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Opinions of Friday, 10 May 2019

Columnist: Agyemang Kenneth

Nosocomial Infections: The Case of Ghana - What the public should know

To the layman, hearing the word “nosocomial” may sound strange. Strange because it is rarely used on the streets, workplaces and even in schools. Except students who study science and medical related courses and health workers, most people have no idea what nosocomial infections are. Meanwhile, the victims of these infections are not medical students or health workers mostly, but patients who are part of the ordinary Ghanaian masses out there, having very little idea or none at all about a risk that might cause them their life if they are not handled with care in any future hospital admission case. The term “nosocomial” comes from two Greek words “nosus” meaning “disease” and “komeion” meaning “to take care of”. In other words, it means diseases gotten as a result of being taken care of. They are infections that patients under medical care contract, mostly when healthcare workers do not wash their hands properly before treating patients or through improper procedures such as inadequate disinfection or sterilisation of equipment.

Nosocomial infections should be a matter of great concern to the health sector and in Ghana.This is because, the rate of increase in morbidity and mortality associated with nosocomial infections is on the rise in the country . A study conducted at Korle-Bu Teaching Hospital on nosocomial infections showed that on the particular day of the study, there were 907 patients on admission. Out of this number, 61 of them, representing 6.7% had nosocomial infections. Amongst the nosocomial infections, wound infection was identified as the commonest, followed by skin and lower respiratory infections. Also, in May 2011, the Deputy Minister of Health, Mr. Rojo Mettle Nunoo, stressed on practising basic hygiene so as to help decrease the rate of hospital infections in health facilities in the country. He described the rise in nosocomial infections as alarming, hence, urged health care personnel to adhere to hygienic procedures since most of them were noted to ignore some of these procedures. Basing his fact on the assessment of practice by the Institutional Care Division, he encouraged health workers to save patients from nosocomial infections through simple compliance to the norms.This proves that, the cases in Ghana are not so insignificant and that, much attention should be given to solving and prevention of any future occurrence and prevent it's rise.

Also to be noted is a worldwide assessment by the World Health Organisation (WHO).The World Health Organisation as at 2011 had stated that, there were 1.4 million reported cases of people infected by hospital-acquired infections. It also revealed that methods used for activities such as sterilisation, cleaning practices, waste management and other procedures were inadequate. A scrutiny of the report provides enough reasons to raise an alarm for healthcare practitioners to engage in activities that will reduce the occurrence of nosocomial infections in our country, Ghana.

Mostly, the incident of nosocomial infections in the Intensive Care Unit is higher than the rate in the general in-patients hospital population. Although we cannot ignore the fact that all hospitalised patients are susceptible to contracting nosocomial infections, some of them are at greater risks than others. Notably, young children, the elderly and persons with compromised immune systems are more likely to attract nosocomial infections. Other risk factors of nosocomial infections are long hospital stays, the use of in-dwelling catheters; failure of healthcare workers to wash their hands; and overuse of antibiotics.

For these infections, the causative pathogens involved are bacteria—entero bacteria, staphylococcus and pseudomonas. Legionella, however, infrequently isolated cases, multi-resistant bacteria could be associated with nosocomial infections. Amongst nosocomial viruses; VRS, Rota virus, HIV, influenza virus and hepatitis B and C viruses are cited as some causative pathogens in nosocomial infected cases. Also, fungal agents such as aspergillus, candida, and Plasmodium as well as non-conventional agents (prions) serve as agents of nosocomial infections.

Looking at the way out, healthcare providers should either wash their hands with soap and water or clean their hands with an alcohol-based hand rub before and after treating every patient. Also, hospital equipment like catheters should be used only when necessary and should be removed immediately after use. Cleaning the surgical site or the skin where the catheter is inserted is helpful in saving a patient from hospital-acquired infections. In addition, adhering to the mandatory order of wearing hair covers, masks, gown and gloves is really needful. It is also important to note that when a patient is already infected, immediate attention and treatment is required to avoid the worst from occurring.

Generally, people apportion blame on health workers when nosocomial infections occur. Regarding the factors that increase the risk of being infected in health facilities, it will not be far from the truth if relatives of patients with nosocomial infections call out health workers as people to blame for these infections. It will be of great benefit to the patients themselves, their relatives and the country as a whole, if healthcare practitioners would maintain maximum hygienic standards at the in-patients hospital population, especially at the Intensive Care Unit where the rise of infection is higher.

At its peak, nosocomial infections can take precious human lives if health personnel do not co-operate in dealing with it. Patients infected through surgery may spend additional days, a week or less or even more, depending on how severe the infection is. Discharged patients are also likely to be re-admitted and could even die in the long run. Again, it is important to note that patients who have acquired nosocomial infections and are fresh from surgery are likely to be readmitted at the Intensive Care Unit of hospitals.

After a critical look into hospital acquired infections,it was realized that, surgical infections alone account for up to 10 billion dollars annually in healthcare expenditure in the United States alone. Although we have not yet ascertained how much Ghana is spending on nosocomial infections, it is highly probable that the amount we spend is quite huge. This therefore makes it appropriate for one to think if it is prudent for Ghana as a middle income earning country to spend so much on a situation that can be totally prevented.

Writer: Agyemang Kenneth

BSC. physician assistantship

University of Cape Coast Ghana.