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NDM-1: A Potential Superbug Epidemic—What Does it Mean for Health Workers?

New Delhi recently joined the ranks of other metropolitan cities like Washington D.C., Berlin, Singapore, Beijing, and Moscow with antibiotic-resistant bacteria, known as a ‘superbug,’ taking its namesake.

New Delhi Metallo-beta-lactamase-1 (NDM-1) is an unwelcome badge of notoriety, but experts estimate that most countries have produced home-grown superbugs from the overuse and misuse of antibiotics perhaps with the exception of some Scandinavian countries and Taiwan, China. So what do these superbugs mean for health workers and health systems?

In India’s case, the Indian government is particularly concerned about how news about drug-resistant infections will affect its booming medical tourism industry. Last month, The Lancet published a study  about 180 patients who were carriers of NDM-1 and had visited the Indian subcontinent, a number of whom had specifically visited India. The Lancet warns of a potential ‘worldwide public health problem,’ a forecast that the government of India rebuts vehemently. India’s Ministry of Health has voiced concerns that The Lancet report was aimed at deterring the number of people—estimated at half a million—who travel to India every year for medical procedures that cost less than what they would pay in their own country.

The country's high rate of hospital-acquired infections is a grim reality, however, that can’t be denied. An estimated one in five patients in India may contract a hospital-acquired infection. Ventilator-associated pneumonia, blood poisoning, and urinary tract infections are some of the common types of infections picked up in hospitals. Additionally, the so-called superbugs are said to spread through air conditioners and on infected hands and surfaces. Elderly patients and those on multiple antibiotics are especially vulnerable to contracting these infections. The growing number of invasive clinical procedures may also contribute to the rise in hospital-acquired infections.

In many ways, health workers are the first line of defense and can prevent these infections by adopting simple preventive measures like frequently washing their hands and using sterile catheters, gowns, and gloves, as well as closed suctioning equipment. Health workers and hospital managers are also key to stopping the over- and unregulated use of antibiotics and creating and implementing procedures to minimize the risks of spreading hospital-acquired infections.

Prioritizing the teaching of proper hygiene health workers’ training and orientation could go a long way in preventing the infection of unsuspecting patients. A reduced rate of hospital-acquired infections will translate into lighter workloads for health systems since these infections mean prolonged hospitalization and higher costs. Regulating the use of antibiotics requires a policy change at the service provider level, which might not be an immediate reality in all places. However, working with the health workers on the ground to put the brakes on this potential epidemic is a more realistic goal and a critical action.