Hospital acquired infections (HAI), also known as hospital associated infections or nosocomial infections, are defined as the infectious manifestations appearing in a patient who was hospitalized with complaint of some medical condition other than the infectious pathogenesis. Patients can acquire the infectious pathogen while attending different services in a healthcare unit, for example, out-patient department, intensive care unit (ICU), obstetrics, surgical units and others. Most commonly identified HAIs include urinary tract infections (UTI), respiratory tract infections, surgical site infections and bloodstream infections¹.

The World Health Organization (WHO) has stated hundreds and millions of patients getting affected by HAIs annually. These figures show significant burden on health infrastructure in terms of economical and average mortality rate. Moreover, the incidence of HAIs is greater in economically less stable countries with low- or middle-income population as compared to developed countries with high-income majority. Approximately, 10 out of 100 hospitalized patients in developing countries are subjected to acquire at least one HAI during their stay in hospital. In contrast, this ratio decreases to 7 out of 100 hospitalized patients in the developed countries. Likewise, ICU-acquired infections are estimated to be 30% in developed countries while it is incremented 2-3 times in the developing countries. These statistics show relationship between socio-economic parameters and frequency of HAIs in a given population².

In India and other low income or middle income countries, the prevalence of HAIs is estimated between 5.7-19.1%. Among these, only ICU-acquired infections are reported as high as 88.9%, whereas the average frequency of HAIs during hospital stay is estimated as 42.7 infectious episodes per 1000 days of hospitalization. In addition, the use of invasive devices in intensive care further increments the HAI frequency up to 19 times than that of reported in developing countries including Germany and Unites States of America (USA). Similarly, HAIs are also commonly observed in neonatal care wards of developing countries, where the infection rate is 2-3 times higher compared to neonatal care units in developed countries².

During the recent corona virus disease (COVID-19) pandemic, the problem of HAIs has been exacerbated. Not only patients, but also their attendants and healthcare staff are more at risk to get exposed with deadly pathogens than ever before. Awareness campaigns through print, electronic and social media has been excessively used to encourage general public to stay home and to avoid unnecessary hospital visits during the global pandemic. Healthcare staff in different sectors ran educational drives to educate public about medical conditions that do not require urgent hospital visit. For this purpose, help was sought from national celebrities, artists and public figures to effectively communicate the message³. Moreover, routine examinations of patients with long term illnesses such as diabetes, hypertension, and cancer were asked to get in touch with their physician through virtual means⁴. Telemedicine services were launched and propagated throughout the country in order to minimize in-hospital movement of patients, their attendants/caretakers, family members/friends and to handle the spread of deadly virus along with other HAIs. Hygiene standards were more focused to introduce clear protocols, implementation and with positive reinforcement along with monitoring of sanitation practices. Nevertheless, some studies pointed out emergence of multi-drug resistant pathogenic infections in the COVID-19 patients hospitalized for treatment⁵. Therefore, more interventions are required to increase public awareness regarding standard operating procedures during hospital visit/stay and to improve sanitation and hygiene practices at healthcare setups.

References:

1. 1. Dey R, Datta S. Epidemiological Profile of Hospital-acquired Infection in a Tertiary Care Hospital of Eastern India. 2019; 7(2):70-4.
2. 2. World Health Organization. Health care-associated infections Fact sheet. Available from: https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
3. 3. Chugh MS, Thakur MS. Awareness during COVID-19: an analysis of celebrity endorsement on social media. PalArch’s Journal of Archaeology of Egypt/Egyptology. 2020; 17(6):2022-8.
4. 4. Pandey N, Srivastava RM, Kumar G, Katiyar V, Agrawal S. Teleconsultation at a tertiary care government medical university during COVID-19 Lockdown in India–A pilot study. Indian Journal of Ophthalmology. 2020; 68(7):1381.
5. 5. Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-resistant Candida auris infections in critically Ill coronavirus disease patients, India, April–July 2020. Emerging Infectious Diseases. 2020; 26(11):2694.