Fighting Hospital Acquired Infections in Kilifi

Fighting Hospital Acquired Infections in Kilifi

Dr Neema Mturi is in charge of the paediatric service at Kilifi District Hospital which is run in a general ward, including a neonatal unit, and a high-dependency unit. Here she talks to Anne Ashitiva about how hospital acquired infections are detected  and managed in Kilifi.    

Anne Ashitiva:  Yesterday, you made a presentation at the Infection Prevention Conference in Mombasa about infections that are acquired in hospital.  How much of a problem is this in Kilifi?

Neema Mturi: Hospital acquired infections or “HAI” are infections that a patient gets in the course of receiving treatment in hospital.  In order to work out how often this occurs we reviewed all admissions at our hospital between April 2002 and September 2009. HAI were detected in 6 out of every 1000 children admitted during this period.  

Anne Ashitiva:  Is this problem unique to Kilifi Hospital or does it occur in all hospitals

Neema Mturi: No, infections occur in all hospital settings both in developed and resource poor countries. At KDH we have been very vigilant and we have a policy in place to monitor and minimise the risks. For example, we very strongly emphasise hand-washing, we group infectious patients together or isolate them in separate parts of the ward and we use our surveillance data to decide which antibiotics are most likely to work against HAI. This kind of vigilance has contributed to making Kilifi an award winning hospital in 2009

Anne Ashitiva: How do you detect a bacterium is causing problems in the children's ward and what should you do to get rid of it?

Neema Mturi:  Normally, we suspect a child may have caught a HAI if he or she has a fever that doesn’t get better despite treatment or develops a new fever, or gets suddenly sicker whilst in hospital. We investigate children like this with tests to grow the bacteria like cultures of blood or urine  Sometimes children who have been nursed close together show similar symptoms and on further investigation grow the same organism in their cultures meaning that a ‘mini-outbreak’ has occurred.  In such instances, we carefully investigate to isolate the particular organism that is causing the problem and find the appropriate antibiotics to use.

Anne Ashitiva:  Would this be a cause of worry to a mother bringing a sick child to hospital?

Neema Mturi: No. The risk of a HAI is very small and the benefits of hospital treatment are great so it is important to bring sick children to the hospital. We try to make sure that the levels of HAI are kept to the absolute minimum, for example, all hospitals have infection control policies and infection prevention and control teams. The Government has issued guidelines* to reduce HAI which include ensuring that there is running water, soap and functional sinks so that health workers can wash their hands before and between patient encounters.  Other measures include isolation or grouping of patients, care for intravenous cannulas, urinary catheters, and antibiotic policies that will ensure that drug resistance does not arise.

Anne Ashitiva:  What are the take home messages of your research?

Neema Mturi: The research project is the first to measure the size of the problem in a typical African hospital. You can’t tell if your service is improving unless you know the size of the problem in the first place, so the important message is to look – to measure the amount of HAI disease. We also identified the main culprits – the bacteria that are most easily transmitted in hospital and this knowledge will help doctors to prescribe appropriate treatments when they see a child with a HAI.

The finding of the study have been reported in The Lancet. Full Article

*National Infection Prevention and Control Policy (20l0) download