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Exploring Healthcare Hygiene in Oman with Pradeep Ratnagiri

 

Mr. Pradeep Ratnagiri, Chief Operating Officer, Shifa Hospital, Oman shares important insights about the country’s infection control practices in the healthcare sector.

 

Filed under
Infection Control
 
October 25, 2022
 
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Exploring Healthcare Hygiene in Oman with Pradeep Ratnagiri
 

In the past 2 years, a lot has been said about healthcare hygiene already. Today, even a common man understands its sensitivity. We understand and recognize the pivotal roles cleaning and hygiene teams are playing to ensure the safety of patients and healthcare workers. However, healthcare hygiene in Oman is seldom spoken about, despite the amazing work this country has witnessed. 

To discuss this further, we have with us Mr. Pradeep Ratnagiri, Chief Operating Officer, Shifa Hospital, Oman. Pradeep is a seasoned healthcare professional with over 17 years of experience in Hospital Operations. 

Tell us about the healthcare hygiene scenario in Oman.
When it comes to healthcare, it is all about infection control and well being of human beings. However, hospitals and infections almost always go hand in hand. I say this because anyone coming inside the hospital is at the risk of Hospital Acquired Infections or HAIs as we popularly know them. Every hospital in Oman as well as in the world, this is one major fightable thing. It can be prevented. HAIs are very common but every hospital is doing its best to fight it. We adopt the basic hand hygiene in the whole scenario so that the infection doesn’t pass on from the patient to the healthcare workers, and the visitors or attendants of other patients

The World Health Organization (WHO) has documented Oman’s hand hygiene experience as among the most successful examples worldwide. Tell us how Oman's healthcare system has led by example in terms of hand hygiene?

W.H.O was very kind enough to list Oman in the hand hygiene program as one of the top examples to follow. It is not an easy task to get there.
One of the major factors in Oman’s hand hygiene success is the initiative taken by the Ministry of Health. They ensured the scale of hand hygiene awareness is so massive that it reaches all the healthcare facilities, including primary health centers to tertiary care hospitals. The trainers were trained including the nurses and quality control departments of healthcare centers. All of them collectively were responsible for making this event successful. 

The suppliers of hand hygiene solutions also played a key role in sponsoring this campaign. However, we saw that training remained a major issue. The end user needs to be motivated and must practice whatever the hand hygiene measures the government recommends. I think the awareness campaign has indeed trickled down to the end user.  

Hand hygiene has many steps and to reinforce them, several videos were made that were in sync with popular music and elaborate hand hygiene measures were demonstrated. These videos went viral and were impactful. 

I think all of these factors put together - videos, MOH campaigns, end user awareness and compliance, support from suppliers, etc. have facilitated the success of Oman’s hand hygiene initiative.  

The end result is that infection rates have come down. These rates were monitored by the World Health Organization and Oman was listed as one of the top examples to follow.

What are the hygiene practices that you follow in your healthcare facility?

When it comes to public hygiene or infection control in a hospital, this is everyone’s responsibility. From the cleaner to the CEO of the organization, the commitment towards this cause should come from everyone. 

It starts with very basic things like hand hygiene. After seeing a patient or after touching an infected surface, it is very important to clean the hands in a certain way with soap and water or an alcohol based sanitizer. 

Secondly, cleaning of the toiletries, the seating areas, the washrooms and other common places of use is very important. This runs very deep. The skills of the cleaner, the quality of mops and other equipment they are using, the effectiveness of solutions and disinfectants they use - all of these need to be taken care of. The cleaner can only do a great job in cleaning and disinfecting the hospital thoroughly when all of the other factors are taken care of by the management or concerned teams. 

We practice these basics very thoroughly and these are even monitored by our quality team. They constantly study the data associated with HAIs and derive conclusions on our progress and what should be the way forward. 

What are the common challenges you face in maintaining a hygienic healthcare facility and how do you overcome them?

I would say the biggest challenges lie in compliance and training. You can train people, you can teach them every effective method of cleaning but if they do not comply, the training goes to waste. So compliance is very important.

Secondly, at the ground cleaning staff level, the effectiveness of people who train and supervise them is important. Are they monitoring the cleaning operations well? Are they ensuring that compliance is in the right order? These are some of the questions we must constantly ask. 

This also requires a 360 degree approach of selecting the right people, training them and monitoring them. 

After all the hygiene and awareness campaigns that are being constantly conducted, it is again the role of each individual to contribute to the larger cause at hand. Let’s say if all the nurses, doctors and cleaners are doing their job properly but some minor thing goes wrong or the end-user doesn’t cooperate, the ensite process will get disturbed.

I also have to mention that HAIs are a very costly affair in the entire healthcare system. It practically burdens the healthcare facility. Let us say that despite all the precautions and measures, if something goes wrong or gets missed and an infection breaks out among the staff, that becomes a big cost for the healthcare facility and the whole system collapses.

In healthcare, infection control was, is and will always remain a very serious business and anyone who has ever worked in the healthcare sector understands this. 

What are some of the common mistakes you see in healthcare hygiene around you?

I will divide my answer into clinical and non-clinical for a clearer understanding. 

On the clinical side, they have more awareness and they know about the consequences of not following the prescribed hygiene measures. So the compliance rate is very high. 

On the non-clinical side, the attrition rate of cleaners is very high. It is very hard to find a skilled person in cleaning. Let us say you have trained someone for a particular period of time, but due to attrition because of any reason, you can’t just bring anyone to clean a facility as sensitive as a hospital, unless they have the right knowledge to bring to the table. 

Secondly, one of the most common mistakes we see is in the dispensing of chemicals. If chemicals are not used in the right proportions, they don’t yield good results. An excess of chemicals can prove to be toxic and less proportions could render the whole cleaning operation ineffective. This whole process has to be monitored very closely. 

These are some of the things that could go wrong on the non-clinical side. However this doesn’t mean that there are no mistakes on the clinical side. Sometimes on the other side, due to the workload or any other factor, they might not get the time to follow each step or maintain the correct sequence of hygiene practices. However, these mistakes occur very rarely.

What does your cleaning schedule look like and what are the areas of improvement that you would like to see in healthcare hygiene?

Cleaning schedule inside a hospital is again little different than other facilities. Especially in the night, when there are not many patients, the deep cleaning of the hospital is carried out. During the times when the inflow of patients is very high, cleaners will be continuously on the job, cleaning anything if spilled or maintaining washroom hygiene after each use. When OPDs are not busy, they will be cleaned, the common seating areas are continuously cleaned and disinfected because they pose the maximum risk of HAI infection. 

Again, I would like to focus on compliance here. In the night, when the deep cleaning happens, if there is no supervision, compliance remains a big problem. A hospital can train and teach but during odd hours, it is the discretion of the cleaner to do things the right way or not. So training, coupled with supervision and monitoring is extremely important. This might sound like a very basic challenge that is prevalent everywhere but look closely and you will see how sensitive of an issue it is inside a hospital. There is a footfall of 300 to 500 patients in a day and without a proper cleaning structure, a hospital would not be able to function.