Hospital-acquired infections in spite of strict guidelines and enforcement tactics continue to be a challenge.

Hospital-acquired infections (HAIs) are a serious threat to public health and one of the primary causes of patient morbidity and mortality. HAI are far more common in India than in western countries. This occurs at the alarming rate of one infection per four hospital visits compared to one in ten for a European country and one in twenty for the United States. At a rate this high, and due to the potential infection for immunocompromised patients, this could be a large contributing factor to the spread of disease in the country.

Occurrence of HAI poses a grave threat to patients as well as healthcare personnel. They may lead to long-term disability, increase in hospital stay, and financial burden to the family members. This viewpoint has been acknowledged by the World Health Organization (WHO), which has focused on the Clean Care is Safer Care campaign, focusing on the basics of hand hygiene. The WHO presents a strong case for an overhaul of the hygiene system from the ground up, preventing the spread of infection rather than treating it when it occurs.

It has been found that a large number of the infections stem from medical devices like mechanical ventilators and catheters. Again this relates to a lack of hygiene associated with the device, with suggestions that different, potentially outdated, devices are often used in Indian hospitals and so often will not adhere to modern standards. A study published by the International Nosocomial Infection Control Consortium (INICC), conducted by INICC founder Dr Victor Rosenthal, assessed the rates of device associated infections across 40 Indian hospitals compared to a number of other countries. The findings indicate that 7.92 central line-associated bloodstream infections occurred per 1000 central line-days, 10.6 catheter-associated urinary tract infections per 1000 urinary catheter-days, and a ventilator-associated pneumonia rate of 10.4 per 1000 mechanical ventilator-days.

All of this has healthcare providers and hospitals looking for innovative ways to battle and destroy the bacteria and viruses that cause acute illness and death in patients admitted to healthcare facilities. Healthcare facility managers are widening the net to use technology and new product developments to inhibit or eliminate dangerous pathogens throughout treatment spaces, on medical equipment, and in building systems. Healthcare facility cleaning and decontamination is of course paramount to infection control, but so too are the surfaces being cleaned and the products being used. The true effectiveness and then long-term efficacy of antimicrobial materials and products can impact potential contamination levels.

A cabinet handle, a handrail, a countertop – choose your weapon. Or choose all of the weapons. The battle with HAIs is resulting in innovative methods to combat the dastardly bugs that are attacking patients after they are admitted to hospitals and other healthcare facilities. Healthcare designers, building material and product manufacturers, and equipment and furniture industries are beginning to gain traction on this front within the physical environment of healthcare settings. Infection control leadership, clinicians, central sterile, environmental services, and other ancillary support teams have an uphill battle to reduce infection rates from surgeries and clinical procedures that involve invasive catheters, respirators, and medical equipment. Where product innovators and designers can support these employees is in the physical healthcare spaces that have been documented to harbor and spread HAIs.

The market for infection control in India is being driven by rising concerns with respect to a significant upsurge in HAIs. Thisfacilitates greater penetration of infection control products. An influx in development of new biologics and subsequent demand for sterilized formulations serve as key growth factors for the infection control market. The healthcare organizations are focused on implementing strategies for early recognition, reporting, isolation, and surveillance of disease episodes of potential public health concern. As a consequence of the aforementioned factors, it is presumed that there will be significant improvement in the overall penetration rate of infection prevention and control products, which is also anticipated to fuel the market demand as well as the revenue to unprecedented heights.

Government Initiatives

Hygiene routines are already in place for Indian hospitals. Standards have been set and there are rules to follow. Many HAIs are prevalent despite this. This implies that infections are occurring not through absence of set rules, but through noncompliance to the rules that are already in place. Several organizations are involved in defining the concept of quality in healthcare, measure of quality, and surveillance of quality in India. National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation program for healthcare organizations. Infection control is one of the areas where NABH has set standards and guidelines to reduce hospital acquired infections.

Although hospital accreditation is not mandatory in India, NABH and the National Health Mission's National Health Systems Resource Centre have incorporated programs on infection prevention and control, including surveillance of healthcare associated infections, as a core part of the review and certification process. At the national level, there has been growing recognition of the need for policy and guidance documents, and in 2016 the Indian Council of Medical Research (ICMR) released guidelines on infection prevention and control. In addition, as part of the national Swacch Bharat Abhiyan, the National Health Mission launched Kayakalp (clean hospital initiative), which aims to promote and reward cleanliness, hygiene, and infection control practices in public healthcare facilities.

Despite these initiatives, the successful implementation of an infection prevention and control program in Indian healthcare settings faces some important challenges, including insufficient funding and human resources, hospital overcrowding, and low nurse-to-patient ratios even in intensive care units. Nevertheless, there is clear interest among doctors and other providers in healthcare facilities to improve infection prevention and control. Many facilities have started hospital infection control committees, although with varying effectiveness. Some institutes have also begun targeted infection control interventions, such as the use of infection prevention and control bundles to prevent surgical site infections and infections from indwelling devices.

Demonstrated improvements in infection control practices and reductions in healthcare associated infections can help secure the commitment and funding needed to sustain these infection prevention and control programs.

Global Market

The global infection control market size was estimated by Grand View Research at USD 150.4 billion in 2016 and is anticipated to grow at a CAGR of 6.2 percent from 2017 to 2025. The factors driving the growth of this market are increase in aging population, rising occurrence of hospital acquired infections, increase in number of surgeries performed, proper maintenance of hygiene among hospital staff, and increasing awareness among people.

The rising number of government initiatives to ensure high degree infection prevention is presumed to be a significant driver of the market. The government organizations are increasingly involved in issuing guidelines in order to promote awareness pertaining to efficient prevention measures globally, which is expected to contribute to the market growth over the years. For instance, the WHO has issued guidelines for prevention and control of pandemic- and epidemic-prone acute respiratory diseases in healthcare. The guideline ranges from standard precautions such as hand hygiene, usage of personal protective equipment to guidelines for disinfection and sterilization.

In 2016, consumables constituted the largest share of the type segment. The dominant share captured by consumables is predicted to be a consequence of consistent usage and short life cycle possessed by these products. Consumables are being extensively incorporated in disinfection, sterilization, and other control procedures, and are an indispensable part of the procedures, thereby, accounting for a larger share.

The disinfection products segment accounted for the largest share of the infection control market. This is majorly attributed to the large-scale use of disinfectors and medical nonwovens in the healthcare industry. However, the sterilization products market is expected to grow at a higher CAGR due to growing emphasis on infection control policies within hospital premises and strengthening of government regulations for quality of healthcare services.

In 2016, North America accounted for a dominant share of the market. Consistent number of strategic collaborations adopted by key market players to widen their product portfolio and infection control capabilities are believed to be responsible for the greater share captured by this region.

The Asia-Pacific market is expected to exhibit the fastest CAGR owing to the growing presence of outsourcing organizations, growing healthcare expenditure, and unprecedented evolution of the healthcare standards and infrastructure across this region. Presence of various voluntary and government organizations focused on improving infection control standards is also one of the significant factors contributing toward the growth of Asia-Pacific region.

Increasing trend of outsourcing by established market players in developed economies will also serve as key growth impelling factors for the market. For instance, Asia-Pacific Society of Infection Control (APSIC), a voluntary organization is working in the direction of establishing collaborative partnerships to facilitate quality improvement and conduct infection control research to promote cost efficient practices throughout the Asia-Pacific region.

The competition is marked by extensive implementation of collaborative strategies by major companies such as Advanced Sterilization Products, Sterus Corporation, Cantel Medical Corporation, which accounts for their dominant market share. Other key players in the market include 3M Company, Ansell Limited, Belimed, Getinge Group, Halyard Health, Hartmann Group, and Sterigenics International Inc.

The players are highly focused on adopting competitive strategies such as mergers & acquisitions, new product development initiatives, and geographical expansion. For instance, in March 2017, 3M and Kimberly-Clark Health Care signed an alliance to co-develop and deliver surgical and infection prevention solutions utilizing their respective expertise. Moreover, in January 2017, Advanced Sterilization Products launched Sterrad 100NX System with ALLClear in the United States and is planning to expand its footprint into regions such as Europe, Africa, and Middle East.

Technology Trends

The physical environment is an important link in the chain of infection prevention and control. Contaminated environmental surfaces provide an important potential source for transmission of healthcare-associated pathogens. Cleaning and disinfecting of environmental surfaces in healthcare facilities is fundamental in healthcare facilities. Experts agree that monitoring terminal room cleaning and disinfecting practices in healthcare facilities is an important element of infection control programs.

One way to break the chain of infection includes the use of innovative technology. Newer technologies, such as antimicrobial materials, improved waste management, UVC technology, and real-time locating systems, are putting new teeth in the war on HAIs and helping hospitals and increasing room turnover time.

Antimicrobial metals for high-touch surfaces. The use of proven antimicrobial metals for high-touch surfaces, such as door, cabinet and plumbing hardware, bed rails and grab bars, can significantly reduce microbial growth. Copper is one of the best performing such metals, but is a high-cost option. Copper alloys including brass and bronze are effective alternatives.

However, there are a number of healthcare-grade copper products that are now more affordable than when first introduced to the market.

Antimicrobial metals protecting nonmetallic surfaces. New technologies and manufacturing innovations have allowed companies to bring the benefits of antimicrobial metals to nonmetallic surfaces throughout the healthcare facility. Copper oxide, silver, and silver ions add proven antimicrobial protections to countertops, wall panels, furnishings, railings, and even curtains, scrubs, and bed linens.

For instance, small amounts of silver have been used in fabrics for cubicle curtains, hospital scrubs, and bed linens. Silver is a proven antimicrobial. It is typically a more affordable heavy metal option compared with copper, because a smaller amount of content is effective.

Antimicrobial paint. The recent development of antimicrobial paint that has the power not only to inhibit the growth of common microbes but actually to kill bacteria is a major breakthrough for the healthcare industry.A recent paint product, with an EPA registration, employs a quaternary ammonium compound as its active ingredient and, according to lab tests, inhibits growth of common microbes and has the power to kill bacteria including staph, MRSA, and E. coli.

Electrostatic disinfectant application systems. As compared to traditional spray-and-wipe, fogging, and UV lighting, electrostatic disinfection application systems present a complementary and cost-effective approach to healthcare facility environmental surface disinfection methods. Based on Coulomb's law, the application system applies disinfectant more evenly to all surfaces. Electrostatics is a proven technology in the agricultural and automotive industries, and is now being integrated into healthcare settings as a tool to break the chain of pathogen mobility.

UV-C LED technology. The development of LEDs capable of operating in the germicidal spectrum is now enabling a new generation of applications that is transforming the use of UV-C in hospitals. LEDs are smaller, more controllable, robust, and are far less hazardous. As a bonus, LEDs require no warm up time, meaning that they will start working when switched on.

LEDs can now be built into devices such as handheld UV wands that allow medical staff to quickly and easily disinfect beds and clothing, something that would traditionally require high-temperature washing. They can also be embedded into lightweight, wearable devices that can be attached to the operator's coat to quickly disinfect medical instruments like stethoscopes. Storage containers for medical instruments can have their own UV-C enabled containers that provide a dose of sterilizing UV-C every time the device is put away. They can also be designed into fixtures and fittings.

RTLS technology. Nowadays, there are also technologies to enhance hand hygiene, which is one of the best ways to prevent the spread of infection both inside and outside of the hospital. Real-time location systems (RTLS) integrate sensors with dispensers to detect usage.

RTLS can also be used to retrace the steps of an infected individual to determine who they came into contact with and where, and to reduce cross-contamination of equipment. It may be perceived as a sort of indoor GPS.

Way Forward

When financing healthcare becomes limited, HAIs become a crucial issue facing hospital staff and patients alike. Luckily the infection control market is a secure investment for companies seeking to market treatments, tests, or prevention equipment, as infections will always exist. Preventing, testing, and treating hospital-acquired infections provides the infection control industry with three indispensable segments when new technology must continually be developed and manufactured to keep up with infected patients. Factors like advanced products that will treat infections, improved admission screening, and increasing interest in sterilizing and disinfecting programs are making the infection prevention and control market promising.

To address the issue of increasing burden of HAIs and to pave way for implementation of appropriate preventive strategies, the primary step is to assess the burden of HAIs. HAI surveillance plays an important role to evaluate the economic burden of HAI. In India, though the burden of HAI is higher, HAI surveillance continues to be neglected. This is mainly attributed to paucity of dedicated resources and lack of expertise in infection control. Many a times healthcare associated infections can be prevented by using standard guidelines, precautions, and correct protective measures by health care workers. NABH evidence base guidelines are thus a useful resource in this regard for any hospital to get enrolled and get help in implementing these.

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