Inside the War Room: How Kokilaben Hospital is Fighting Infections with Data, Technology, and a Patient-Centric Approach
By Arunima Rajan
Dr. Sweta Shah, lead consultant for microbiology and infection prevention at Kokilaben Dhirubhai Ambani Hospital in Mumbai, sits down with Arunima Rajan to unpack the latest shifts in hospital infection control—what’s working, what’s not, and what’s next.
What role is technology playing in infection control at Kokilaben Hospital?
The Infection Prevention and Control Program and antimicrobial stewardship program were implemented since inception at Kokilaben Hospital as safety of the patient was one of the goals of the hospital. We believe in preventing every hospital associated infection is an opportunity in prevention of multi drug resistant bacteria and hence use of high end antimicrobials, thus adding safety to the patient but community at large. Technological advisory plays a crucial role in the infection control at Kokilaben Hospital. Such sophisticated tools as UV lights have been used for the disinfection of high-risk areas including Bone Marrow Transplant units for ensuring the sterilisation of surfaces, cutlery, and even books used by patients. Technologies used include UV lights in the air handling units, HEPA filters in operating rooms, and negative/positive pressure isolation rooms to provide filtered air and guard against airborne infections. AI-driven data analytics are being explored to enhance infection surveillance and prevention strategies.
Dr. Sweta Shah, Lead consultant, Microbiology and Infection Prevention, Kokilaben Dhirubhai Ambani Hospital, Mumbai
How has Kokilaben Hospital been enhancing its antimicrobial stewardship to prevent resistance?
In carrying out antimicrobial stewardship in combating MDR, Kokilaben Hospital sets a very ambitious goal to provide real-time, data-driven development of annual empiric antimicrobial guidelines for practice and monitoring prescription trends monthly. The ASP daily engages with clinicians for appropriate usage, giving regular feedback on this.
How have infection control practices evolved post-pandemic, particularly in the context of adapting to lessons learned during COVID-19?
Our antimicrobial resistance rates skyrocketed after covid pandemic. However, over last year, the resistance has decreased.
During the early phase of the COVID 19, it was hoped that hand hygiene and masking will improve incidence of health care associated infections. However, the disease itself and varied treatment modalities, resulted in high incidence of fungal infections. Not only did mucormycosis incidence skyrocketed, Candida auris, an important MultiDrug Resistant [MDR] fungus, became prevalent in most ICUs across the country. The unnecessary and inappropriate use of gloves in hospitals led to increased MultiDrug Resistant Organisms [MDRO] in hospitals. Unavailability or substandard disinfectants contributed to the same. Many unscientific practices were supported by social media which wasted more resources like spraying disinfectant on people.
India learnt that relying on western guidelines was incorrect. During the pandemic, relevant guidelines were generated by Indian Council of Medical Research [ICMR]. The dissemination of guidelines has improved since then. Most unscientific practices now are not practised. Dependency on import of personal protective equipment has reduced significantly. Training and communication methodologies have changed.
Laboratory capacities were improved in both the government and private sector. Hence there is improved diagnostic stewardship.
Community has become conscious about many infection prevention strategies like hand hygiene, use mask, cough etiquette etc. also, adult vaccination which was not a common scene in India, was initiated. There appears to be a golden line on a dark cloud as collaborative practices in infection prevention has improved significantly.
Have there been new advancements or trends in environmental cleaning and sterilisation methods at Kokilaben Hospital?
Kokilaben Hospital has advanced cleaning protocols by integrating automatic mechanical equipment alongside conventional methods. A dedicated team manages the cleaning and disinfection of electronic and biomedical equipment. To prevent cross-contamination, cleaning carts are segregated, and disposable dusters are used in operating theatres. Enhanced surface sterilisation with UV lights in high-risk areas has significantly reduced healthcare-associated infections (HAIs).
How do you ensure both patients and healthcare workers are well-informed about the latest infection control measures?
We have realised the importance of involvement of both patients and health care workers in infection prevention and control measures. We put up electronic posters in our foyer for all visitors which include hand hygiene, cough etiquette, vaccination, prevention of mosquito bite, prevention of tuberculosis, use of antimicrobials among others. We train our admitted patients about surgical bath or prevention of surgical site infections after discharge from the hospital. Similarly, if patients are going home with a urinary catheter, we train the caretaker about the management of the catheter.
Our dialysis patients and their caretakers are in touch with the dialysis unit staff on social media for queries of catheter care. When we celebrate Hand Hygiene day, the posters created by staff are displayed in the patient area so that patients and their relatives read them out of curiosity.
Our staff training is very rigorous. We use scheduled class room teaching, demonstrations, video circulation on phone, and informal training like quiz, drama, poster making during Infection prevention week or antimicrobial awareness week.
Our training is often risk assessment and data driven and hence are focussed. Most trainings are hybrid where it can be attended even when one is not on duty or can be seen a recorded version when free.
What trends have emerged in reducing surgical site infections?
The prevention protocols for surgical site infection (SSI) at Kokilaben Hospital have used high-end robotic instruments and an intense environment of filtered air, temperature, and sterile surfaces. Operating theatres have stainless steel walls with antifungal coats and joint-less vinyl floors; and all patients and families are prepared before and after the discharge process, including preparation of their skin. All these measures have seen narrow-spectrum prophylactic antibiotics result in SSI rates currently acclaimed at national and international levels.
Hand hygiene has always been a cornerstone of infection control. Are there new measures or trends that have improved compliance or effectiveness in hand hygiene among staff?
To optimise compliance, Kokilaben Hospital offers hand rubs at every bed and workstation and measures their use both quantitatively and qualitatively. Hands-on demonstrations, such as culturing hands to draw attention to bacterial presence, prove useful. Feedback loops that link hand hygiene practices to infection outcomes motivate staff, and ICU designs incorporating washbasins in every cubicle further support adherence.
How is data being used to improve infection control measures at Kokilaben Hospital?
Data collection and analysis are essential components of the infection control strategy of Kokilaben Hospital. Smart data is used to plan empiric antimicrobial therapies and assess trends in hospital-acquired infections. Real-time feedback on compliance with prevention bundles and infection rates are used for immediate corrective action. Monthly reporting to the leadership ensures continuous strategic adjustments. Diagnostic stewardship ensures the timely escalation and de-escalation of antibiotics, considering patient-specific data.
Has there been a renewed focus on air quality and ventilation systems to control infections?
Air quality still remains the basis of infection control at Kokilaben Hospital. The use of UV lights along with HEPA filters in air handling units ensures clean air circulation within the operating rooms and isolation units. System validation done periodically, along with maintaining appropriate rates for air exchange along with temperature and humidity, ensures optimal air quality. All these developments have certainly minimised the risks of airborne infections.
Are Indian hospitals, including Kokilaben, collaborating more on infection control initiatives?
Indian hospitals are always buzzing with various Infection prevention and control activities. NABH has helped standardise certain practices of infection control among hospitals. Various societies, Hospital Infection Society, India, CAHO, Society of Clinical Microbiology, Clinical Infectious Disease Society, Hospital Infection Society Mumbai Forum, Indian association of Medical Microbiology and others help in collaborating activities. Social media has improved connectivity.
Usually, Clinical Microbiologists, Infection Control Nurses and Infectious disease specialists play key roles in sharing practices on social media. The guidelines are also often circulated. This has helped generate multicentric Indian data which is very useful.
Sharing of Quality Improvement practices is a new and very helpful trend as it helps understand nuances of infection prevention in the Indian context.
There are corporates who have tied up with CAHO for CSSD or OT practice certification. These certifications help standardise practices.
With rising concerns around multidrug resistant organisms, what new strategies are being employed to tackle this issue effectively?
The institution will be adopting a multi-pronged approach to address multi-drug-resistant organisms. This approach involves judicious use of antimicrobials, which is further strengthened by ASPs and diagnostic stewardship. The hospital improves MDRO in the community through vaccinations preventing infections and biomedical waste management. Effluent treatment plants and targeted education campaigns ensure a holistic approach towards reducing the prevalence of MDRO.
Are there any trends towards making infection control more patient-centric, perhaps through better education or involvement of patients and families in infection prevention protocols?
There is a significant emphasis on patient-centred infection control at Kokilaben Hospital. Patients and their carers are specifically educated in ways such as antiseptic bathing for surgical site infection prevention, urinary catheter care or PICC line care. Initiatives like dialysis-patient interactive social media groups and visual campaigns in public spaces are a motivating factor that can create an inclusive approach. Health care professionals will only be successful in infection prevention if the staff work collaboratively with patients.
Infection prevention has many links in a chain and it is as strong as the weakest link. Thus, every person in the hospital and every step are crucial for infection prevention.