How hospitals make or mar your health

December 5, 2013 3:44 PM

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Hospital acquired infections have become a huge problem, contributing to long hospital stay, bloodstream infections, surgical site infections and even death. Experts say that hospitals need to do more to prevent and cope with these infections, to comply with the do-no-harm principles, reports Sade Oguntola.

THIRTY-three-year-old Mrs Kehinde Aluko (not real name) was admitted to the hospital for a caesarean operation to have her second baby. She was a completely healthy, normal person before this delivery that denied her most basic joy of motherhood. It was two months before she could even touch her child because afterwards, she acquired a life-threatening infection.

Although, the medical doctors placed Mrs Aluko immediately on antibiotics, her infection did not respond to it. Due to the infection, she developed an acute kidney failure and her lungs started failing. Invariably, she had to be treated with the latest generation antibiotics, which are very expensive.

Antibiotic resistance and hospital-acquired infections have become a huge problem that medical experts, including those at the University College Hospital (UCH), Ibadan, Oyo State, are worried about, as evidenced by the mammoth crowd at the Ibadan Medical Society Scientific and Educational Programme with the theme: “Hospital Acquired Infection.”

Hospital-acquired infections have become a huge problem. In most of hospitals, what is happening now is that a person comes with a certain problem to the hospital, is admitted and then gets a hospital-acquired infection. This is even more difficult to treat than the basic problem that they come with. Sadly, it has become a life-threatening issue.

Try as they might, hospitals still face challenges when it comes to preventing hospital-acquired infections, also called nosocomial infections, which are infections acquired in hospital or healthcare service unit during the course of receiving treatment for other conditions. Such first appears 48 hours or more after hospital admission or within 30 days after discharge following admission at the hospital.

“These infections are unrelated to the original illness that brings the individual to the hospital and are neither present nor incubating as at the time of admission,” said Dr Hannah Dada-Adegbola, a Senior Lecturer, College of Medicine and Consultant Microbiologist.

Often times, hospital acquired infections are commoner in such places as the surgical wards and special care units such as the intensive care unit and special care baby unit. Unfortunately, Dr Dada-Adegbola said these infections which are related to medical care, can be devastating and even deadly, thus making them important public health problems.

Infections related to medical care dates back to over 2,500 years, but these infections remain a cause of concern she said, because “patients come into hospital for care and “cure”, therefore, it is expected that the hospital, at least, should not add to their suffering, if it cannot make them better.”

Indeed, the burden of hospital acquired infection is enormous. Approximately, one out of every 20 hospitalised patients will contract a hospital acquired infection. Sadly, health care-associated infections are more frequent in low- and middle-income countries than in developed countries.

For instance, she said, “approximately 30 per cent of patients in intensive care unit stand a risk of contacting these infections in the intensive care unit of a hospital. Also, newborns are at higher risk of acquiring health care associated infection in developing countries than in high-income countries.”

According to Dr Adegbola, monthly surveillance by the infection control nurses, between 2008 and 2012, at the UCH, Ibadan, for instance, indicated that patients were most at risk of contracting hospital-acquired infections at the surgical units of the hospital, followed by the paediatric clinical services.

Nosocomial infections typically affect patients who have their body immunity compromised because of age, underlying diseases, or medical or surgical treatments.

Also, poor knowledge and application of basic infection control measures, poor or deferred maintenance practices and increasingly aggressive medical and therapeutic interventions, including implanted foreign bodies and organ transplantations, have created a group of particularly vulnerable persons.

The most frequent infections include urinary tract infections, respiratory tract infections (an infection that occurs if germs enter through the ventilator, a machine that is used to help a patient breathe), infections after surgery (SSI), bloodstream infections and others like diarrhoea and colon infections, due to Clostridium difficile.

“Among urinary tract infections acquired in the hospital, approximately 75 per cent are associated with a urinary catheter, which is a tube inserted into the bladder or urine bag to drain urine,” Dr Adegbola-Dada declared.

Infections after surgery could occur in the part of the body where the surgery took place. Although, it is sometimes an infection involving the skin only, others may be more serious and can involve tissues under the skin, organs, or implanted material.

contributes to prolong hospital stays, increase resistance to common antibiotics and represent a massive additional financial burden for health systems, aside causing unnecessary deaths.

But Professor Samuel Omokhodion, Consultant Paediatrician and Head, Department of Paediatrics, College of Medicine, University of Ibadan, linked cases of hospital acquired infection in special care baby unit also to throat and nose of hospital staff serving as reservoirs for some disease-causing germs.

Dr Adeyinka Ademola, a general surgeon, however said cases of infection after surgery cannot be resolved without surgical interventions.

Given that about two per cent of all surgeries could be complicated by infections after surgery, he said infections after surgery are a distress to the patient because the wound will have to be reopened to ensure it heals.

Mr Adesina Odekanmi, a medical laboratory scientist at the Department of Medical Microbiology and Parasitology, UCH, Ibadan, however, linked increasing cases of health care-associated infections to three major factors, including many hospital personnel failing to follow basic infection control, such as hand washing between patient contacts and patients in hospitals.

Odekanmi, who stressed the need for availability of new technology that could detect, identify and characterise micro-organisms, said there was the need for the microbiology laboratory to collaborate with the infection control team of the hospital on the investigation of any micro-organism outbreak.

According to him: “Infections mean extra treatments, laboratory tests, medications, isolation, supplies, cleaning, laundry, nursing and physician’s care, all of which tie up scarce healthcare resources. Therefore, everything must be done to reduce occurrence of HAI to the barest minimum.”

Infection Control Officer, Mrs Bimpe Gbaja, UCH, Ibadan, said it is difficult to stop hospital-acquired infections because they have many mediums of transmission, adding, ‘the prevention of hospital acquired infections is the responsibility of all. Everyone must cooperative to reduce the risk of infection to patients and staff.”

She declared: “Correct hand washing is an effective weapon against transmission of hospital acquired infection. Wash immediately after contact with blood, body fluids, secretions, excretions and contaminated items / equipment, regardless of whether gloves are worn or not. Wash hands between patients contact, tasks or procedures on the same patient.”

Gbaja added that adequate quantities of water and antiseptic soap remove more than 90 per cent of the transients organisms, stressing that common toilet soap is not good enough for infection control.

According to her,”hospital acquired infections are costly, deadly, waste of manpower, but largely preventable, thus the need to enforce strict adherence to policies and guidelines of infection control, if the trend is to be reduced.”


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