It’s An Obligation

Naresh Trehan, chairman and managing director, Medanta, a super-specialty hospital, is a renowned cardiovascular and cardiothoracic surgeon. He has got Padma Shri and Padma Bhushan awards. In an interview with Naina Gautam, he discusses the importance of hand hygiene in healthcare facilities

What is Medanta’s approach to hand hygiene?

Medanta is undergoing an inspection by the Joint Commission International (JCI).  JCI has certified us for the last nine years, and they evaluate us as a protocol every three years. At Medanta, we instill a culture of handwashing throughout the organisation. To properly wash our hands, we suggest and practice six motions. We advise doctors to wash hands at least three to four times per day, with soap and water, and use hand rub before and after consulting and examining patients, or doing anything that necessitates caution and sanitisation.

To ensure hand hygiene is followed properly, we have placed a dispenser of hand rub outside every room so that before doctors go on their rounds, they immediately use hand rub or wash hands for 20 seconds, following the six motions. Before entering a patient’s room, they must use sanitiser, and then sanitise again before examining the patient in person because the environment may be contaminated. A precise methodology is adopted by people.

There are reports of an increase in healthcare associated infections among patients due to lack of compliance with infection control guidelines like hand hygiene. Why?

We understand the importance of the situation and have zero tolerance for laxity. Every staff member is required to follow handwashing protocol. By prioritising and implementing handwashing and hygiene, we can reduce infection rates across the globe. Medanta has proven this year after year in comparison to other institutions. Furthermore, efforts to maintain hand hygiene can have a large payoff and need to be invested in any hospital. Efforts have to be made to ensure clean air, clean water and a clean disposal system, but hand hygiene is extremely important because you can unknowingly spread infections because you did not wash or sanitise hands between two patients.

What are the solutions to improve hand hygiene in healthcare facilities?

The value system in the healthcare sector should be disciplined. When a patient arrives at the hospital suffering from any disease, he or she hopes to be given the best possible treatment at a reasonable cost, and to be assured that s/he will be protected. And when a hospital fails to follow the requisite procedures with patient’s health as a priority, the patient becomes infected with a variety of other infections. Administrations and senior leadership have to practise hygiene, and ensure everyone follows the rules.

We as a country have come out of Covid-19, and we did follow hand hygiene, and we know it really helped. Additionally, it does not cost a lot to follow the same on a regular basis. It has to be better ingrained in people’s minds and mindset, followed as a habit, and strict action should be taken in institutions if someone violates the same.

How can behaviour change instilled during Covid be sustained?

People in hospitals have to be properly trained; they should understand how the sequence works. A training programme should be implemented in hospitals to educate new employees about the strict protocol for hand hygiene and patient safety. The leadership should follow the practice, and insist on and create proper protocols to ensure that everyone in the hospital practises hand hygiene.

If someone does not follow hospital policies, it may infect a patient and endanger the patient’s life, and should be considered a disservice, which is completely contrary to the Hippocratic Oath that doctors or entire healthcare fraternity follow. In my opinion, it is not just doctors or healthcare practitioners who are responsible for ensuring a patient’s healthy stay at the hospital, but the staff and caregivers who must follow the hospital’s strict handwashing and sanitisation guidelines.

The results of maintaining proper hand hygiene can be measured by checking the end result, that is, by compiling the data on infections, infection control, and number of reinfections on a regular basis. This will highlight if hand hygiene protocols are strictly followed, as any loophole can endanger patients’ safety at the hospital. So, it demonstrates that if strict policies are followed, the end result is always in the best interests of the patients.

How does lack of national data on basic water sanitation, hygiene service and hospitals, as reported recently by a  monitoring programme of WHO, affect hand hygiene practices?

I am sure many hospitals don’t have that information, but environmental agencies keep a close eye on issues. Environmental authorities do monitor the quality of the water as well as your STP (Sewage treatment plants). We, as an institution, are required to submit data to environment agencies on the quality of water after we have treated it. There are strict guidelines that institutions like ours must follow. However, the question arises as to whether the same is followed in small towns as well, which may be partially true. However, it is the responsibility of every hospital to follow these guidelines in order to provide safe drinking water for sterility and handwashing.

How does India compare with others in hand hygiene in healthcare facilities?

Wherever a programme like hand sanitisation is implemented, it has to be viewed as a priority by the hospital, as failure to invest can jeopardise the hospital’s reputation. I believe this is an area in which you need to invest, and learn from global players because the quality of patient care is directly related to it.

How can handwashing be promoted?

Handwashing is a simple exercise that requires only a change in mindset. And once a person realises how beneficial it is, she may wash hands voluntarily. People should be made aware of the positive impact it can have on everyone’s lives, resulting in fewer infections and, eventually, a lower healthcare burden.

Handwashing should not be accompanied by a fear of pandemic or endemic; it is the right duty that we need to follow. As a hospital, it is our obligation to patients. People have to practise this through the year, and not make any compromises because it has immense consequences for patients who trust us.