Hospital-acquired infections are a moral, medical and legal dilemma. Dr. Vickie recounts her experience in clinical practice
Infections that we treat in the hospital could arise from various sources but a good number of them are hospital-acquired, and determining who is liable is a medical, moral and legal dilemma that we deal with daily on hospital wards and management boardrooms. I’ve also had my fair share experience-wise.
One of such cases I’ve encountered in the hospital was that of a 16-year old 300 level law student who was involved in a road accident. Her left leg got broken around the thigh region although there was no open wound. I remember the diagnosis was close femoral fracture. She underwent surgery and was subsequently discharged. Crutches were recommended and antibiotics were prescribed.
We thought that was it, but we were wrong.
Up till 8 months after the surgery, she continued to present at the hospital with persistent watery discharge from the thigh. We knew right away that infection had set in. it is worthy to note that the surgery was done at a tertiary health facility and under sterile condition. Also remember that it was a close fracture, under antibiotics cover and uncountable doses of antibiotics since then – different types again and again.
Sometimes she would wake up with her bed soaked, there were times when she will not be able to stay in the classroom because after the wound dressing is soaked, her clothe is next, she’s always seen around the dressing room or follow up clinic. She has had 3 sessions of debridement and the next step is removing the implant (the metallic material used to hold the bones in place).
“The fear I’m having now is losing this leg,” she said.
This situation is not peculiar to this lady alone, I also remember a fellow health worker that underwent a caesarean section to deliver her baby. Her operation site got infected and the wound got broken down – it was so bad that you can see the layers that made up her tummy. It was really terrible. She had wound dressing everyday with different substances with associated pain, different antibiotics (she had to take drugs daily), wound swabs samples for test until the wound was free from infection then secondary closure was done.
Also of significant importance is the cost implication of all the treatments. She had to stay in the hospital for almost three months after delivery, the baby went from neonate to infant right there inside the ward, at least she was able to feed and take care of the baby. It was not a pleasing experience.
I can give several other examples of similar experiences, they are countless. All these people went to tertiary health institutions, they received the best of care, but, unfortunate for them, they had to pass through the stress of dealing with hospital-acquired infections.
Anybody in their shoes would be required to pay admission fee, demand medical and nursing services daily, pay for sterile packs including all the cotton wools and gauze with instruments, buy the spirit, Savlon, honey and other materials for wound dressing. Of course you will pay for laboratory investigations and you will buy all your drugs. How does that sound? Let’s not even mention the psychological and emotional stress you will pass through. At one point or another you will ask yourself – “is it my fate or destiny?”
Tackling hospital-acquired infections within the hospital system
Every hospital is required to ensure sterile procedures are sterile. These days almost all procedures are carried out with antibiotics cover but that’s not enough, we need to ensure that sterile packs are actually sterile. With the rate at which patients get infected in the hospital – from ‘common’ malaria to wound infections and other infections that are gotten from the hospital – it’s obvious that something is missing, which from my personal experience is coordination.
Where is the place of quality assurance, infection control unit, maintenance unit and other groups that are responsible for changing of worn-out window nets, curtains and other equipment that might be faulty? I often see surgeons sweating by the operation table in the theatre during surgery. No matter how many times you mop his face, he will continue to sweat because the theatres are hot. And sweat is not sterile; it could be a source of infection.
I must say that nurses, particularly matrons, are trying when it comes to ensuring that things work well in the hospital; they have a lot of responsibilities on their necks and the aftermath is that it becomes very difficult for them to focus on small things. For instance, when last did anybody pay attention to training and re-training health workers on the job? When they say it’s sterile we assume it is. The hospital is so busy that, except you need it for research or litigation, verifying things may not be easy.
I’m also particularly concerned and probably fixated on patients’ follow-up. Within the current healthcare system, who follows the patients up? Doctors are incapacitated because all they do is treat patients; most of the time they don’t meddle with patient’s finances; whether it’s a fresh case or recurrence, the truth is there’s no difference – the cost is the same. Let’s assume it’s our relatives or co-workers who had to stay in the hospital for almost 3 months after delivery and had to foot the bills, what are we going to do about it? Are we going to continue folding our hands or take responsibility and see how the hospital could be of help?
Now, who should be blamed for this kind of misfortune and who should bear the cost implication? I know that hospital-acquired infections happen to be one of the least worries of Nigeria’s healthcare system presently since we have a full plate already – Lassa fever, primary healthcare woes, malaria, HIV/AIDS, infant and maternal mortality, surging population, tuberculosis, drug resistance, cancer, poliomyelitis and several others including sexual impotence. But it will not be a bad idea if we begin to think of developing a holistic approach to hospital-acquired infections since it is a major issue across the country’s health institutions. When people are getting sick at a place that should make them well, I think it deserves some attention – even if all we could do is to get things done right.