Indian ICUs hotbed of infections: Report They Fare Worse Than General Wards; Experts Say 20% Of All Infections Are Acquired Here

Indian ICUs hotbed of infections: Report

They Fare Worse Than General Wards; Experts Say 20% Of All Infections Are Acquired Here

Kounteya Sinha TNN

New Delhi: Intensive Care Units (ICUs) — believed to be the safest part of any hospital — are teeming with bad bugs.
    Contrary to popular belief, scientific evidence shows that Indian ICUs are a hotbed for bad infections.
    This was also the primary fear of doctors treating the 23-year-old gangrape victim Nirbhaya.
    Deputy medical superintendent of Safdarjung Hospital Dr T K Bhowmick said infection rate in Indian ICUs are almost 40% higher than even general wards. “That’s why our primary focus was to wheel out Nirbhaya from the ICU into a general ward at soon as possible. ICUs can cause serious life-threatening infections. The primary reason is that patients admitted in ICUs have multiple tubes inserted into them like the ventilator, IV lines or catheters, all of them being major source of infections.”
    He added, “Besides, ICU patients are usually more serious and immune compromised since they are on heavy doses of antibiotic. Pathogens in the ICUs are more resistant to these antibiotics. Patients are more prone to catching even the slightest infections.”
    Experts say that although ICUs account for fewer than 10% of total beds in most hospitals, more than 20% of all infections are acquired in ICUs. Infections are the leading cause of death in non-cardiac ICUs and account for 40% of all ICU expenditures.
    A recent Indian Intensive Care Case Mix and Practice Patterns (INDICAPS) study with a sample size of 4,209 patients admitted in 124 ICUs across 17 states found that one out of every eight patients in India die from infections contracted in ICUs.
    Sepsis that infected Nirbhaya is one of the primary threats. INDICAPS found that 26% of the patients in ICUs contracted sepsis with 42.2% of them dying of it.
    Dr Narendra Rungta, president of Indian Society of Critical Care, said, “Hospital Acquired Infections (HAIs) are very common in India. Only one in 10 ICUs observes practices that are vital to keep it infection free. Hand washing with alcoholbased solution for 90 seconds is the single most important intervention that can cut down 90% of HAIs.” Dr Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy (CDDEP), said antibiotic resistant infections are difficult — and sometimes even impossible — to treat.
    “They lead to longer hospital stays, increased treatment costs, and in some cases, death. Research estimates that of the approximately 1.9 lakh neonatal deaths in India each year due to sepsis, over 30% are attributable to antibiotic resistance. HAIs should be the highest public health priority in India.”
    The World Health Organization (WHO) says that of every 100 hospitalized patients at any given time, seven in developed and 10 in developing countries will acquire at least one HAI.
    “At any given time, the prevalence of HAI varies between 5.7% and 19.1% in low and middle-income countries. Frequency of overall infections is as high as 42.7 episodes per 1,000 patient days — almost three times higher than in high-income countries,” it said.
    While urinary tract infection is the most frequent HAI in high-income countries, surgical site infection is the leading infection in India, affecting up to one-third of operated patients — nine times higher than in developed countries.
    Device-associated infection densities in India are up to 13 times higher than in the US. According to a recent European study, the longer a patient stays in an ICU, the more s/he is risk of acquiring an infection. On average, the cumulative incidence of infection in adult high-risk patients is 17 episodes per 1,000 patient days.
    CDDEP research on HAI in India has revealed several concerning trends.
    In Indian ICUs, the rate of vancomycin-resistant enterococcus (VRE), a dangerous hospital infection, is five times than the rest of the world. Rates of methicillin-resistant Staphylococcus aureus are also high, with one study finding over 80% of samples positive for resistance to the antibiotic methicillin.
    A study of 71 burn patients at PGI, Chandigarh, found that up to 83% had HAIs. Another six-month study conducted in the ICUs at AIIMS found that 11% patients had over 150 different HAIs. A separate study of 493 patients in a tertiary teaching hospital in Goa also found that 21% patients admitted in ICUs developed 169 different HAIs.
    The INDICAPS study also found that it wasn’t those who had undergone surgeries weren’t the prime sufferers, which is a common myth. Around 27.6% of the patients who died of sepsis were not operated upon and were in hospital for non-surgical treatment.
    The percentage of deaths in surgical cases was around 14.4%. Common sites of infection in patients that resulted in sepsis included bedsores, intravenous lines, surgical wounds and surgical drains.
    Dr M C Misra, chief of AIIMS Trauma Centre, said prolonged and inappropriate use of invasive devices and antibiotics and long stay in ICU makes every patient admitted in it prone to HAI.