When hospitals make us sick...

Surgical Site Infections (SSIs) are infections associated with surgical procedures and are a major source of post-operative illness. "These infections are responsible for approximately one quarter of all nosocomial infections and affect 1.4 million people worldwide at any time. SSIs result in longer hospitalization, increased patient mortality and higher costs for healthcare providers and payers" said Professor (Dr) Rama Kant, who is the national President-elect of Association of Surgeons of India (ASI) 2012 and former Head of Surgery Dept, King George's Medical College (KGMC) and former Chief Medical Superintendent of Gandhi Memorial and Associated Hospitals.

Prof Rama Kant was addressing healthcare professionals in Srinagar, Jammu and Kashmir on 13 March 2011.

"There are few patient-related risk factors too that scale up vulnerabilities to contract SSI. These include advanced age, malnutrition, obesity, diabetes mellitus, history of smoking or tobacco use, distant infection, steroid therapy, chronic inflammation, open wounds, radiation. Immunosuppressed among others" said Prof Rama Kant who is presently officiating as the Managing Director of 'Piles To Smiles Clinics' at C-block crossing Indira Nagar and Professor-Director at SIPS Hospital, Chowk, Lucknow.

"The risk factors associated with surgical procedure or technique that scale up vulnerability to contract SSI include duration of operation, duration of surgical scrub, preoperative shaving, skin preparation, inadequate OR ventilation, inadequate sterilization of instruments, surgical technique, poor hemostasis, failure to obliterate dead space, tissue trauma, skin antisepsis, antimicrobial prophylaxis, surgical drains, length of preoperative hospital stay, insufficient preoperative preparation, personal hygiene, hair removal, skin disinfection, insufficient antibiotic therapy, intra-operative hypothermia, intra-operative hypoxemia, intra-operative hypotension among others" said Prof Rama Kant, who is a WHO Director-General's Awardee 2005.

In another exclusive CNS interview recorded by Shobha Shukla, CNS Editor last year, Dr Sudhir Krishna had said: "There is a crying need for 100% sterilized and infection proof medical devices in India. Gauze and cotton as is available and used, is a source of life threatening infections. Autoclaving, as done in our country, has no effective controls or checks which can ensure that the end product is totally infection free and safe. These products are accepted "sterile on assumption."

Autoclaving is the process where saturated steam is used under pressure to kill micro organisms. It is one an efficient and economical means of sterilization used in health care facilities for sterilization of surgical instruments, medical devices, gauze, cotton and linen. But it has now become suspect due to extremely poor quality control of the steam and sterilization strips used. Also the items for steam sterilization have to be packaged properly in permeable material for loading into sterilizers. Traditionally, wrapping material for surgical trays, instruments, table tops, dressing sets is green linen. But generally this of very poor quality and gets contaminated with blood and pus stains due to poor washing and drying techniques. Again, all autoclaved products, wrapped in cloth have a shelf life of 48-72 hours only. Unfortunately, this fact is not known to most medics and para-medics. These packs are often stored on racks for weeks together.

So, the next best alternative is steel drums, trays and boxes. But sufficient steam cannot penetrate these containers, even through the inlet vents (which are often not opened). So the end products are actually unsterile."

"Comprehensive infection-control protocols include dozens of pre-operative, intra-operative, and post-operative components should be employed by healthcare facilities that include disinfection of operation theatre (OT), skin preparation, hair removal, patient scrubbing, antibiotic prophylaxis, sterile instruments, drapes, gowns, gloves, dressing of wound, among others" said Prof Rama Kant.

Rahul Kumar Dwivedi - CNS