Prof. B. M. Hegde,
“The greatest truths are the simplest, and so are the greatest men.”
J.C and A.W. Hare.
“Every
year 5,000 patients in hospitals in Britain die from an infection acquired
after they were admitted. Up to 100,000 more - almost one in 10 in-patients -
endure extended illness, pain and suffering caused by bugs they contract in the
place where they came for a cure. The number of deaths exceeds that from road
accidents, and that from drugs and HIV/AIDS combined. Our rate of infection is
among the highest in the world, above that of Australia, Denmark, Norway, the
Netherlands and Spain. It costs the NHS more than £1bn a year. Today, the
Government will launch its latest crackdown on poor hygiene to cut the rate of
hospital infections, of which the worst is MRSA (methicillin-resistant Staphylococcus
aureus)” says a government report. Over the last ten years the dearth rates
due to resistant hospital infections have more than doubled. The Tory health
spokesman, Andrew Lansley, said: "It is a national scandal. Over the last
seven years, deaths from MRSA have doubled.”
One
in three people naturally has staphylococcus infections on their skin, which is
not a problem in the healthy. Recently there has been a sharp growth in
staphylococcus infections resistant to methicillin and other antibiotics.
Today, 40 per cent of Staphylococcus aureus bloodstream infections are
caused by MRSA. When these organisms get into the blood of people who are
seriously ill and elderly through a wound or a needle inserted in a vein they
become seriously ill because they are immune compromised. They are hard to treat
because the organism is resistant to antibiotics. Yet the infections could be
sharply reduced by ordinary measures such as washing hands.
The highest rates
were seen in some of UK’s most prestigious hospitals. Guy's and St Thomas' NHS
Trust in London had the highest MRSA rate at 0.45 cases per 1,000 bed days,
followed by Addenbrooke's in Cambridge, with a rate of 0.38. "The war
against hospital- acquired infection must be pursued on many different fronts,
including a more robust approach to antibiotic prescribing and hospital
hygiene, instituting a system of mandatory surveillance and persuading all NHS
staff to take responsibility for effective infection control," said Sir
John Bourn.
It
is estimated that 15 per cent of cases were preventable by better hospital
practices, nearly 750 deaths in the UK a year which could be prevented by
adopting simple hygienic measures. “MRSA is caused by overuse of antibiotics,
especially by the agriculture industry, where they are added routinely to
animal feed as growth promoters. Bacteria resistant to the drugs grow and
multiply, by a natural process of evolution, and the more widely the drugs are
used the greater the opportunities for resistance to develop” says a report
from the UK
Dr. Richard Besser, of the Centre for Disease Control of the US, in 1995, said
the number of unnecessary antibiotics prescribed annually in that country for
viral infections was 20 million. Dr. Besser now refers to tens of millions of
unnecessary antibiotics. There were a total of 88,000 deaths in US hospitals in
one year costing a total of $5 billion dollars in treatment without any
success. You might wonder as to why I
have only given western statistics. Indian figures are anything but reliable. Even
in the west the figures given above might be far below the actual figures and
many of the nosocomial deaths do not get reported correctly in the death
certificate.
Doctors
must be made to realize that the majority, nearly over 90%, of the upper
respiratory viral diseases need no antibiotics, or worse still they will get
worse with antibiotics, but these are the usual situations millions of doses of
antibiotics are prescribed. The minor illness syndromes, like the viral
infections in the upper respiratory tract, are the ones that cause the largest
sick absenteeism in the world, especially during the winter. This brings
patients to their doctors who take shelter under the cover of prescribing
antibiotics to those patients thinking that their infections, mostly viral,
will get better with the intervention.
The
poultry industry uses large quantities of antibiotics along with hormones to
keep their flock healthy while the growth hormones shorten the egg-table time
of the birds; the antibiotics are given as a preventive measure to check
enhanced infection due to the abnormal growth of the chicks under the influence
of the growth hormone. Mastitis, a common occurrence in milch cows in any diary
farm also results in large doses of powerful antibiotics being injected into
the udder. The milk from such cows should be discarded at least for week to
avoid the drug getting into humans. But the profit making industry would not do
that for commercial reasons. All these expose every one of us to small doses of
antibiotics making us resistant to their use when the need arises. It also
encourages the growth of resistant germs in the environment.
The
so-called “super-bugs”, the resistant germs, are seen in many hospital
operating rooms as well. In the recent past several operating rooms even in
British hospitals had to be closed as they could not be cleaned of those super
bugs! Deadly germs have been cultured even from doctors’ neck ties and
stethoscopes making it mandatory in the UK for male obstetricians to use only
bow ties. Simple hand washing repeatedly, even in between patients, could help
a great deal but “big” bosses in India couldn’t care less. Poor nurses in
Indian hospitals can not force the medical staff to conform to the hygienic
guidelines.
The
worst place for any patient to be, in a hospital, is the intensive therapy unit
where the seriously sick elderly are invariably admitted. (For what good
scientific reasons, I don’t know) Many of them meet their maker prematurely,
reminding us of the dark days in the
early hospitals in the first half of the eighteenth Century when any one going
to the hospital was going there en route to heaven- hospitalism. The one hundred per cent hospital mortality was
brought down to just over forty per cent by Florence Nightingale only through
her meticulous cleaning rituals and bed spacing with good ventilation in the
wards. Elderly patients that get admitted to hospitals are immune compromised
in the first place and the super bugs do not need much help to kill them. Most
of them die in the hospital of nosocomial infections rather than the original
disease for which they got admitted in the first place.
In
the USA, a recent report puts doctors’ interventions and adverse drug reactions
as the first cause of death only to be followed by cancer and heart attacks. A
large chunk of this statistic comes from the deaths due to nosocomial
infections. I wonder what rank we in India get if some one audits hospital
deaths accurately. We can’t do better than the US anyway as they are the first
rank holders there we will have to follow suit, as many doctors and most lay
people in India believe that American medicine is the best to follow. Another
fourteen developed country survey did show that America had the last but one
place leaving the last place to Germany in overall medical care, despite the
fact that America ranked first among those countries in healthy life style of
the populace!
Let
us learn from the American’s mistakes and take remedial steps before things get
out of hand. Compared to the American population of 250 million where annually
nearly 7,98,000 people die due to doctors’ interventions and adverse drug
reactions, we in India could have that number in millions! Doctors are trained
to keep the health of the public but in the present scenario we have become
their main enemies. Let us also not forget that when doctors went on strike in
Israel death and disability rates fell down significantly only to go back to
the original levels when doctors came back to work. This was the experience in
Los Angles County some years ago and in Saskatchewan in Canada a few decades
ago! We have hard work to do in this area and miles to go, miles to go before
we sleep!
“Find a need and fill
it.” ………Ruth Stafford Peale.