Hospitals, clinics: Dens of infection

Hospitals and clinics are specialised institutions for healing the sick and suffering humanity. There professional care and curative attention is provided to overcome infections, diseases and injuries. Patients come to hospital and clinics with medical or surgical problems that are rectified by the physicians or surgeons' expertise and skill. Naturally, many patients with various types of infections come to the outpatients' department or are admitted to the hospital for treatment. These prospective patients can however involuntarily spread infection that can be transmitted to otherwise healthy people, having some minor ailment! Some infections that can be transmitted in this manner are tuberculosis, viral hepatitis, among others. It indicates the need for segregating these two types of patients; one with infectious disease, and the other with some minor problems. Generally hospital and clinic based infections are spread in this manner; particularly in the outdoor areas. Apart from this, hospital related infections can also be caused from simple routine invasive procedures of simple surgery, intravenous therapy or catheter insertion quite often needed for treating patients. The potential lack of resistance among the many patients present in the hospital, also adds to the probability of being infected. Factors like old age, diabetes and cancer, particularly those undergoing chemotherapy are more at risk. These persons are more prone to bacterial infection, which does not usually infect normal healthy people. Some of the potentially identified sources for infection in hospitals and clinics could be: i) Respiratory tract infection like tuberculosis and respiratory viral infections; ii) infected blood, related to viral hepatitis and HIV; iii) chicken pox, herpes and streptococci infection and, iv) infected discharge like pus. These infections can be spread in any of the following sources: i) Through patients' mouth, nose, gastrointestinal or skin lesions; ii) residual microbes from healthcare workers, casual visitors or other patients, and iii) contaminated medical instruments, dressings, needles usually associated with invasive procedures. Hospital related infections are a serious matter. It is estimated that around 1.4 million people around the world suffer from infections that are acquired at hospitals or clinics. To contain hospital and medical clinic related infections, the following areas need to be strictly monitored that is often neglected in many hospitals in Bangladesh. These are: i) To ensure proper and regular hand washing of all related personnel; ii) safe water supply -regularly tested for pathogens; iii) separation of hospital traffic for all areas related to infectious diseases; pathological laboratories, toilets and such areas; iv) strict control of access to rodents, insects, pests and other pet animals; v) wet moping and dry sweeping, and refrain from any form of dusting or linen shaking in the air that releases air borne microbes; vi) sneezing, coughing and spitting needs to be strictly monitored and controlled; and vii) air filtration quality must be strictly monitored and air change frequency (15 per hour) has to be maintained. Hospital environment temperature should be close to 2022 C and relative humidity maintained around 55 per cent, which inhibits bacterial growth. Hospital food supply and management is an important area for control particularly with elderly and patients with low immunity. The following areas need particular attention: i) Food for patient should never be prepared more than six hours before the scheduled time of consumption; ii) no food (raw or processed) should be stored at room temperature; iii) personal hygiene and cleanliness of food preparing and handling personnel must be strictly monitored; iv) all kitchen personnel must put on washed aprons daily; v) food preparation and handling staff must not work while suffering from respiratory or skin infections. Hospital waste, a potential source of pathogenic micro-organisms, is another important area for containing chances of cross infection in hospitals and clinics. Wastes are to be handled and disposed off in an approved manner. These steps need to be properly and correctly carried out to ensure that all infection risks are contained. This involves steps for segregation, collection, storage, needed treatment up to final safe disposal, making the waste pathologically harmless. Hospital wastes are broadly classified as hazardous or non-hazardous. Hazardous wastes include toxic drugs and chemicals, and even radioactive waste materials. These could also be sharp and can cause skin puncture or tear to the handler and can lead to possible infection. Common such items are, broken injection vials of drugs, needles, disposable syringes and glass bottles and test tubes and catheters, miscellaneous tubes, cotton waste, discarded wound dressings, adhesives and gauze that are non-sharp objects yet microbiologically dangerous. Another group of wastes come from pathological laboratories these could be blood, urine, sputum, stool and many other tissues and samples, and even dissected portion or amputated body parts. Most non-hazardous wastes come from food preparation and disposal of surplus or uneaten portions. These are bio-degradable and can be buried in a safe and restricted location. Recyclable wastes, like paper, board and plastic packaging materials, empty packets, and sundry boxes and many opened containers, both metallic or non-metallic. All toxic and pathologically contaminated wastes are usually incinerated, and their disposal is done by authorised vendors licenced for the work. Radio-active wastes are handled only by government authorised agency that are responsible and trained on radio-active waste disposal methods. This in general covers most of the foreseeable problems and acceptable solutions for the disposal of various hospital wastes. Many of these wastes are potentially biologically dangerous, while some could well be lethal. It is therefore felt necessary in overall public interest that our government set out specific rules and instructions for the proper disposal of the various types of medical wastes. This need to be controlled and monitored by the health authorities so that uncalled for diseases and infections are not by accident or carelessly let loose, leading to even possible dangerous epidemics. The writer is an Engineer with experience on Medical Engineering Systems