Ensure infection control in hospitals to contain black fungus: Centre to states

In the backdrop of increasing number of patients suffering from mucormycosis, the Health Ministry on Friday directed states to review their preparedness for infection prevention and control in hospitals.

Union Health Secretary Rajesh Bhushan wrote to the states to implement specific actions to ensure infection control in Covid-19 hospitals as per national guidelines for Infection and Control in Healthcare Facilities prepared by the Union Health Ministry. “This involves the following key components of infection prevention and control manual; guidelines on antimicrobial use and management; educational programmes and strategies; risk assessment and risk management; planning, monitoring, audit, and feedback; and implementation strategies,” Bhushan wrote.

The ministry reiterated the need for “meticulous adherence” to Infection Prevention and Control while managing immuno-compromised patients such as Covid-19 patients on steroid treatment, with co-morbidities — such as diabetes where good glycemic control needs to be established as per ministry guidelines. “In due course, establish surveillance of healthcare-associated infections with a focus on ventilator-associated pneumonia, catheter-associated bloodstream infection, catheter-associated urinary tract infection, surgical site infections, gastrointestinal outbreaks,” Bhushan told the states.

Bhushan wrote that transmission-based precautions need heightened focus on droplet, airborne and contact precautions “from the perspective of protecting healthcare workers and ensuring patient safety”.

The ministry emphasised that Infection Prevention and Control practices needs to be enhanced in ICUs to prevent device associated infections such as ventilator associated pneumonia or catheter-associated bloodstream, and urinary infections. “Infection Prevention and control practice in the clinical laboratories and those attached to hospitals are very crucial for the safety of laboratory/hospital staff and health security of the community,” Bhushan wrote.

The directions come in the backdrop of the health ministry making mucormycosis notifiable, and making it mandatory for states to report both suspected and confirmed cases to the integrated district surveillance system.

Mucormycosis is a fungal infection, where sinuses or lungs of individuals get affected after fungal spores are inhaled from the air. Earlier, incidence of this infection was found to be low and was mainly reported in patients with uncontrolled diabetes.

But due to Covid-19 treatment, many hospitals are reporting a significant increase in the number of cases of Covid-19 associated Mucormycosis (CAM) due to two broad reasons: in Covid-19 patients who have diabetes, where the risk of fungal infection is high; and, second, due to indiscriminate use of steroids during Covid-19 treatment.