How India’s Hospitals Can Win the War on Infection

Hospitals should be safe havens — yet for thousands of Indians, they turn into sources of infection. Healthcare-Associated Infections (HAIs) cause nearly two million cases and 80,000 deaths every year in India. These are not unstoppable superbugs, but failures in basic Infection Prevention and Control (IPC). Dr R Sukanya, Consultant – Clinical Microbiology & Infection Control, outlines 20 common IPC mistakes and practical solutions hospitals can adopt to make patient care truly infection-free.

Systemic and Leadership Flaws in IPC

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These mistakes relate to the high-level strategy, resource allocation and organizational culture surrounding IPC.

1. Inappropriate Budgeting for IPC
   • Mistake: Not adopting proper financial analysis methods for IPC, often resulting in a budget that is only on paper or insufficient. IPC expenditure is frequently viewed as a “bleeder” rather than an investment.
   • Corrective Action: Treat IPC expenditure as an investment in Quality and Patient Safety, building scientific business cases for the required costs. Use previous data (e.g. on training, equipment, hand rub standards) to ensure appropriate and wise allocation of resources.
2. Considering IPC Cost a Business “Bleeder”
   • Mistake: Seeing the cost incurred for IPC as a financial drain on the business.
   • Corrective Action: Adopt a scientific approach to justify costs, understanding that quality and patient safety are important and require appropriate financial commitment. A robust IPC program is cost-effective in the long run by reducing HAI-related expenses and litigation.
3. Viewing IPC as an Autonomous, Solely Responsible Department
   • Mistake: Regarding the IPC department as the sole entity responsible for infections, with no accountability fixed on individuals or other clinical/non-clinical departments.
   • Corrective Action: Management and Administration must fix accountability for IPC on each healthcare worker (HCW). IPC must be taken seriously and responsibly through a culture of “leading from the front and pushing from the top.”
4. Excluding IPC Team from Critical Purchases
   • Mistake: Purchasing critical items like equipment, disinfectants and hand rubs without discussion or consultation with the IPC team and in-charges of all clinical and non-clinical areas.
   • Corrective Action: Ensure the IPC team is integral to the procurement process. Seek feedback from staff on feasibility and quality to prevent poor compliance and the purchase of substandard items.

Human Resources and Professional Development Errors

These issues focus on the Infection Control Nurses (ICNs), educators and the professional dynamics within the hospital.

5. Undermining the Infection Control Nurse (ICN) Role
   • Mistake: Viewing the ICN role as “easy”, non-clinical, and solely dedicated to data collection and system work, leading to a lack of deserved payment, increments and professional recognition.
   • Corrective Action: Recognize ICNs as essential clinical and non-clinical leaders. Ensure their compensation, career progression, and respect are commensurate with their critical, specialized responsibilities.
6. Inappropriate Communication and Lack of Empowerment
   • Mistake: Poor communication between ICNs/IC Team and doctors/staff, often due to a lack of hierarchical recognition for the ICN.
   • Corrective Action: Hospital leaders should empower ICNs through formal training in communication and leadership and public recognition in the presence of higher-hierarchy staff. This fosters confidence and courage in communicating compliance issues.
7. Failing to ‘Train the Trainers First’
   • Mistake: ICNs and educators are often not formally trained in educational methodologies, communication, or leadership, relying on outdated teaching methods.
   • Corrective Action: Identify training gaps and provide exposure to varied platforms, certifications, and workshops to upgrade the skills of IPC trainers.

Policy, Protocol, and Implementation Missteps

These address the development, deployment, and enforcement of Standard Operating Procedures (SOPs) and clinical practices.

8. SOPs Developed in Isolation
   • Mistake: Standard Operating Procedures are formulated only by the Quality team and exist “only on paper” without considering practical feasibility.
   • Corrective Action: Formulate and finalize protocols through a collaborative process, circulating drafts to respective teams for vetting and feedback on feasibility and challenges. Conduct regular, appropriate trainings and reviews.
9. Reluctance to Invest in Continuous Education
   • Mistake: Hospitals being reluctant to pay for continuous educational resources, leading to stagnation of scientific knowledge among staff.
   • Corrective Action: Budget for and encourage continuous professional development, attending conferences, and subscribing to relevant journals to ensure staff’s scientific knowledge is constantly updated.
10. No Committed Involvement of Consultants and Doctors
    • Mistake: Lack of consistent, committed involvement from consultants and doctors, which is not sufficiently emphasized by the Management.
    • Corrective Action: Encourage and require doctors to actively participate in Hospital Infection Control Committee (HICC) Meetings and discuss their infectious cases, fostering a sense of shared responsibility.
11. Punitive or Negative Feedback Mechanisms
    • Mistake: Relying on punitive measures or negative feedback for non-compliance.
    • Corrective Action: Adopt a constructive and positive method for reinforcement. Focus on the recognition and rewarding of good performances and high compliances to protocols.

Data, Communication, and Feedback Failures

These points highlight lapses in internal communication and the utilization of surveillance data.

12. Fear of Communication Among HCWs
    • Mistake: Healthcare workers fear communicating non-compliances, adverse events, or non-availability of essential resources (equipment, disinfectants, infrastructure).
    • Corrective Action: Address this through regular, anonymous forums or meetings, and establish a culture of encouragement and motivation to report issues, making HCWs feel a part of the solution.
13. Data Presentation Without Action or Discussion
    • Mistake: Data on infections is merely presented by the ICN in HICC Meetings without proper Root Cause Analysis (RCA) for Healthcare-Associated Infections (HCAIs) or non-compliances. Discussion with concerned clinicians is often missing.
    • Corrective Action: Mandate clinician attendance and participation in HICC meetings. Ensure every HCAI case undergoes a thorough RCA with the involvement of all concerned departments and personnel, leading to actionable interventions.
14. Compliance Data Not Communicated to Frontline Staff
    • Mistake: Compliance data (e.g., hand hygiene, bio-medical waste) is confined to meetings and not communicated back to the concerned doctors and staff of the various clinical areas.
    • Corrective Action: Empower Link Nurses and In-charges to communicate critical IPC aspects, compliance data, and interventions discussed in HICC meetings directly to their departmental staff.
15. Lack of Data-Driven Monitoring and Digital Integration

• Mistake: Many hospitals still rely on manual checklists, fragmented Excel sheets, or paper-based documentation for IPC monitoring. Without real-time data or trend analysis, it becomes difficult to identify infection hotspots, track compliance lapses, or initiate timely interventions. This leads to a reactive rather than preventive approach to infection control.

• Corrective Action: Integrate digital dashboards and automated monitoring tools to capture real-time IPC indicators — such as hand hygiene compliance, disinfection frequency, and isolation room readiness. Periodic analytics and visual dashboards help leadership detect early warning signs, make evidence-based decisions, and sustain improvements. A data-driven IPC system transforms compliance from a routine task into a proactive culture of safety.

Operational and Infrastructure Shortcomings

These focus on training of support staff and investment in tools for environmental cleaning.

1. Heavy Dependency on Only One or Two IPC Staff

16. Mistake: Over-relying on a few ICNs, creating excessive pressure, fear of failure, overconfidence, and a closed attitude towards peer learning.
17. Corrective Action: Implement a distributed IPC leadership model, with trained link nurses and a robust team, to ensure resilience and a wider culture of learning and compliance.
18. Inadequate Training for Cleaning Staff
    • Mistake: Training on cleaning/disinfection methodology, techniques, and safety is not regular, standardized, or effective for cleaning staff, leading to sharp injuries and chemical exposures.
    • Corrective Action: Mandate regular, standardized training using videos and role-plays, as many cleaning staff may have low literacy or varied backgrounds. Focus on safety, techniques, and the correct handling of sharp objects.
19. Ineffective Cleaning and Disinfection Protocols
    • Mistake: Even with good products, cleaning and disinfection are ineffective due to a lack of supervision and stringent training on dilution protocols and methods of use.
    • Corrective Action: Implement strict supervision and refresher training on dilution and application methods for cleaning staff. Regular audits are essential to ensure efficacy.
20. No Investment in Advanced Cleaning Technologies
    • Mistake: A “Penny wise, Pound foolish” mindset leads to a reluctance to invest in better technologies for cleaning, disinfection, and decontamination (e.g., machines for scrubbing, soiled linen washing).
    • Corrective Action: Recognize the value of digital solutions and advanced machinery in ensuring consistent, high-standard cleaning and decontamination practices, which is a core pillar of IPC.
21. Minimal Patient Involvement in IPC
    • Mistake: Infection prevention is treated as an internal hospital matter, with minimal direct involvement or education of patients.
    • Corrective Action: Increase patient awareness through visible reinforcements like posters, audio messages, and technological solutions. Educated and involved patients are an essential layer of compliance and vigilance, which elevates both patient satisfaction and trust.