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Opinion/Gambian Health Matters

Tuesda, August 18, 2015Tuesday, August 18, 2015

Why Are Many Gambians Dying Young?

Preventing or Decreasing Hospital-acquired Infections is the Key.

By Bakary M. Jallow, Associate Editor

In The Gambia, it's not uncommon to hear stories about patients dying shortly after having a minor surgery or visiting our hospitals and health centers. It is unfathomable to hear that a young and energetic person has died shortly after undergoing a simple surgery. There are many factors to account for these kinds of tragedies but it’s very likely that these people are dying from complications such as infection and not necessarily from improper surgical techniques. But most often the tendency is to put the blame on the lack of experience by the surgeon.

Or better still, to ascribe such untimely deaths as the acts of God. "It was destined to happen by Allah," usually goes the refrain. So in our attempt to wrestle with these frequent, preventable deaths in our healthcare facilities, we've become wired to think in binary terms: these deaths are either the consequence of incompetence or the handiwork of God.

Frankly, we've to move beyond that kind of mindset if we want to have some meaningful improvement in our healthcare system. There is a reason why people don’t jump in front of moving cars or drop themselves from the top of a five-story building; and that is because they know there are consequences for doing that. Likewise in healthcare, not taking necessary precautions to prevent infections puts one at risk of infection which could cause death.

Infection prevention and control in any healthcare institution is a quality of care issue that should be hardwired throughout the institution and owned by its administration. There is no way around infection prevention when it comes to delivering safe medical and nursing care. Infection prevention and control measures are indispensable in a healthcare system.

One of the goals of a healthcare system is to protect its patients, healthcare workers, visitors and anybody who comes in contact with the healthcare environment. The sudden death of healthcare workers is another thing that is worth pondering about. Are these people dying of hospital-acquired infections? As long as we stay mute, and do not ask questions if someone dies when receiving care in our health institutions, we will continue to have our patients and healthcare workers die mysteriously. It is unfair to lose one’s life when caring for the ill.

Many a time when people suggest meaningful reforms, the usual outcry is the lack of funding. The costs of implementing infection prevention and control measures are way cheaper than treating patients with hospital-acquired infections, or nosocomial infections, as normally understood. Research has shown a correlation between hospital-acquired infections and an increase in length of hospital stay; increase in medical cost; and mortality among hospitalized patients¹.  The overall increase in hospitalization for patients with hospital-acquired infections is 8.2 days, 3 days for gynecological surgeries, 9.9 for general surgeries and 19.8 for orthopedic surgeries²

 The solution to hospital-acquired infections boils down to implementing four main things: educating staff and patients about infection prevention measures; providing cheap, unsophisticated equipment and materials that aid in infection prevention; developing engineering controls; and putting in place administrative measures to support infection prevention efforts. Implementing a very effective hand hygiene/washing program will have a tremendous impact on the quality of care we deliver. There is strong evidence that hand washing prevents nosocomial infections. Educating caregivers on the importance of hand washing, and providing easy access to soap and water will certainly make a difference³.

An effective infection prevention program requires some cultural and behavioral changes which are slow to achieve, but once these hiccups are overcome, society will benefit immensely. We cannot afford as a nation to lose people due to preventable ailments such as hospital-acquired infections. Going into a hospital for a simple appendectomy, hernia repair or orthopedic surgery and then end up dying from bleeding, sepsis, surgical site infection, or pneumonia, etc., is unacceptable.

In order to overcome the aforementioned challenges, we have to start with baby steps, and eventually, we will get to where we want to be with little resources invested. I suggest the following:

• Develop and implement a national infection prevention program.
• Integrate infection prevention and control measures in all the country’s healthcare facilities.
• The national healthcare leadership to take the lead and champion a comprehensive infection prevention program that covers all healthcare facilities.
• Establish national infection prevention and control guidance.
• Train and provide resources to healthcare workers who will run infection prevention programs in their healthcare facilities.
• Make it mandatory and a condition of employment for all healthcare providers to be trained on basic infection prevention measures.
• Build and strengthen capacity for a national hand hygiene program and incorporate it into the healthcare infection prevention strategy.
• Educate patients on ways they can contribute towards protecting themselves from acquiring hospital-acquired infections.

References

1. Glance, L, et al (2011, Mar 21). Increase in mortality, length of stay and cost associated with Hospital acquired infections in trauma patients. Retrieved on July 6, 2015 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3336161/

                2.  World Health Organization (no date). Prevention of hospital-acquired infections: A practical guide. Retrieved on July 7, 2015 from: https://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

                3. World Health Organization (2007, May). Improve hand hygiene to prevent healthcare-associated infections. Retrieved on July 7, 2015 from: https://www.who.int/patientsafety/solutions/patientsafety/PS-Solution9.pdf

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About the Author: Bakary M. Jallow, a Registered Nurse, holds a Bachelor's of Science in Nursing from Angelo State University and a Master's degree in Public Health from Texas A & M University, Texas. He is Board Certified in Infection Prevention and Control. 

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Why Are Many Gambians Dying Young? The series by the author

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