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70% of the beds in India provided by small hospitals run by doctors as “one-man” operation

Rajesh Barnwal

New Delhi: Rajnish Rohatgi, director, medical surgical systems, BD India, in an exclusive interview with AalaTimes, spoke about the NABH Safe-I hospital infection control programme.

Rajnish Rohatgi

The NABH Safe-I programme acts as the first stepping-stone towards the NABH accreditation for those hospitals that lack the resources and managerial bandwidth to achieve the full NABH accreditation.

Under the Safe-I programme, NABH (National Accreditation Board for Hospitals and Healthcare Providers) recommends safe injection and infusion practices, biomedical waste management, healthcare workers safety, and sterilization and disinfection.

BD India, a part of the US-based global medical technology company BD (Becton, Dickinson and Company), is a technical partner for the NABH Safe-I programme. The company helps applicant hospitals prepare for the Safe-I certification.

The Safe-I programme, started on a pilot basis in March 2012, is currently being run in 21 hospitals across Punjab and Kerala. Tagore Hospital and Heart Care Centre, Jalandharrecently became the first hospital in India to get the NABH Safe-I certificate.

What’s the story behind the origin of the NABH Safe-I programme? How has it evolved over the last one year?

NABH Safe-I is a culmination of a journey that was triggered by an important insight that about 70 per cent of the beds in India are provided by small hospitals run by doctors as a “one-man” operation, lacking managerial bandwidth and the technical expertise on infection control to implement the multi-functional and multi-departmental changes needed for improving patient safety. A survey of 41 hospitals across four cities also confirmed that most were keen on improving quality, but found the existing accreditation to be too complex and demanding and virtually impossible to achieve in one attempt.

While the large corporate hospitals could go for NABH Accreditation, but overall quality of care in India would not improve unless these small hospitals, accounting for over 70 per cent of the beds in the country, could also be initiated to start on the journey to improve quality.

After conducting pilots in Kerala in 2009 in partnership with the National Rural Health Mission (NRHM), Kerala and the Indian Academy of Paediatrics (IAP), 20 out of 33 applicants improved their practices and infection rates to qualify for a certification issued by the NRHM, Kerala. This response encouraged us to take the programme at the national level, for which we approached the NABH with a proposal for “Level 1″ Certification that would be a stepping stone for smaller hospitals, focused only on infection control – possibly, the most important of the 10 chapters required for full accreditation.

NABH also agreed to adapt two aspects of its approach: (a) to set standards that were a combination of processes and outcomes, making it mandatory for hospitals to submit data on infections, and (b) to provide for mentoring and hand-holding of the applicant hospitals in building capability and expertise to run an effective infection control programme.

As a global medical technology company, what role BD plays in the NABH Safe-I programme?

Through this collaboration with NABH, BD is happy to provide its expertise towards enhancing patient safety and healthcare worker safety. BD will work with NABH to enhance infection control standards in the hospitals of India.

As the Knowledge Partner, BD has been asked by NABH to provide on-site handholding of applicants, covering help in creating hospital capability — Hospital Infection Control Committee (HICC) and Infection Control nurses — to drive compliance of agreed protocols and processes by training of all nurses and staff, installing and collecting surveillance data on the six Healthcare Associated Infections (HAIs) — needle-stick injuries (NSI), catheter-related bloodstream infection (CRBSI), phlebitis, ventilator-associated pneumonia (VAP), surgical site infections and urinary tract infections — analysis and report back to the HICC, along with conducting base-line and end-line assessments.

BD’s global experience ensures that BD is able to design training programmes and protocols that are in line with global standards and trends.

This infection control programme will comply with a mandatory submission of infection data to the NABH secretariat, which can potentially lead to the setting of a national repository of data. Our launch in Kerala and Punjab is trying to create the right eco-system to encourage hospitals to apply for this voluntary accreditation and eventually impact the patient outcomes, leading to enhanced reputation and profitability for the private hospitals.

How infection control is important for hospitals of all sizes, particularly for enhancing patients’ safety and healthcare workers’ safety?

The essence of a patient coming into a hospital is to get treated and go back home safe, without getting an infection. The infection that a patient inadvertently gets in a hospital is called a HAI (Healthcare Associated Infection). HAI is becoming a problem today. Patients are becoming more susceptible to infections because of more serious underlying illnesses. Poor compliance with hand hygiene by healthcare staff, lack of access to safe water, unclean instruments and environmental surfaces contribute to this growing problem. The environment of patient care is also important. Factors such as understaffing, high levels of bed occupancy and increased transfer of patients also create new risks of infection.

WHO (World Health Organization) reports that at any time over 1.4 million (14 lakh) people worldwide are suffering from infections acquired in hospitals. Between five per cent and 10 per cent of patients admitted to modern hospitals in the developed world acquire one or more HAIs. In the United States, one out of every 136 hospital patients becomes seriously ill as a result of acquiring an infection in hospital; this is equivalent to 2 million cases and about 80,000 deaths a year. In England, more than 100,000 cases of healthcare-associated infection lead to over 5,000 deaths directly attributed to infection each year. In Mexico, an estimated 450,000 cases of healthcare-associated infection cause 32 deaths per 100,000 inhabitants each year. Healthcare-associated infections in England are estimated to cost £1 billion a year. In the United States, the estimate is between $4.5 billion and $5.7 billion per year. In Mexico, the annual cost approaches $1.5 billion.

How has been your experience while working with small and medium size hospitals in India to help them prepare for the NABH Safe-I certification?

We have had an interesting journey till date. Most hospitals that we have come across want to improve their quality of care, and are currently unsatisfied with their current quality. They all want to take steps to make a difference, but do not know what exactly to do differently from tomorrow, to be able to make that difference. When these hospitals come across the Safe-I programme, they can realize the steps they need to take to make a difference.

Of the scheduled three phases, the Safe-I programme has already completed the first phase of organising infection control workshops across hospitals in India? What’s the roadmap ahead for the next two phases?

The three phases are sequential. Once the hospital comes into the programme, the next phase of handholding happens. Here a Safe-I consultant helps the hospital in understanding the basics of the infection control programme, developing the surveillance tools, developing a set of trainers who would train the staff of the hospital on the standards, setting up of a hospital infection control committee etc.

The consultant prepares the hospital to achieve the NABH Safe-I certification in terms of infection control practices. However, once the consultant completes this work, it is the responsibility of the hospital to prepare itself for the third phase, which is that of assessment. Here an independent Safe-I assessor visits the hospital and assesses the practice of the healthcare workers, protocols being followed by the healthcare workers, surveillance mechanisms being put in place, availability of standards as laid down by Safe-I etc. The assessor submits the findings to the Safe-I secretariat. The reports are assessed by the Secretariat, and a board constituted by the NABH decides whether the hospital should be provided the certification.

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