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Healthcare industry needs to be more transparent in sharing data related to hospital-acquired infection rate

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The COVID-19 pandemic has left hospitals grappling with the issue of hospital-acquired infections (HAI). While most hospitals are trying their best to maintain infection control standards, virus propagation through critical departments is becoming a major risk factor. Amidst this situation, facility management service providers have levelled up with improved cleaning patterns going beyond the traditional practice of visible cleaning, with technologically advanced tools that ensure sanitation and quality infection control practices. Sambit Sahu, Country Director, Healthcare, Sodexo, India, speaks about the technologies they have deployed to help hospitals, in conversation with Raelene Kambli  

You have been working with hospitals for a long time now, what kind of demand for products have you got so far given the COVID 19 pandemic in the backdrop?

The world first learnt about COVID-19 when it emanated in Wuhan, China. Being a newly discovered virus, there was very limited understanding of its origin, how it spread and the mitigation measures. However, being in the healthcare business and front-ending the COVID battle with our team of experts in the hospital environment in China, it gave us a better understanding about the virus, which we used to adapt our services to support our clients in managing COVID care centres and the overall hospital campus. We were able to share key learnings and best practices with Indian healthcare institutions and better our preparedness. We anticipated a shortage of Personal Protective Equipment (PPEs) and healthcare support staff, for which adequate provision was made across the 450+ facilities we maintain.

Further, we sensed the need for businesses and consumers to feel confident that their environment is safe. By working with clinical experts, we are working to leverage the latest research, data and insights to set a strong and medically guided foundation for our protocols.

Sodexo launched its Medical Advisory Council to support the development of new protocols and standards, including COVID-19 related services delivered worldwide. Our goal is to minimise risk and enhance safety for all of our stakeholders.

Hospitals these days are scared that their critical departments such as OTs, Cath lab, etc., do not become the reason for virus propagation. What is your opinion on the same?

The challenge is indeed real. There are numerous cases of patients at triage being diagnosed as COVID positive, either during or after their treatment for other ailments. It is not that the hospitals aren’t equipped to handle patients with contagious diseases requiring isolation. The bigger concern is lack of information on handling the virus along with the quick overhaul or infrastructural changes required in the hospital design and operations to handle such large numbers. But a few healthcare institutions have quickly turned around. They have re-designed working areas like pre-screening chambers (which minimises direct contact with patients); have ensured segregation of the facility, medical equipment and set up a robust team to handle COVID patients. Cleaning services and frequency have also intensified.

Coming to the topic of cleaning, there is a need for a paradigm shift in the way we look at Environmental Infection Control in hospitals. The industry needs to be more forthcoming and ensure transparency in sharing data related to HAI rate. In fact, in developed nations, reporting of HAI rate is mandated by the local authorities. The same should be applicable to India. It will incentivise hospitals with better management of HAIs, thus improving the overall situation. The basis of Environmental Infection Control is people, and we will need to continue to invest in certifying the cleaning/ housekeeping team, train them, offer competitive remuneration, recognition and motivation to maintain the standards. Studies have shown that by following standardised processes and best practices with an understanding of risk frameworks around environmental infection control, the propagation of the virus is critical departments can be greatly reduced. Like pest control, Environmental Infection Control also needs a holistic approach and hospitals will have to engage partners with Integrated Facility Management capabilities to provide services ranging from dining options to laundry, technical service and biomedical maintenance services.

What precautionary measures and initiatives are taken for high-risk areas in hospitals (Emergency wards, ICU, OTs)?

Here are a few things we can relate to the challenges we have seen with hospitals:

Increase in demand for ICU-beds: There has been a sharp increase in the demand for ICU-beds in major metros, given these are the places where the maximum impact of the pandemic is witnessed. Anticipating the increased demand and matching it to the hospital’s capacity to cater to is important. The requirement is to have the equipment (Ventilators Bi-PAP, etc.) right PPEs, consumables stocks and pharmaceuticals to cater to the growing COVID cases. Further, infrastructural checks like change in air cycles are equally important given that only 15-20 per cent of the ICUs have negative pressure.

Healthcare workers and their morale: We are seeing a shortage of healthcare workers to manage the critical areas like ICU, emergency wards etc. The reasons are many but the major being the nosocomial transmission of the infection within the healthcare workers, physical exhaustion and mental health issues. It is critical to ensure that the organisation works on all these three areas for the sustainability of operations. Needless to mention, continuous training during these times cannot be ignored.

Collaboration at a local and regional level: As we are dealing with a unique challenge, never seen before, it is important for the healthcare professionals, industry bodies and other-related industry operators to work together and ensure collaboration across the board. The learnings and best practices need to be shared and used as soon as possible, to better our readiness to deal with the pandemic.

Hygiene has suddenly taken centre stage, be it at home or hospitals or workplaces and that will be the norm in the coming times. So, is there any kind of special demand from hospitals or healthcare institutes for some kind of hygiene products or solutions?

COVID-19 is an enveloped virus and gets killed by regular disinfectants used in hospitals. The challenge is – it is highly contagious and hence the need for adaptation of frequency and process of disinfection in hospitals is extremely critical. We will see changes in the use of more disposable consumables from reusable ones, especially in all critical areas. For instance, there will be a gradual shift from the usage of cotton mops to microfiber reusable to microfiber single-use wipes and mops, to ensure effectiveness in cleaning. Choice and use of chemicals will not be based on brand names but by means of their effectiveness in eliminating pathogens in the cleaning process. (99.9 per cent killing of germs is not ok as that 0.1 per cent might be the pathogen causing HAI). In-home, office and school environment, the significance of personal hygiene, frequent hand washing have become important.

How important is infection control as a service in all COVID care centres?

The role of customised infection control services, better known as quarantine services, in healthcare institutions cannot be emphasised enough. It is well established that patients are privy to hospital-acquired infections – also known as HAIs, with studies showing incidence rates in India varying from 11 up to 83 per cent for a different kind of HAIs.  This can be extremely dangerous in the COVID-19 scenario given its highly contagious nature and the fact that frontline healthcare workers are a cohort group with a higher risk of infection. Current evidence from the Indian Council of Medical Research (ICMR) is that COVID-19 is transmitted via droplets when people sneeze or cough. Therefore, there is a strong need for comprehensive environmental services in these care centres to ensure seamless infection control.

In these times of crisis, technology has been a blessing in disguise. So what according to you are the technological changes that we will witness in the coming months and years?

Given the scale of a global challenge, technology is and will continue to play a vital role in the containment of COVID-19. All countries, including India with the help of leading tech companies are working on building solutions/apps to identify hot spots or ensure contact tracing and prevent the spread of the virus. We have witnessed success in a slowdown of COVID-19 in Korea, Taiwan, Hong Kong, Singapore and China, as a consequence of this concentrated effort.

Additionally, the following technological advancements are supporting business continuity through the COVID times:

Digitisation of services: In equipment maintenance and in food services, like cashless transactions 

UV disinfection with pulsed-xenon to combat HAI. While it has been adopted by the western countries for some time now, India will certainly see an increase in implementation of ultraviolet environmental disinfection in its acute care setting.

Use of technology for training healthcare workers, for example, Sure Wash for hand hygiene, robotics to facilitate services such as portering, to minimise human contact in high-risk areas. 

Telemedicine: The government in various geographies is promoting telemedicine consultations. This will help to ensure that primary care is made accessible to the larger population, and non-critical patients.

How can service providers like Sodexo provide support? 

Sodexo already provides facility management solutions to hundreds of government and private hospitals, medical colleges, PHCs, CHCs, pharmaceutical facilities, E-education facilities, mining and offshore facilities and corporate workplaces across India. In the healthcare sector alone, we deliver services to 450+ sites, maintain 52,000+ medical equipment, serve 65,000+ meals, manage 35,000+ linen, and manage 10 million+ square feet of the facility every day. We also provide food services at most of these healthcare facilities for patients, students, doctors, nurses, staff and visitors.

In recent times, we have been at the frontline, serving COVID-19 positive patients across the globe. We have been active in the UK, Spain, Canada, the US and Belgium. Thus, we already have first-hand knowledge to effectively plan, resource and rapidly mobilise COVID care centres, COVID dedicated health centres and dedicated COVID hospitals in India. 

Here are a few highlights of our quarantine services:

Environmental cleaning services: A dedicated on-site team will deliver cleaning services, 24×7, equipped with relevant tools like PPEs, chemicals, consumables, disposables and hospital-grade disinfectants. The team will be adequately attired in gloves, masks, eye goggles, face shields, gowns, etc, to guard against infection. Guidelines by NCDC and WHO will be strictly adhered to.

General Duty Attendant Services (GDA): Our GDAs will work with the nursing team to assist patients at the COVID 19 care centre and support intra facility transport requirements. They will emphasise on hygiene, safety, empathy and timeliness on priority.

Food services: We have a wealth of expertise in clinical nutrition and we will harness our experience to deliver pre-packed nutritious food in disposable and microwaveable containers, according to NCDC norms. Food will be delivered from Sodexo’s HSE approved kitchens, and the food waste will be disposed of, according to current best practice recommendations.

Laundry services: To prevent the spread of infection, we will provide laundry and linen services that are compliant, hygienic and quality-driven. We have an extensive health, safety and compliance regime with appropriate policies, procedures and training to ensure we comply with clinical laundry standards.

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