President's Address, IX HISICON 2007
National Conference of Hospital Infection Society - India

The first adage of patient care is "to do no harm". However, health care associated infections (HCAI) constitute and continue to be a major complication of hospitalisation. Infections associated with health care increase the suffering, prolong hospital stay and result in high costs to patients, their families and the health care system. Added to this cost is the erosion of trust and confidence in health care institutions among the public and health care providers. Recent reports indicate that at any time about 1.4 million people worldwide suffer from HCAI. According to estimates the risk of HCAI is 2-20 times higher in developing countries where the overall incidence of HCAI is about 10% of hospitalised patients.
World wide, the challenges faced today in providing safe health care are:

• Increasing antibiotic resistance,
  
• Emerging infections,
  
• Immunosuppressive therapies and modalities leading to Immuno-compromised patients with increased vulnerability to infection,
  
• Increased survival and extremes of age.
  
• Insufficient compliance and motivation of health care staff

Global Patient Safety Challenge

To tackle this problem, the World Alliance for Patient Safety was formed in 2004 and the global patient safety challenge was launched with the theme "Clean Care is Safe Care". The theme includes the challenge of safe clinical practices, hand-hygiene, blood safety, safe injections and safe health care waste management
In collaboration with this effort of WHO, India took the following pledge along with other countries:

• Acknowledge the importance of HCAI,
  
• Share with the WHO World Alliance for Patient Safety available information on this problem including surveillance data if appropriate,
  
• Consider the adoption of WHO strategies and guidelines to tackle HCAI,
  
• Develop campaigns at national or sub-national levels for improving hand hygiene among health care providers
  

Hand Hygiene Guidelines

As a first step in the Global Patient safety Challenge, advanced guidelines (draft) on hand hygiene were developed. These are available for comments on the Internet. Accepting that clean hands are the single most important factor in the control of HCAI, these guidelines provide evidence-based recommendations for hand-hygiene in the following areas

• Government and institutional responsibilities
  
• Educational and motivational factors
  
• Indications - when
  
• Technique - how
  
• Selection of products/agents
  
• Surgical hand hygiene
  
• Skin care of staff
  
• Glove usage
  

The Situation in India

A country with great diversity, India has on one hand state of the art corporate hospitals and on the other hand there are basic health centres, which are still strapped for resources. As we grow from a developing to a transitional economy several old challenges such as of lack of education and awareness, non-uniform availability of resources remain while we also face the challenges that confront the developed world. A major stumbling block is that standards of care are still not established and uniformly implemented. Continued organized surveillance does not exist. Information about the magnitude is anecdotal. Except for the Biomedical Waste Management and handling rules, no other legislation exists pertaining to quality and standards in health care.

Accreditation Standards for Infection Control

Recently, the National Accreditation Board for hospitals (NABH) has been established under the Quality Council of India. The NABH standards guide the provision of an effective infection control programme in a hospital aiming at reducing the risk of HCAI in patients and staff and also ensure the safety of the environment.

Some of the major issues that need to be addressed to prevent and control HCAI in India are:

• Spreading awareness about infection control in health care facilities in remote areas
  
• Establishing surveillance and a data base for HCAI
  
• Reestablishing basic methods of infection control with strong rationale
  
• Encouraging research to develop evidence based practice, discover new methods and confirm the old.
  
• Standardization of hospital practices at national level
  
• Assessing the cost of health care
  
• Planning and design of health care facilities with consideration for patient safety including infection control
  
• Strengthening the role of laboratory in HCAI diagnosis, control and surveillance
  
• Monitoring trends in antibiotic resistance, advocating for rational antibiotic use and developing and implementing antibiotic policy. Stopping over the counter sale of antibiotics.
  
• Education and training of health care workers
  

Targeted efforts are being made in the country in the above areas, by the Government as well the non Governmental sector.

• Infection control has been incorporated in medical and paramedical curriculum. In medical journals, increasing number of articles are being published on infection control in the country.
  
• In the field of Health Care waste management, rules have been notified, national guidelines developed, and pilot projects have been implemented with help from the WHO across the country
  
• Infection control programmes are being established in increasing number of hospitals
  
• It is being accepted now that the quality of a hospital's infection control programme is a reflection of the standard of care provided by the institution.
  
• Hospitals are applying for accreditation with JCI and NABH
  

Hospital Infection Society India is an association of medical professionals with a special interest in the prevention and control of hospital infection. It is registered with Registrar of Societies at Delhi.
The society presently has 475 members from across the country. It is a multidisciplinary society and includes microbiologists, clinicians, administrators, nursing professionals, and CSSD managers as its members.
Established over a decade ago with the vision that every Indian hospital has a functioning infection control programme.
HISI is a member of the International Federation of Infection Control, a federation of 56 infection control organizations in the world with similar vision for its member societies

Mission statement

The Society (HISI) provides the essential tools, education materials & communication that unite HISI members and foster development of Hospital Infection Control programmes founded on evidence based medicine.

Components of an effective Infection Control Programme:

• A policy making infection control committee comprising of a representative of every major department and an infection control team responsible for day to day activities for infection control.
  
• Organized surveillance to establish rates and types of infection. Surveillance to include monitoring of antibiotic resistance,
  
• System of reporting rates, antibiotic resistance patterns to the clinicians
  
• Documented practice and procedures for infection control in clinical care, based on scientific evidence.
  
• Detection and investigation of outbreaks
  
• Implementation of control measures
  
• Employee health and prevention of occupational transmission of infection.
  
• Education and training of health care staff in infection control
  

• Advance medical knowledge and disseminate information on the subject of HCAI and their prevention.
  
• Provide a common platform for people active in the field of HCAI, viz. Microbiologists, Administrators, Clinicians, etc.
  
• Provide individuals and institutions with information and assistance to form hospital Infection control programmes and similar activities.
  
• Gather and disseminate information about HCAI and their prevention in both technical and practical aspects.
  
• Hold training courses and educational symposia, seminars on all aspects of HCAI.
  
• Form liaison with similar associations at national and international levels.
  Do all such things as are incidental or conductive to the attainment of the above objectives, or any one of them.

Activities of HISI:

Through Six active state chapters: Delhi, Mumbai, Kolkata, Gujarat, Hyderabad and Chennai, HISI carries out the following activities

• Conducts CME and training in all areas of HCAI prevention
  
• Consensus groups to develop guidelines e.g.: CSSD, Operation Theatre Disinfection, Isolation precautions, ventilation standards, Biomedical waste Management, Antibiotic policy, surveillance of HCAI, Definitions etc
  
• Act as a resource to individuals and hospitals to establish infection control programmes
  
• Brings out Newsletter, Bulletins to provide information on various areas in infection control
  
• Holds a National Convention every two years, an educational conference with national as well as international participation
  
• Collaborates with WHO, Government of India (NACO, MOHFW, MOEF, CPCB, BIS) whenever required to provide the technical resource in various areas of HCAI prevention
  

As fellow members of Hospital Infection Society of India I appeal to you to pledge your commitment, efforts and advocacy to improve the standards of infection control in the country and to collectively realize the vision that every health care institution in the country has an effective Infection Control Programme founded on evidence based medicine

- Geeta Mehta
16 February 2007
Chandigarh