PREVENTION OF NOSOCOMIAL INFECTIONS IN THE NEW BORN: THE PRACTICE OF PRIVATE HEALTH FACILITIES IN RURAL COMMUNITIES OF NIGERIA.    [Original Research]
SAKA M.J.1,  SAKA A.O.2,  ADEBARA V.O.3, , 
1. Department of Epidemiology and Community Health (Health Management Unit), College of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria
2. Department of Paediatrics and Child Health, University of Ilorin Teaching Hospital Ilorin, Kwara State Nigeria.
3. Department of Paediatrics and Child Health Federal Medical Center Ido Ekiti, Ekiti State, Nigeria.

[emedpub – International Infectious Diseases :   Vol 1:9]                  [Date of Publication: 06.19.2011]
ISSN 2231-6019

June 19, 2011 at 11:33 AM

Abstract

Objectives: Nosocomial infection is defined as an infection acquired in a hospital by a patient who is admitted for a reason other than that infection. The study assessed infection prevention practices among private hospitals in rural community in Nigeria.

Design: The study was carried out using tool on Quality of Care for Integrated Services. A planning meeting was held to plan the modalities for the assessment. The outcome of the planning meeting among others was the determination of composition of the team of assessors to visit each selected health facilities. The tool was administered after its pre-test at Kwali Area Council of Abuja in the north central Nigeria to ascertain the ease of administration of the tools.

Methods: A cross sectional study was carried out on seventeen randomly selected private health facilities in rural community in Nigeria.

Results: The knowledge of hand washing by staff between clients was 64.7%. Barrier to infection prevention practices with the use of linen was 58.8%. More than fifty percent of the hospitals assessed had stocks of 0.5% of the chlorine solution.

Conclusions: Although poor knowledge on infection prevention was observed, disinfectants such as 0.5% chlorine solution was most commonly used in private hospitals. The practice of aseptic hand washing was good. We recommend private healthcare providers to set up hospitals infection control committees and to work in collaboration with the public hospital infection control committees and encourage continuous medial education to develop appropriate policy and programs against hospital acquired infections.

Introduction:

Nosocomial infection, also called “hospital acquired infection” is defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection1. An infection occurring in a patient in a hospital or a healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility2.

Patient care is provided in facilities which range from highly equipped clinics and technologically advanced University hospitals to front-line units with only basic facilities. Despite progress in public health and hospital care, infections continue to develop in hospitalized patients, and may also affect hospital staff. Many factors promote infection among hospitalized patients: decreased immunity among patients; the increasing variety of medical procedures and invasive techniques creating potential routes of infection; and the transmission of drug-resistant bacteria among crowded hospital populations, where poor infection control practices may facilitate transmission.

Nosocomial infections occur worldwide and affect both developed and resource-poor countries. Infections acquired in health care settings are among the major causes of death and increased morbidity among hospitalized patients. They are a significant burden both for the patient and for public health. A prevalence survey conducted under the auspices of WHO in 55 hospitals of 14 countries representing 4 WHO Regions (Europe, Eastern Mediterranean, South-East Asia and Western Pacific) showed that an average of 8.7% of hospital patients had the occurrence of nosocomial infections. At any time, over 1.4 million people worldwide suffer from infectious complications acquired in hospital3. The highest frequencies of nosocomial infections were reported from hospitals in the Eastern Mediterranean and South-East Asian Regions (11.8 and 10.0% respectively), with a prevalence of 7.7 and 9.0% respectively in the European and Western Pacific Regions4.

The most frequent nosocomial infections are infections of surgical wounds, urinary tract infections and lower respiratory tract infections. The WHO studies, and others, have also shown that the highest prevalence of nosocomial infections occurs in intensive care units and in acute surgical and orthopaedic wards. Infection rates are higher among patients with increased susceptibility due to old age, underlying disease, or chemotherapy. In northern Nigeria with an overall prevalence of urinary tract infection of 26.0% (n=910); community–acquired urinary tract infection was 14.9% (n=520) and hospital-acquired urinary tract infection was 11.1% (n=390).12 Hospital-acquired infections add to functional disability and emotional stress to the patient and may, in some cases, lead to disabling conditions that reduce the quality of life.

Nosocomial infections are also one of the leading causes of death5. The economic costs are considerable 6, 7. The increased length of hospital stay for infected patients is the greatest contributor to cost8,9,10. One study11 showed that the overall increase in the duration of hospitalization for patients with surgical wound infections was 8.2 days, ranging from 3 days for gynaecology to 9.9 for general surgery and 19.8 days for orthopaedic surgery. Prolonged stay not only increases direct costs to patients or payers but also indirect costs due to lost work. The increased use of drugs, the need for isolation, and the use of additional laboratory and other diagnostic studies also contribute to costs.

Hospital-acquired infections add to the imbalance between resource allocation for primary and secondary health care by diverting scarce funds to the management of potentially preventable conditions. Preventive measures include hand washing, education, breast-feeding, proper food preparation and hygiene, knowledge of risks of animal exposure and travel, immunization, and interaction with public health officials when illness occurs. Interruption of fecal-oral spread is essential for diminishing transmission of enteric pathogens. If hospitalized, individual patients should be isolated during an illness. Strict hand washing procedures should be initiated, as should appropriate processing or disposal of contaminated materials. In Nigeria most government hospitals set up hospital infectious disease committees to prevent and control hospital acquired infections but in private hospital settings, extent of preventive caution had not been examined. The study therefore examined the hygiene and infection prevention practices among private hospitals in rural communities in Nigeria.

Materials and Methods:

A cross sectional study was carried out on seventeen randomly selected private health facilities in the rural areas of northern, southern, and eastern Nigeria. After consent was obtained from each health facility head/Director and from professional bodies such as Nigeria Medical Association Kafancha Branch Kaduna State, Medical Women Association Cross River and Abia State Branches, Association of General Private Medical Practitioners (AGPMPN), Federation of Muslim Women Association of Nigeria (FOMWAN) and Evangelical Church of West Africa (ECWA), the study was initiated.

The facility assessment of clinics / hospitals was carried out in seventeen (17) hospitals drawn from the service delivery facilities of Non-Governmental Organizations (NGOs), Nigeria Medical Association Kwara and Kaduna State branch, Medical Women Association Cross River and Abia State branches, Association of General Private Medical Practitioners (AGPMPN), Federation of Muslim Women (FOMWAN) and Evangelical Church of West Africa (ECWA).

The study was carried out using approved Pathfinder International’s Quality of Care for Integrated Services: Facility Assessment Tool. A planning meeting was held to plan modalities for the assessment. The outcome of the planning meeting among others was the determination of composition of the team of assessors to visit each selected health facility. The pre assessment training was to acquaint the assessors with the tools and agree on modality and deliverables. Deployment to the field took place after the training meeting. The tool was administered after the pre-test at Kwali Area Council of Abuja in the capital of Nigeria to ascertain the ease of administration of the tools. The administered tools were returned and analyzed.

Results:

More than half (58.8%) of the hospitals assessed had stocks of 0.5% of chlorine solution, and 11.8% of the facilities had available instructions for mixing of solution. Majority (94%) of the hospitals did not label the chemical solution. Only 29.4% of the hospital health care providers wore protective rubber gloves. Also, 17.5% kept the instrument in chlorine solution for at least 10 minutes immediately after its use. Knowledge of correct mixture of chlorine solution was poor (Table 1).

Table 1: Infection Prevention Practices and Decontamination

Parameters NP

n(%)

IAQ

n(%)

AQ

n(%)

G

n(%)

Total

n(%)

0.5% Chlorine solution is available 0 5(29.4) 10(58.8) 2(11.8) 17(100)
Instructions for mixing chlorine solution 3(17.6) 8(47.1) 4(23.5) 2(11.8) 17(100)
Bucket and solutions are labelled 2(11.8) 8(47.1) 6(35.3) 1(5.9) 17(100)
Wear rubber gloves 2(11.8) 6(35.3) 4(23.5) 5(29.4) 17(100)
Post-procedure decontamination 3(17.6) 7(41.2) 4(23.5) 3(17.6) 17(100)
Mixing chlorine solution correctly 2(11.8) 7(41.2) 5(29.4) 3(17.6) 17(100)
Clean exam table with disinfectants between clients 2(11.8) 6(35.3) 6(35.3) 3(17.6) 17(100)

Aseptic practice using soap was very common (70.6%). The knowledge of hand washing by staff between clients was 64.7%. Barrier to infection prevention practices with the use of linen was 58.8% as shown in table 3, while 52.9% of the hospitals changed linen between patients. Half of the hospital wiped couches with chlorine solution at least once daily (Table 2).

Table 2: Infection Prevention Practices – Asepsis hand washing

Parameters NP

n(%)

IAQ

n(%)

AQ

n(%)

G

n(%)

Total

n(%)

Soap available 0 0 5(29.4) 12(70.6) 17(100)
Clean towel available 0 0 5(29.4) 12(70.6) 17(100)
Staff wash hands correctly for 15 min 0 2(11.8) 3(17.6) 12(70.6) 17(100)
Staff wash hands between clients 0 1(5.9) 5(29.4) 11(64.7) 17(100)

Table 3: Infection Prevention Practices – Barriers

Parameters NP

n(%)

IAQ

n(%)

AQ

n(%)

G

n(%)

Total

n(%)

Clean linen 1(5.9) 6(35.3) 10(58.8) 0 17(100)
Paper or linen is changed between clients 0 2(11.8) 6(35.3) 9(52.9) 17(100)
Changed gloves between procedures 0 1(5.9) 7(41.2) 9(52.9) 17(100)
Wiped table with disinfectant once daily 1(5.9) 1(5.9) 6(35.3) 9(52.9) 17(100)
Gloves are put properly 0 2(11.8) 6(35.3) 9(52.9) 17(100)
Gloves are disposed off properly 2(11.8) 1(5.9) 7(41.2) 9(52.9) 17(100)*

Not Present (NP), Inadequate (IAQ), Adequate (AQ), Good (G)       *Total does not tally

Discussion:

The infection prevention practices of health facilities for selected categories such as decontamination, hand washing, and hygiene barriers are presented in Tables 1, 2 and 3. The figures presented showed that infection prevention practices were generally good with above 80% of clinics/hospitals having average to good practices, especially in the areas of asepsis (hand washing) and implementation of barriers. However, the ideal would be to have all (100%) clinics assessed practicing good / above average infection prevention.

It is important to note however, that while the use of 0.5% chlorine solution and availability of instructions for mixing chlorine solution did not seem to be widespread, most hospitals assessed used prepackaged chlorine solutions such as Jik, and other disinfectants such as Izal, Dettol and Savlon.

The four most common nosocomial infections are urinary tract infections, surgical wound infections, pneumonia, and primary bloodstream infections. Each of these is associated with an invasive medical device or invasive procedure. Specific policies and practices to minimize these infections must be established, reviewed and updated regularly, and also be monitored for compliance13. The importance of hands in the transmission of hospital infections has been well demonstrated14, and can be minimized with appropriate hand hygiene16,17,18. Compliance with hand washing, however, was frequently optimal in all the hospital assessed, a slight variation in some hospitals was due to a variety of reasons, including: lack of appropriate accessible equipment, high staff-to-patient ratio, allergies to hand washing products, insufficient knowledge of staff about risks and procedures, and a 15-minute long duration recommended for washing14,15,16,17,18. As recommended by WHO infectious control methods, almost all the facilities met the requirement for hand washing with running water: large washbasins which require little maintenance, with antiseptic devices and hands-free controls products: soap or antiseptic depending on the procedure facilities for drying without contamination (disposable towels if possible).

Conclusions and Recommendations:

There is poor knowledge on hospital infection prevention procedures among private health facilities in rural Nigeria; however, most of the health facilities use chlorine solution as a disinfectant/decontaminant. Items such as soaps, gloves were available for prevention but appropriate utilization is a challenge in most of health facilities assessed. We recommend faith based organizations, nongovernmental organizations and professional bodies, such as AGPMPN and NMA branches in rural Nigeria to set up hospitals infection control committees and other professional programme such as continuous medial education to develop appropriate policy and programmes for private hospitals.  There is also a need to develop and monitor policies on cleaning and decontamination of reusable equipment, contaminated equipment, wrapping procedures, and sterilization.

ACKNOWLEDGEMENT

Dr Saka A.O and Dr Adebara V.O provided inputs for research protocol design, tool design, conduct of survey and implementation of this research. We also thank the principal investigator Dr Saka MJ for providing the leadership in all component of the research.

For study sites, we thank the Medical Directors of the following hospitals: New Era Hospital & Maternity, Kafanchan, Kaduna State, Godiya Clinic and Maternity, Godiya Kaduna State, Royal Hospital Kachia Kaduna State, Jama Clinic Kaduna State, Danex Medical Centre, Ugep, Cross Rivers State, County Specialist Hospital Ikom, Cross Rivers State, Faith Foundation Specialist Clinic & Maternity Calabar, Cross Rivers State, Immanuel Infirmary Hospital Calabar, Cross Rivers State, Mission Hill Clinic & Maternity, Calabar, Cross Rivers State, Mt. Zion Medical Centre, Calablar, Cross Rivers State, Seventh Day Adventist Hospital & Maternity Home, Aba, Abia State, Princess Mary Specialist Hospital, Aba, Abia State, St. Anthony’s Hospital, Aba, Abia State, Presbyterian Urban Health Centre, Aba South, Abia State, Shammah Christian Hospital, Aba South, Abia State, Kowa Medical Centre, Godo Godo Kaduna State, ECWA Comprehensive Health Center, Kagoro, Kaduna State, MWAN Clinic, Cross Rivers State.

Finally, we thank Pathfinder International for the approval and use of the integrated tool and Community Initiative for Family Care and Development (CIFcad). We also thank them for the financial and technical support.

References

1. Ducel G et al. Guide pratique pour la lutte contre l’infection hospitalière. WHO/BAC/79.1.

2. Benenson AS. Control of communicable diseases manual, 16th edition. Washington, American Public Health Association, 1995.

3. Tikhomirov E. WHO Programme for the Control of Hospital Infections. Chemiotherapia, 1987,3:148– 151.

4. Mayon-White RT et al. An international survey of the prevalence of hospital-acquired infections. J Hosp Infect, 1988, 11 (Supplement A):43–48.

5. Ponce-de-Leon S. The needs of developing countries and the resources required. J Hosp Infect, 1991, 18 (Supplement):376–381.

6. Plowman R et al. The socio-economic burden of hospital- acquired infection. London, Public Health Laboratory Service and the London School of Hygiene and Tropical Medicine, 1999.

7. Wenzel RP. The economics of nosocomial infections. J Hosp Infect 1995, 31:79–87.

8. Pittet D, Taraara D, Wenzel RP. Nosocomial bloodstream infections in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA, 1994, 271:1598–1601.

9. Kirkland KB et al. The impact of surgical-site infections in the 1990’s: attributable mortality, excess length of hospitalization and extra costs. Infect Contr Hosp Epidemiol, 1999, 20:725–730.

10. Wakefield DS et al. Cost of nosocomial infection: relative contributions of laboratory, antibiotic, and per diem cost in serious Staphylococcus aureus infections. Amer J Infect Control, 1988, 16:185–192.

11. Coella R et al. The cost of infection in surgical patients: a case study. J Hosp Infect, 1993, 25:239– 250

12. S.I Nwadioha , E.E. Nwokedi, G.T.A. Jombo Antibiotics susceptibility pattern of uropathogenic bacterial isolates from community- and hospital- acquired Urinary Tract Infections in a Nigerian tertiary hospital. The Internet Journal of Infectious Diseases 2010 : Volume 8 Number 1

13.  Prevention of hospital acquire infection http://www.who.int/emc accessed April 25 2011.

14. Underwood MA, Pirwitz S. APIC guidelines committee: using science to guide practice. Am J Infect Control, 1998, 26:141–144.

15. Larson E. A causelink between hand washing and risk of infection? Examination of the evidence. Infect Control Hosp Epidemiol, 1988, 9:28–36.

16. CDC guidelines for hand washing and hospital environmental control. Amer J Infect Control, 1986, 17:110–129 or Infect Control, 1986, 7:231–242.

17.  Larson EL. APIC guideline for hand washing and hand antisepsis in health care settings. Amer J Infect Control, 1995, 23:251–269.

18.  Health Canada. Hand washing, cleaning, disinfection, and sterilization in health care. Canada Communicable Disease Report (CCDR), Supplement, 1998, 24S4.

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