When the hospital is no longer a safe place for visitors

Monday January 9 2017

Some hospitals have rules for non patients of

Some hospitals have rules for non patients of wearing a mask during visiting hours. PHOTO|NY TIMES 

By Syriacus Buguzi sbuguzi@tz.nationmedia.com

Last October, on one calm evening around 5pm on Friday; all was not well for Maria Karwani’s 3-months-old baby, Allan. He was breathing with difficulty, restless, and had high grade fever.

The urgency to rush Allan to the hospital was increasing, says Maria. But, the mother of two kids was in the midst of a dilemma.

“I was living with another two-year-old daughter, Judith. I could not leave her at home alone. I had no house-help,” Maria narrates. She added that she had no choice but to take her son Allan to Mwananyamala Hospital along with Judith [who was not sick].

“I didn’t know that taking Allan to the hospital alongside Judith, meant that I could end up nursing two sick children in the hospital,’’ recalls Maria as she narrates how her daughter later grappled with a “hospital-acquired infection.”

For, Allan, he was later diagnosed with severe pneumonia. “He was put on a dose of injectable medicine and admitted in the children’s ward for about four days,” says Maria, 30, a petty trader and a single mother.

The resident of Mabibo suburb in Dar es Salaam, admits that she was repeatedly warned by the medical staff at Mwananyamala hospital not to keep her daughter [who was not sick] in the children’s ward.

“But I did not take heed of their advice. There was nothing I could have done. I had no one- else to take care of Judith,’’ Maria told Your Health in an interview last week.

“In the ward, we [Judith, and I] were sharing a bed with sick Allan. On the third day of Allan’s admission, I made arrangements so that Judith could be transferred to her grandmother in Kimara but it was too late. Judith had started coughing. It was mild though,’’ she recalls.

“By the time Allan was recovering, Judith’s condition had already started getting worse. She was also becoming breathless like Allan,’’ says Maria.

Then it dawned on her that the doctors were right. She says, “One doctor told me that children usually have low immunity and they could easily catch certain infections, especially pneumonia at the hospital.”

HAI go unnoticed but affects a large populus

Maria’s children are not the only people at risk. Health-care-associated infection (HAI) is a major global safety concern for both patients and health-care professionals, a study published in 2011 on the World Health Organisation (WHO) website shows.

The study, titled, “Health-care-associated infection in Africa: a systematic review,’’ shows that 5 to 15 per cent of hospitalised patients in regular wards and as many as 50 percent or more of patients in intensive care units (ICUs) are affected by HAIs.

People visiting hospitals, getting in contact with hospital equipment, such as bed covers and door knobs, are usually advised to wash hands in order to protect themselves from HAIs.

In Tanzania, public hospitals have to contend with congestion of relatives of patients who throng the facilities during the visiting hours.

Congestion of people at the hospital, may, according to experts pose a risk of HAIs to non-patients.

Last year, Muhimbili National Hospital (MNH) embarked on the move to limit the numbers of relatives visiting their patients by introducing hospital-prepared meals. But, the idea did not materialise, although partly it was aimed at cutting down the congestion.

Studies show that overcrowding and understaffing in hospitals results in inadequate infection control practices, and a lack of infection control policies, guidelines and trained professionals also adds to the extent of the problem.

On any given day, one in 25 hospitalised patients - 4 per cent - is battling an infection picked up in a hospital or other healthcare facility, according to a survey by the Centers for Disease Control and Prevention (CDC).

That translates to more than 600,000 hospital patients each year globally. Roughly 74,000 of them have to fight more than one hospital-acquired infection in the United States, researchers found out in a 2014 study.

About half of those infections were either linked to a device attached to the patient, like a catheter or ventilator, or occurred after a surgical procedure at the site of the surgery.

The new study, led by Dr. Shelley S. Magill of the CDC and published in the New England Journal of Medicine, was based on an analysis of 11,282 patients treated at 183 hospitals in 10 states.

The survey in each hospital was done over the course of a day, involving as many as 100 patients per facility.

Pneumonia accounted for about 22 per cent of the hospital-acquired infections. Another 22 per cent were infections at the surgical site, and 17 per cent were stomach or intestinal illnesses.

Here in Tanzania, Dr Mpokigwa Kiputa, a Medical Officer at the Ministry of Health, says that Hospital-acquired Infections (HAIs) in the country are of many varieties but the public is “less informed of about them” as they are under-reported.

“In our health system, there are no measures in place for tracking down and reporting hospital-acquired infections. So, they just go unnoticed. They are dealt with as other kinds of infections,’’ he tells Your Health.

Over the years, researchers have warned of the trend of the HAIs in lower and higher level hospitals, and recommended further research on the specific causes.

One study, titled: “Prevalence of hospital-acquired infections in a tertiary referral hospital in northern Tanzania,’’ identified HAIs as urinary-tract infections, surgical-wound infections and then lower respiratory-tract infections. Twenty HAIs cases were ‘unspecified’.

Published in the PubMed Journal more than a decade ago, the study shows HAIs were associated with long hospitalisation (of more than 30 days), being admitted in the general surgical wards.

Dr Masura Gulamhussein, from Arusha suggests that there should be some sort of contact tracing for patients diagnosed with common HAIs, noting that this would help to identify the key areas for interventions.

“One factor for not reporting could be due to the fact that those exposed to HAIs usually seek help at a later date and probably elsewhere from where they might have acquired it. The victims won’t be able to tell where they might have acquired the infection,’’ says Dr Gulamhussein.

From his experience, the medic believes that the kind of hospital-acquired infection one suffers from depends on the wards visited at a hospital.

He says, “Pneumonia is a common HAI especially in children. But people who visit medical wards with Tuberculosis patients can also suffer from TB,’’ he warns.

At times, the infection can go along to be transmitted to members of the family when someone goes home.

Dr Gulamhussein recalls an incident where his colleague, a medical attendant at one hospital acquired Tuberculosis, forcing his family to intervene to prevent the bacteria from being transmitted to his children.”

“A friend of mine got TB. It’s understood this was a medical personnel [meaning it could be regarded an occupational health hazard]. When he was fully diagnosed, his children had to be put on pre-exposure medications to protect them from TB infection, ’says the medic.

This, he says, has also happened in cases of Hepatitis C. “This was also medical personnel but the risk is for those who are attending to that particular patient. The risk of infection increases in such situations.”

The safety on each person visiting the hospital is of paramount importance.

Despite that a hospital is a place where people get healed of diseases; the irony is that they can acquire infections from the hospital environment if great care is not taken.