resistance by use of simple, basic
practices like isolation precautions and barrier nursing in resource-limited
settings for patients colonised by multidrug resistant organisms. Isolation
precautions have been proven as an effective modality. Rather basic infection
control practices have been time-tested during Ebola outbreaks recently, and
also for unknown or undiagnosed diseases which are yet to be identified. The
techniques are simple, yet highly effective. They are perfect to implement for
resource-limited settings and are also justified since they do no harm to sick
patients with multidrug resistant infections who seek medical care. Isolation
precautions help to prevent the spread of infection from one patient to another
patient, thus breaking the chain of transmission of pathogens.
One of the challenges is also to find out the burden of drug-resistant bugs in
resource poor settings, since there is poor availability of microbiology culture
facilities. Such facilities are confined to either public teaching hospitals or
private hospitals. There is a lot of cross-discipline practice in laboratories
wherein the facilities might be doing cultures, but the reporting is not done by
a clinical microbiologist. It is done by pathologists who have little expertise
or exposure, or perhaps by automated systems which is just oversimplification
by depending upon the intelligence of a machine or software. There is always
a possibility of over-reporting or underreporting in such circumstances. Need-
based laboratory in community settings are vanishing with the advent of
referral laboratory concept wherein most samples for testing are outsourced.
There too, compromise in quality is there because the culture needs to be
plated immediately after collection, otherwise contaminants can overgrow
and give false positive results especially in samples like urine and sputum.

Another important aspect is quality of material supplied for testing
antibiotic sensitivity. For example: Quality of disc, content of disc, method
used for inoculum preparation, standard guidelines if any used; incubation
period, lawn preparation, sterility maintenance, technical expertise and
quality of media. There are other factors like preparation of media, pH,
temperature of incubation, inoculums effects etc. which indirectly affect the
results of testing. False susceptibility or resistance can be due to the same.
There are also laboratories which are run by trained laboratory technical staff
who are qualified for performing tests but not for interpretation of medical
tests, yet they are signing the test reports because there is short supply
of medical doctors and poor regulation by the government and other
overseeing agencies.

Clean India Journal
www.cleanindiajournal.com 51
June 2019