Page 52 - Clean India Journal Magazine June 2019 Issue

HOSPITAL HYGIENE

The poor availability of culture facility is reorienting surveillance systems which will
one of the reasons because of which the drug clearly reflect the picture of antibiotic resistance
resistance in tuberculosis and pan-drug resistant in the community. There is a need for better
bacteria belonging to Enterobacteriaceae family laboratory infrastructure to know the actual
became so rampant in the 21st century. Another estimate of the problem especially at district and
reason is too much availability of culture; too sub district level. There is also an unmet need
much dependency can make the problem worse, for concept of community laboratory that caters
especially for doctors because of consumer and to local populations and their needs for bacterial
medico-legal aspects. In the background, the culture and antibiotic sensitivity testing. The
government is providing shelter for quacks to medical curriculum needs include integrated
flourish under its ministry without scientific problem solving solutions and enhances the
authentication of facts or findings. These skill set of antibiotic prescribing community.
factors too affect the prescribing practices for There is a need for a leadership system that will
antibiotics. Most of the quacks have clinics and drive the antimicrobial stewardship programs
antibiotic prescriptions from these categories of at organizational level. Also, the entire focus
doctors who are not lawfully allowed to practice should be decentralized to organizational level
antibiotic therapy. as every organization has different pattern of
pathogens, their drug resistance and set practices
Today is the era of Google search. Patients which caters to these local level issues. Hospital
know their symptoms and what should be the environment and hygiene research should
guidelines for treatment. If doctors don’t give be promoted so also research on new drug
antibiotics, patients ask for the same. If the resistance mechanisms and developing new
consultant who is an expert in a medical field molecules and infection control practices.
does not prescribe some, they can easily go
down the lane and to one of the quacks who There is urgent need for reforms in
will. Antibiotics are also available over the government policies, law enforcement,
counter at pharmacies and chemist and druggist training and education of doctors, nurses,
shops locally. pharmacists and clinical pharmacology
experts, pharmaceutical industry and
We have to understand that the problem their representatives, veterinarian experts,
of antibiotic resistance is perpetual and the animal husbandry specialists, dentists and
extent to which it has become so rampant in ultimately society at large. Another important
community is a failure of human behavioral environmental aspect is improving sanitation
systems which are complex to understand. In and hygiene at local level; proving clean and
case of antibiotic resistance, the stakeholders potable water for consumption, reducing soil,
are multiple, starting from lawmakers to the last water and air pollution, appropriate management
link in the chain that is the ultimate consumer of effluents, garbage and sewage and improving
who is a patient seeking medical care. Apart overall cleanliness can definitely help in
from medical use, the growth promotional use of eliminating pathogens or help in breaking the
antibiotics is practiced in animal husbandry and chain of transmission of pathogens.
poultry. Antibiotics are used to promote growth “In such a case, the thoughtless person playing
and to prevent illnesses. Somewhere there is with penicillin treatment is morally responsible
awareness which is building up at a large scale, for the death of a man who finally succumbs to
but efforts and practices are still in infancy. infection with a penicillin resistant organism. I
We may follow international and foreign hope the evil can be averted.” -- Sir Alexander
guidelines and formulate policies, without Fleming, Nobel Laureate for the discovery of
realizing the ground reality of the indigenous penicillin, in a newspaper interview in 1945.
nature of complex interactions leading to larger Dr. Dhruv K. Mamtora,
problems. There is an urgent need to recognize Consultant Microbiologist and Infection control officer,
the extent of the problem by reorganizing and S.L. Raheja Hospital, Mumbai

52 Clean India Journal www.cleanindiajournal.com
June 2019