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Today, it is not uncommon that a patient getting admitted for a particular ailment, gets treatment for another ailment contracted while at the hospital due to lack of hygiene. Yet, maintaining cleaning standards is still not given the topmost priority. Mohana M enumerates how intelligent cleaning practices can bring about a difference in a special report on Saifee Hospital, Mumbai
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Cleanliness is subjective; it is all the more so in India where keeping clean is directly related to the ability, affordability and willingly of an entity or establishment to do so. Speaking of cleanliness from a common man’s perspective, for a person who does not get direct water supply at home, taking a sponge bath every day still means clean than not taking bath at all. In certain strata of the society, even if clothes are worn for several days without washing, it is considered normal. Over a period of time, even dirty clothes seem okay, as it becomes the way of life. These very people also make their way to the hospital as patients or as visitors.
“Leave alone the common man wearing unwashed clothes, has anyone found out when was the last time our good doctor washed his tie? Well, it is much more contaminated than the medical garbage bag hanging on a nursing trolley in the ICU!”, opines Huzaifa Shehabi, Chief Operating Officer.
Saifee Hospital, a multi-speciality hospital, has cleaning practices ingrained in every process.
While there is no one single common solution to tackling infection, there are many studies on this subject providing solutions. But one needs to adapt it to suit the local circumstances. “It is important to understand the people and their way of life, to fit in solutions suggested by various studies,” explains Huzaifa Shehabi.
“Even if simple hand washing practices are adhered to or implemented effectively, there will be at least 25% dip in infection related cases. It will also result in reduction of resistant infection. A spec of infection left behind due to improper washing of hand can spread from one person to another. The more the infection is passed on, the more the increase of resistant protypes.”
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“I am a regular reader of Clean India Journal and the topics discussed and information provided give insight into the systems that need to be adapted and more importantly implemented correctly.”
– Huzaifa Shehabi
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Similarly, adopting solutions intelligently can help control of infection. Every hospital wears an odour which instantly hits our nostrils. “One will find no odour of disinfectant while entering Saifee. In fact, it will not feel like an hospital but just another building, as the disinfectants being used by us are odourless and highly effective.”
One of the main channels of spread of infection is the air-conditioning system. “However, by increasing the air changes, the quality of air can be maintained. With this system, a certain cusecs air is flushed out of the building and sucked into the system, treated, cooled and then again flushed back into the building. Yes, this process could increase the energy bill but this method restricts spread of infection. Imagine the OT, where so many of the patients are opened up for surgery and the different concoctions of antibiotics and bacteria are circulating in the air at every 50ft or so. The number of strains of bacteria that are looming around can be cleared with frequent air changes.”
Right from the flooring to the kind of mopping required have been well-planned and implemented at Saifee. “I am a regular reader of Clean India Journal and the topics discussed and information provided give insight into the systems that need to be adapted and more importantly implemented correctly,” he adds.
“The science of disinfecting is not dependant on what chemical is costly or cheap but is dependent on what is being used, at what concentration and how it is being used. It is a matter of what kind of chemicals one uses. Similarly, what is the cycle of the mop being used and so on. This is exactly what I am taking care of. The cost may be a little higher but the success story is that in the last one decade we have not had to change any product.” Due to bacteria resistance, many are forced to change disinfectants but at Saifee the same disinfectant is still in use.
Enumerating more examples, Huzaifa Shehabi said that there is a tendency in many organisations to treat certain areas of the building like below the staircase, with cheaper chemicals. People pass through that area and carry the infection through their clothes up the stairs, touching the railing… thus spreading infection. Hence, through intelligent practices of using one single chemical for treating the entire premises uniformly, can curb infection and ensure that the premise is maintained clean and hygienic.
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As a general practice, spring cleaning is done on a daily basis and deep cleaning is taken up on weekends in most organisations. This probably is also defined as best cleaning practices. However, can these same practices be applied to a hospital and still be called the best? Probably, not.
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Two of the core departments that are directly related to maintaining cleanliness and implementing hygiene practices are the housekeeping and the CSSD.
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– Ammin Rajqotwala
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Housekeeping
Every hospital has a different cleaning protocol, says Ammin Rajqotwala, CMD, Rare Hospitality and Services Pvt. Ltd, the facility management company maintaining Saifee Hospital.
“The infection control committee of the hospital decides the cleaning standards that are to be set. The nature and frequency of cleaning, identifying the areas that needs to be cleaned, the process of dealing with each area… For example, for infection control in the high-risk areas, what chemicals to be used, how it has to be used, etc., are decided by the committee. We work very closely with them and are bound to match those standards. Hence, each hospital has a protocol which we need to follow.”
In order to keep up with the standards laid down, Rare Hospitality emphasises on regular training session, off-site and onsite, for the entire team working in the hospital. Following the training, the staff is also tested and the outcome is shared with the client. “At any point of time when there is some shortcoming, we sit with the client and get it rectified,” he explained.
“The bottom line for Saifee is hygiene, cleanliness and no infection.” There are constant tests conducted to ensure standards. “There are swap tests carried out. When it comes to grooming and discipline among the staff or handling of patients, the hospitality extended by the staff, proper handling of patients in the suites, etc., are constantly monitored and rectified.”
“We train the boys in multiple tasks. When there is deficiency of workforce in any of the areas, we change roles and shift staff from one department to another. For example, a person in the housekeeping may have to do ward service or admin duty and so on.” Hence, they all receive training on how to handle patients right from moving them into a wheel chair to putting them comfortably on their bed.
“The staff is assigned for a day or week or month and are exposed to the nature and demands of the work. So that the work is carried out smoothly.”
“It is a wonderful experience working with Saifee, since the management is particular about patient experience in terms of both handling and hospitality. Together we make a good team. And must mention that Huzaifa Shehabi is a very knowledgeable and a wonderful person to work with. With him, we never stop learning and always feel can do better.”
CSSD
Cleaning in the healthcare sector involves processes which include disinfection and sterilization. CSSD or the central sterile services department is the heart or the backbone of the hospital. It is an integrated place in hospitals and other health care facilities that performs sterilization and other actions on medical devices and equipment.
“Lack of knowledge in the hospital staff about sterilization procedure is one of the primary reasons for the rise of infection,” says Sadashiv P. Gaonkar, Senior Manager – CSSD, Saifee Hospital.
Maintenance and reprocessing of advance surgical instruments and equipment in modern era of medical science is a challenging experience. The job is demanding and CSSD plays a key role in controlling the surgical side infection in a hospital. “Surgical technique is continuously evolving and surgical instruments have kept pace with technology. While modern instruments have expanded the range of surgical procedures, the technology has also dramatically increased the difficulty in cleaning, decontaminating and sterilizing. These newly designed costly devices create processing challenges because they often contain complex structural anatomy, fragile components like fibre optic cables, lenses, cameras, scopes, etc., usually long and narrow lumen with multiple joints, valves mostly made up of heat sensitive material. Specially minimally invasive instruments, which require changes in sterilization processes.”
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– Sadashiv P. Gaonkar
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Most of the super speciality hospitals import very expensive CSSD equipment & sterilizers. “However, they do get trained staff in India as we do not have recognized CSSD training program.”
For a surgeon, it is difficult to assess the sterility of an instrument, as it cannot be judged sterile by the naked eye. The surety of cleaning, assembly, packing, sterilization, storage, transportation and proper documentation proof with quality assurance test can only be provided by CSSD. To create awareness in Mumbai, we have a Hospital Sterile Services Association (HSSA) which is a registered body formed in the year 2000. Sadashiv Gaonkar is also the president of this association.
In February 2017 in Thailand, Saifee Hospital along with two other hospitals from India have been designated as the laureate of APSIC CSSD Center of Excellence Award 2015-16. “Our hospital has demonstrated outstanding leadership in delivering quality disinfection and sterilization services. This is matter of great honour to us that our hospital represented India at this prestigious program and has been selected for the top prize as the Gold winners in best practices in sterilization. APSIC auditors are also impressed with our in-house innovations, trainings and awareness programs.”