Before Patrick Sawyer brought the Ebola Virus Disease to Nigeria on July 20, the average Nigerian did not know that they could be infected in the hospital even when they have only visited to obtain treatment.

In fact, the way some patients carry on when they are in the hospital environment leaves much to be desired. Take, for instance, a nursing mother who allows her baby to crawl about the hospital, fully aware of the possibility of the child picking anything of interest and putting it in his mouth.

Even where there’s nothing of interest in sight, after doing the round, the possibility of the child inserting his dirty hands in his mouth for whatever reasons are also there.

What about adults that touch all available surfaces as they use the hospital, without the faintest idea that in doing so, they may have picked up all sorts of infectious pathogens that could make them and everybody in their circle – family and friends – sick.

Yet, experts note that hospitals have become particularly notorious for spreading lethal infections, such that hospital-acquired infections (medically called nosocomial infections) now affect one in 25 patients.

Indeed, researchers note that the most common hospital-acquired infections include central line-associated bloodstream infections (which occur when germs enter the bloodstream through a central line); catheter-associated urinary tract infections, surgical site infections after surgery and clostridium difficile infections (a bacterium that causes diarrhoea and more serious intestinal conditions).

Paediatrician and President of the Anu Dosekun Healthcare Foundation, Dr. Efunbo Dosekun, warns that the situation is growing more dangerous because it has been found that hospital-acquired infections may no longer respond to regular antibiotics.

Dosekun laments that in a developing country such as ours, people who have visibly contagious infections are allowed to mingle freely with other patients as they all wait to see the doctor. Consequently, she says, someone who has come to treat malaria fever may return home with tuberculosis if he happens to come into contact with the droplets of an infected person in the hospital waiting room.

Worse still, researchers note, a child who has been brought to the hospital for minor ailment may end up contracting measles as his mother waits in line alongside another mother whose baby has the disease.

The World Health Organisation corroborates this. The WHO states, “Infections are caused by pathogens that easily spread through the body. Many hospital patients have compromised immune systems, so they are less able to fight off infections. In some cases, patients develop infections due to poor conditions at a hospital or a healthcare facility, or due to hospital staff not following proper procedures.”

Some patients acquire nosocomial infections by interacting with other patients, Dosekun says; while others encounter bacteria, fungi, parasites, or viruses in their hospital environment.

She adds that the ‘social status’ of a hospital may also determine the level of infections that patients and health workers alike would be exposed to. In other words, Dosekun says, the higher the net worth of individuals a hospital caters to, the rarer it becomes for patients to be infected.

“This tells you something about the association of poverty with diseases. Poverty, ill health and ignorance are closely interlinked and each is a determinant of the other. Those with poor health tend to fall into poverty and the poor tend to have poor health. And that’s why you see that persons with lower socio-economic status also have the worst health outcomes.

“Again, environmental and social reasons, including crowded living and working conditions, inadequate sanitation, and disproportionate occupation all contribute to developing weakened immunity, which readily exposes the vulnerable such as babies, pregnant mothers and aged persons to higher risks of infection,” Dosekun enthuses.

The way out

Dosekun says first of all, infection control is the responsibility of all health care professionals such as doctors, nurses, therapists, pharmacists, engineers and others. As such, they must practice the following…

Hand decontamination

She says the importance of hands in the transmission of hospital infections has been well demonstrated and can be minimised with appropriate hand hygiene. Towards this end, she says, heath workers must have access to necessary equipment, while the staff-to-patient ratio must be balanced as much as possible. She also suggests that care givers must be knowledgeable about possible risks and procedures so as to guard against infections.

Personal hygiene

“All hospital staff must maintain good personal hygiene. Nails must be clean and kept short. False nails should not be worn. Hair must be worn short or pinned up. Beard and moustaches must be kept trimmed short and clean,” experts counsel.

Shoes

Dosekun says in all aseptic units and in operating rooms, health workers must wear dedicated shoes, which must be easy to clean.

Safe injection practices

In order to prevent transmission of infections between patients who take injections, experts suggest the elimination of unnecessary injections, and the use of disposable sterile needle and syringe. “After they are done, they must also follow safe sharp disposal practices,” the physician says.

Preventing environmental transmission

“To minimise the transmission of microorganisms from equipment and the environment, adequate methods for cleaning, disinfecting and sterilising must be in place. Written policies and procedures which are updated on a regular basis must be developed for each facility,” Dosekun advises.

Cleaning of the hospital environment

Experts say routine cleaning is necessary to ensure that a hospital environment is visibly clean and free from dust and soil.

“This is because 90 per cent of microorganisms are present within visible dirt, and the purpose of routine cleaning is to eliminate this dirt. There must be policies specifying the frequency of cleaning and cleaning agents used for walls, floors, windows, beds, curtains, screens, fixtures, furniture, baths and toilets, and all reused medical devices” Dosekun adds.

Gloves

Hospital workers are expected to wear sterile gloves for surgery, and also when attending to immuno-compromised patients. The same thing applies when they are performing invasive procedures.

Dosekun suggest that non-sterile gloves should be worn for all patient contacts where hands are likely to be contaminated, or for any mucous membrane contact.

Staff protection

As for hospital workers, they are advised to wear non-sterile gloves to care for patients with communicable disease transmittable by contact, or when they want to perform physical examinations. Hands must be washed when gloves are removed or changed; while disposable gloves should not be reused.

To make this a regular experience in our hospitals nationwide, Dosekun says the Anu Dosekun Healthcare Foundation is proposing a workshop for all healthcare workers and hospital management, so that Nigeria can have near-nil healthcare-acquired infections, and thus save patients from avoidable dangers.

 

BY SOLAADE AYO-ADERELE