Dr Joe D’Souza
In the ongoing war of humans versus microbial pathogens, virulence is gaining the upper hand. Deadly and unrelenting, microbial resistance to drugs and antibiotics is becoming more and more challenging to the medical fraternity. Hospitals are generally considered as sterile safe zones in the battle against germs, but in fact, they serve as optimal grounds for the invasive pathogens.
In an attempt to overpower microbes, man developed gnotobiology, which is the science of study of animals or other organisms raised in environments free
of germs.
Though infections are just one measure of a hospital’s safety record, they’re an important one. Every year millions of patients worldwide die of infections developed during a hospital stay. In the USA itself, 650,000 patients reportedly develop infections during Hospital stay and 75,000 die, according to the Centres for Disease Control and Prevention.
India being a tropical country and Goa being particularly having high ambient humidity and optimal temperatures for growth of pathogenic microbes, incidences of hospital-acquired infections as well as guest-acquired infections in luxury hotels are 10-fold or more.
Many of these illnesses and deaths can be traced back to the microbes acquiring resistance to antibiotics, chemo-therapeutic agents, drugs prescribed by medical practitioners, disinfectants, etc that are supposed to fight the infections as they often tend to weaken the immune system thereby making the patients more susceptible to infections. These infections which are acquired in the healthcare facilities are called nosocomial infections. Strangely, the resistance and immunity acquired by microorganisms to the various drugs used for medication are detoxified by these bacteria through mutation of their genes.
Interestingly, penicillin also known as a wonder drug in the past, is today degraded and detoxified by microbial enzyme penicillinase, thus rendering penicillin unavailable to the doctors in their treatment bouquet. It is not just drug resistance alone that pose challenges, but also microbial mutation to various forms of radiation used in human and utility treatment, that has become a matter of grave concern, particularly in the treatment of cancer, surgical wound infections, throat, respiratory infections, genitourinary infections, gastrointestinal infections, renal infections, burns, accidents, etc.
Is the modern man losing the battle against the dynamic and pathogenic micro-organisms?
Among the micro-organisms which are challenging man are Legionella Pnuemophila, Influenza, Campylobacter, Clostridium botulinum,Cryptosporidium parvum,Cyclospora cayetanensis, Escherichia Coli,Giardia lamblia, Hepatitis A,Listeria monocytogenes, Norovirus, Salmonella Shigella, Staphylococcus,Vibrio Parahaemolyticus,Yersinia Enterocolitica,Disease”, Creutzfeldt-Jakob,Clostridium difficile,Pseudomonas aeruginosa,,Leptospira Interrogans,Schistosome,Dracunulus medinensis,Acanthamoeba spp. and Naegleria fowleri,Actinomycetes, candida albicans etc.
The medical fraternity can inadvertently cause human mortality, specially so due to drug resistances acquired by the above micro-organisms and also owing to the fact that these infections could lead to secondary infections and susceptibility of immuno-comprised patients due to the exposure to a variety of opportunistic pathogens.
Patients admitted into hospitals for treatment of one disease are eventually dying of some other disease acquired in the course of hospitalization.
The popular adage in the medical fraternity reads “ If you want to terminate the patient, put him/her in the ICU”. Underlying message: Nosocomial infections are rampant in the ICU as the pathogenic microbes are ubiquitous in the complexities of the instrumentation of the ICU /CCU.
Prevention is better than cure is a well known adage. It is therefore imperative that we focus on prevention of the disease rather than resolution by medication. In Goa, there is garbage strewn everywhere with leachates entering the water bodies contaminating the ground water and various utilities.Our public water supply is in doldrums with many not receiving water for the past 10 days in Panjim including the writer of this article.
Our rivers are totally polluted, our water reservoirs and our water resource department is in shambles. How far will our tourism-based economy continue to support us in this scenario is a matter of grave concern.
How many of us are aware that today after 6 days of no water supply to urban institutions, hospitals and public places, we are reeling under severe environment degradation with pathogenic microorganisms stealing a march over our so called health services and sound sanitary practices.
A recent visit to GMC showed that hospital facilities have been sadly compromised owing to lack of water supply and consequent failure of cleaning and sanitation services leaving patients in a pathetic state of affairs. Washrooms are devoid of water supply since several days and are in a deplorable state. Even the attending medical resident doctors who are posted overnight are without clean bathrooms to use. Ironically, the largest public health institution in the state has failed to provide basic amenity of clean water and healthy ambience to its patients and staff members. Little wonder that today at GMC, patient enters for dengue treatment and dies of waterborne disease.
Ironically, the above mentioned infections are largely owing to a fall out of ‘undoing of the principle of gnotobiology and safe medical practices’.
The medical fraternity is today left with no option but use of antibiotics which include fluoroquinolones such as levofloxacin (Levaquin), and moxifloxacin (Avelox), the macrolides such as erythromycin, azithromyocin (Zithromax), and clarithromycin (Biaxin), and the tetracyclines including doxycycline (Vibramycin). etc. A new class of antibiotics (glycylcyclines) are also being used lately.It is pertinent to add here that ASHRAE (American Society of Heating Refrigeration and Air-conditioning Engineers) , a reputed technical society with growing membership of engineers in India and also in Goa has developed standards viz:188 and 514, to address the various challenges posed by environmental degradation and water contamination. These documents and expertise are available for reference and support.
In view of the degraded environment in Goa, it is now pertinent that we in Goa should use various recommended strategies to control contamination and assure safe public health utilities by chlorination, UV treatment, copper silver ionisation, etc so that nosocomial diseases do not leave a disastrous consequence on the health and tourism sector of our state.
