Hospital infection big problem in India: NABH #indiahealth #nosocomialinfections

Last week, the Indian Express published my column on the urgent need for hospitals – big and small – to follow infection control norms. Click here to read.

While researching the column, I spoke to officials at the National Board for Accreditation of Hospitals and Healthcare Providers (NABH) to understand how the issue might be addressed. While hospital-acquired/associated infections (HAIs) have been a concern for some years now, the spectre of drug resistance makes addressing their occurrence that much more of an imperative. For that, hospitals need to take infection control seriously.

NABH, as its name suggests, sets up and operates accreditation programmes around quality-of-care at Indian hospitals. One of the things that piqued my interest was Safe-I, a handholding programme for hospitals, that is focused on infection control. Since 2012, NABH runs this in partnership with the healthcare company Becton Dickinson. Safe-I hopes to eventually become a robust source of HAI data through a network of participating hospitals. Excerpts from an e-mail interaction with NABH CEO Dr K K Kalra.

What is Safe-I and when was it launched?

Hospital-associated infection is a big problem in our country and across the world. The patient comes in with one problem and gets another infection during the course of treatment. In India, though we don’t have enough data, what we do have indicates that 20 to 25 per cent of patients get secondary infection in hospitals. The treatment costs increase, the length of stay increases and it has a big impact on mortality and morbidity. NABH decided to have a programme – Safe-I – to control and prevent this. Safe-I also acts as a stepping stone for the healthcare set-up to go in for accreditation. We started Safe-I with Becton Dickinson India (BD) as it is a very old company and it has done lots of work in the field of infection control. The Safe-I programme was launched in 2012 in Kerala and Punjab. In 2013, we went to Karnataka and Maharashtra. We are planning to start in Gujarat and Tamil Nadu by next year.

What is the difference between this and other NABH certification programmes?

The main difference is the capacity building for the healthcare organisation. We facilitate applicant hospitals to understand and implement infection control practices and make them aware of different aspects of infection control.

Is this programme necessary for NABH accreditation?

This programme is not necessary for NABH accreditation. But it sensitizes hospital administrators and staff towards patient safety and safety culture. This helps the hospital prepare for full NABH accreditation in a step-by-step manner.

How many hospitals have been through the Safe-I?

Around 150 hospitals are registered with this programme. We have seen that out of 34 (certified) hospitals, 12 have gone for NABH accreditation. Their journey becomes easy. Within four to five months they also get NABH accreditation. Also, they are able to make this journey from Safe-I to NABH themselves and do not have to take help from third party consultants, thus saving money. There are also many hospitals who are already NABH and JCI-accredited (Joint Commission International, a US-based accrediting body) who have gone in for this programme. We are doing some very robust surveillance. We collect and analyse data and send them feedback and recommendations.

Have only large hospitals registered for Safe-I?

Right now, we have around 150 in total of which not more than 10 per cent are less than 50-bedded. We do have some smaller set-ups registered. But there are those who don’t know. It may be because of poor awareness. We would like to have these small hospitals in our programme.

How would you do that?

We are doing workshops. The Indian Medical Association and the Indian Academy of Paediatrics are propogating the programme. We also have to make patients aware. Unless the customer asks for quality, it will not come. Safe-I hospitals have to do health promotion, exchange information about all these practices among patient attendants. Right now, this is limited to those coming in with the patient. We have to do this on a large scale.

Do you think Safe-I can make a meaningful contribution to the available data on HAIs?

At present, we are encouraging hospitals to collect and share HAI data with us though the authenticity and validity of these data are not up to the mark. We are in the process of making the data robust by developing different tools.

Should the state mandate measures to improve infection control and overall quality of care?

Like most countries in the world, accreditation in India is a voluntary process. However, the Ministry of Health, Government of India, has come up with a mandatory program, “Kayakalpa”, for public healthcare facilities for infection prevention and control under the “Swachh Bharat” campaign. To make this campaign successful, different stakeholders are complementing and reinforcing the initiatives taken for infection prevention and control in public and private health care organisations across the country.

Pic sourced from Google Images

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