Think of a hospital. The smell of disinfectants fills the air, nurses in gloves rush from patient to patient, and doctors are seen and handwash stations in scrubs and masks.

In a place where hygiene is clearly at the forefront, why do we talk of Hospital Acquired Infections?

In 1847, a Hungarian obstetrician, Dr. Ignatz Semmelweis noticed higher rates of death amongst mothers being treated by doctors and nurses than those treated by midwives. At the same time, he found that a pathologist who’d cut himself while doing an autopsy on a woman with sepsis (in the same hospital), had died of sepsis himself. He concluded that both infected hands and an infected scalpel could transmit infection. He then introduced chlorinated lime handwashing, and found a massive reduction in death rates. While his theories were dismissed by the medical community at the time, we now know that what he discovered was real.

Hospital acquired infections (HAIs) are infections that patients get as a result of receiving treatment in a hospital or other health care facility. 1 in every 8 people being admitted into an Indian hospital will contract a Hospital Acquired Infection. 10% of these patients will die.

HAIs can be caused due to contaminated hands, equipment or implants, irrational use of antibiotics and improper care of immunocompromised patients

One fact stands out. Hand Hygiene alone, if implemented correctly, would prevent upto 60% of these infections. 

 The WHO breaks this down further. They define 5 specific moments when hand hygiene can be compromised, and lay out exactly how long a healthcare provider needs to use soap and water, or an alcohol based handrub.

Reading this, the technologist in me rejoiced. A few sensors, a bunch of cameras and some software and one should be able to prevent 60% of HAIs. A simple solution for long lasting impact.

On researching this, I found more than 70 peer reviewed studies for electronic hand hygiene monitoring.

Some companies used a sensor-based dispenser or tap, with or without cameras and an AI application running at the background. While these companies seemed to report great results, installing their solution meant massive fixed and operational costs. Every washing and handrub station would need to be replaced.

Others used a real time location system using either Bluetooth connectivity or a Wireless or ZigBee network. Here, the Healthcare Worker wore a band or a badge with an RFID sensor. Here again, investments were massive. To add to this, most healthcare workers felt uncomfortable being tracked. Frankly, I wouldn’t want my hospital’s quality team to be looking at how much time I spent in the bathroom!

Yet another one used a dispenser to spray a fluorescent dye onto the healthcare worker’s hands. Post washing, hands were scanned under a UV scanner, and hand washing was repeated if fluorescence remained. While effective, this was time consuming, and necessitated monitoring healthcare workers for UV exposure.

Other companies used UV-C disinfecting devices and robots, but no solution came without risks and large costs.

Looking at these solutions, I felt that if one used technology that healthcare workers already possessed, a cost-effective solution could perhaps be found. A fitness band or a mobile phone seemed to be the answer, coupled with some software.

And this is when I paused.

How many times have I seen a doctor pick up his phone to deal with an emergency immediately after touching a sick patient? How many times have I seen a nurse’s hand brush past her watch as she strips off her gloves? 

ICUs, where HAIs are rampant, are frantic places. Contamination happens every day.

Researchers who had the same idea used Next Generation Sequencing to identify bacteriophages and virulence factor genes from watches and phones belonging to healthcare workers.

A whopping 87% of smartwatches were contaminated versus 74% of mobile phones and 65% of hands.

It has become painfully clear to me that attempting to eradicate HAIs is akin to playing a game of whack-a-mole.  A definitive solution to HAIs remains evasive and the road ahead continues to become more winding. As people live longer, the number of vulnerable people being treated in hospitals increases. Aggressively pushing antibiotics continues to lead to the birth of super-bugs, which are resistant to newer and potent drugs. 

Understanding the gravity of the problem, in 2020, the Indian Government issued national guidelines for infection prevention and control in healthcare facilities. While the guidelines are a definite leap in the right direction, there is a need to set aside significant resources, including budgets for technology enabled handwash and handrub stations.

Its time to convert these guidelines into a national movement to combat this scourge.