When it comes to Infection control, Kauvery Hospital-Chennai is in the forefront. Dr Aravindan Selvaraj, Executive Director & Chief Orthopedic Surgeon tells Clean India Journal that the carriers of infection are very often the medical staff themselves. Joining the hospital in 2011, he has over a short period of time, managed to put in place an effective system for controlling infection both at the OT and the wards — right from using hand scrub to deep cleaning.
Being an orthopaedic surgeon, I take infection very very seriously. In this stream, metal implants go inside the human body and they are going to stay there. The chances of infection are very high over here. Having worked and trained in the UK and Ireland for over 15 years, I have seen the best practices for both prevention and cure of infections. The HAI is one of the leading causes of hospital deaths everywhere.
“We have a fantastic infection control specialist who was also trained in the UK for 15 years and has joined us. He has inculcated the practice of using the antibacterial scrub among the doctors and the supporting staff. We need to change the culture, including the practice of indiscriminate stocking of antibiotics. Even for mild infection, high dose of antibiotics is taken, preventing the efficacy of even level-1/level-2 antibiotics. Time and again evidence has proved that we need only one dose of antibiotic provided we keep everything else under control and also only first generation antibiotic and not the second and third generation antibiotics. So here we have set up a hospital infection control committee (HICC). They prescribe a procedure to determine where antibiotics should be given and also as the infection seniority grows what sort of antibiotics should be given.
“And of course, we need to pay attention to the theatre infrastructure; we have an ultraclean laminar floor theatre that keeps the air circulating. We follow simple practices. A joint replacement surgery is best done first thing in the morning when OT is absolutely clean. There should be a sufficient turnaround time in between procedures. These are simple work practices which will reduce the HAI. I try to create a culture of everyone from the housekeeping to security taking cleanliness very seriously.
[box type=”shadow” ]Outsourcing ensures staff availability, but when it comes to training, it needs more efforts as housekeeping staff keeps changing. There are areas like critical care units and OT, (high risk areas) which need designated housekeeping department staff.[/box]
“The Standard precautions are followed and put in practice on day to day basis. There are many guidelines which give clear cut views on best practices like WHO, CDC and SHEA.
“Infection is largely controlled best by following hand hygiene practices. WHO has come out with the five moments of hand hygiene (medical and surgical). The WHO and CDC have established tools and policies on how to reduce the health care associated infections. The hospital at all levels should definitely take interest and establish a small HIC committee in the interest of the patients and staff. Continuous training, awareness programs and displays help us to reinforce the hand hygiene practices.
“What we practice is the deep cleaning method. Previously, we used to do fumigation and then we found out this is not that helpful and not necessary. I remember during my medical school days, there used to be an infection OT where only infected cases for example diabetic foot would be handled. However, in the UK, there has been no concept of this infection OT. For them any theatre should be clean; it has to be a deep mechanical cleaning. There are chemicals, but nothing equivalent to deep mechanical cleaning. But as I said, the main infection happens because of the practices of doctors, nurses and everybody and the infection can happen at the time of surgery. I am here and it is my core responsibility that I don’t become the source of the infection. Also, pre-operation procedure is very important. A dental check-up before the surgery can prevent infection if any from settling down.”
The hospital now uses disposable traits instead of linen during the surgery. Also, the practice of shaving the area to be operated is done away with as there is a chance of whatever the bacteria which is silent in the skin coming to the surface. “So, we just do the clipping.”
“Other common source of infection is when the patient is in the ICU. We compulsorily change very frequently the intravenous or arterial lines that can be sources of infection. Some of the instruments go through ultrasonic laser cleaning because these have micro-tip. Also, when the patients are transferred from ICU to the step-down unit – the common ward or the private ward — all this is carried by the hospital infection control committee. One has to be careful while doing the joint injections as well. Sustainability of Infection control practices is very important. This can be possible only if the top management works to get the support of doctors, nurses, housekeeping and other staffs. “Continuous training classes, role plays, monitoring, auditing and presenting of data to respective departments ensure corrective and preventive action is taken. Our methodologies include hand hygiene audit, bio medical waste audit, Isolation audit tools, monitoring based on Care Bundles to prevent CAUTI (catheter associated urinary tract infections) CLABSI, (central line blood stream infections) and VAE (Ventilator Associated Events).
