Actor Suhani’s Death Puts Spotlight on Hospital Acquired Infections: What Is It?

The 19-year-old actor known for her role in the film Dangal passed away earlier this week from a rare condition.

Suhani Bhatnagar, the 19-year-old actor known for her role in the film Dangal, passed away earlier this week.

According to her family, she was battling a rare condition called dermatomyositis for which she was undergoing treatment. However, she was admitted to the All India Institute of Medical Sciences (AIIMS) in Delhi, on 7 February when her condition deteriorated.

According to her father, Sumit Bhatnagar, the heavy medication she was on weakened her immune system and she contracted another infection while she was admitted in the hospital. This further worsened her state, ultimately leading to her death.

"When her condition started deteriorating, we got her admitted to AIIMS. But there was no improvement and her lungs were damaged due to accumulation of excess fluid."

Sumit Bhatnagar, Suhani's father to the media

Hospitals are a place of healing but 'Hospital Acquired Infections' or HAI are more common than you would think, particularly in severely ill patients admitted to the ICU for longer durations.

What Is HAI? Why Does It Happen?

Simply put, Hospital Acquired Infections (HAI), also known as healthcare-associated infections (HCAI), is a blanket phrase used to refer to an infection that a patient can contract while being hospitalised.

According to an analysis released by researchers in India in 2023, 10 to 20 percent of patients admitted to the hospital acquire HAI in India, and a quarter of all hospital infections happen in the ICU setting.

Speaking to FIT, Dr Sumit Ray, Head of Critical Care at Delhi's Holy Family Hospital, says, "HAIs predominantly happen in the setting of a patient who already has comorbidities and their immunology is suppressed. They are on medication already for an infection and they get a secondary infection."

Dr Viny Kantroo, Consultant, Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, Delhi, says, "Many times, a patient comes with a severe viral infection and that makes them prone to another bacterial infection."

Adding to this, Dr Rizul Saini, Critical Care Specialist, Shri Ram Hospital, Rewari, says, "Diabetics, elderly, immunocompromised people, and those on immunosuppressant medication are more prone to acquiring it."

Routine infections in the respiratory tract known as ARDS – acute respiratory distress syndrome – is particularly common, adds Dr Saini.

In severe cases, it can lead to fluid buildup in the lungs, which is what Suhani’s father said happened to her as her condition deteriorated. 

This happens because treating critical illnesses, like autoimmune conditions, requires breaking through the natural barriers to infection. Certain conditions might also require immunosuppressants which can have the counter effect of exposing the patients to other infections. 

What Makes HAIs So Dangerous?

Bacteria is present everywhere. There aren't any unusual pathogens present in hospitals specifically.

In fact, many of the microbes that cause HAIs are ones that exist around us all the time. The difference is that when we are healthy, they don't cause infection, but when we are down with a bad hit, they can wreck havoc. 

But there's more to it. Dr Ray says, "The bacteria that are there (in hospitals) have primarily become resistant. Because they are very resistant bacteria, they are very difficult to treat."

This is because hospitals are frequently disinfected and the pathogens present there are exposed to a higher volume of drugs, and so, over time they have learnt to circumvent them. These 'superbugs' are called anti-microbial resistant (AMR) pathogens.

Dr Ray further explains,

"These patients come with a primary problem and the infection they acquire becomes a secondary infection, which is more often than not a resistant infection, and so it can be severe to the point of fatality as well."

Fatalities from secondary HAIs are, unfortunately, fairly common, adds Dr Ray.

"This is present across the world, but India and South Asia are particularly bad. In the US, nearly 30 to 40 thousand patients die due to hospital-acquired infections a year. Our numbers will probably be more," he says. 

According to the World Health Organization, one in 10 affected patients will die from their HAI. However, the numbers can vary greatly from place to place and hospital to hospital.

‘Steroids and Immunosuppressants Are Necessary Evils'

Any medication that suppresses the immune response or modulates your immune response makes people prone to other secondary infections, this includes steroids as well.  According to Suhani's family, the actor too was on steroids to treat her inflammatory condition.

"These drugs are used in critically ill patients, but they do suppress immunity," says Dr Kantroo.

This, however, doesn't mean that steroids are the bad guys.

"Steroids have got a bad press, but they are essential in many critically ill patients who wouldn't be able to survive without them. Especially in severe COPD cases," says Dr Ray.

He adds, "But like every medication, there are certain unwanted side effects that are inescapable."

"Immunosuppressants are a necessary evil in critical care. It's always a balance in medicine. It all comes down to a risk-benefit analysis."

Dr Sumit Ray

Dr Ray goes on to say that the way to keep the side effects under check is by titrating the doses, balancing out the pros and the cons, and monitoring immune levels.