11 January 2014

Nigeria: 'How Medical Workers Pass Infections to Patients'


Zaria — Dr. Adamu U. Shehu, a Senior Lecturer at the Department of Community Medicine, Ahmadu Bello University (ABU), recently returned from the University of Aberdeen in the United Kingdom under the MacArthur Foundation where five of them went to study ABU's research potential on maternal, neo-natal health and other programmes. In this interview, he explains how medical workers contribute to infection in the course of their work. Excerpts:

You were recently on a two-week trip to the University of Aberdeen in the United Kingdom. What was it all about?

The visit was part of continuous collaboration between the Department of Community Medicine, Ahmadu Bello University and the University of Aberdeen. It is under the Macarthur Foundation Grant which followed a Memorandum of Understanding (MoU) signed by the University (ABU) and the Foundation. The Foundation is interested in making ABU's Department of Community Medicine a centre of excellence in maternal neo-natal health.

There is a research group in Aberdeen by name IMPACT. Already, its member, an academic staff, paid a similar visit [to ABU] in March this year (2013), where they understudied their research potential and output. You cannot talk of improving maternal and child health without referring to quality of service.

We are certainly concerned about infections control, especially in this part of the world where the leading cause of deaths among women is infection. So, that visit gave us an opportunity to understudy the Scottish patient safety programme, which revolves mainly around infections control, especially mothers and children.

We also visited some of their comprehensive maternity hospitals in some of their rural areas, where we saw what infections control is all about. I think it is a very positive visit because it would help us translate what we saw into our own local setting here.

We discussed with our teaching hospital, which mans the service component of our faculty to be able to duplicate what we saw at both Aberdeen Royal Infirmary, which is their teaching hospital equivalent, and one facility at Peter Head, which is their community service outreach.

So, essentially our visit was to look at some of these issues and also discuss some of the other research areas with aim of improving these two aspects of maternal and neo-natal health.

Also, part of the memorandum of understanding signed with MacArthur Foundation is to look at our Master's (degree) public health programme; that is MPH curriculum, to make that curriculum more competency-based, which will enable the graduands to function optimally in these areas with special emphasis on maternal and neo-natal health. We also during the visit discussed the possibility of rekindling our efforts towards reviewing our curriculum in line with the competency-based curriculum.

What is the scope of the collaboration between ABU and MacArthur Foundation?

It is basically to review our curriculum; it is also to ensure that we admit more postgraduate students in our MPH programme. There is a kind of grant under this collaboration from MacArthur that we give some MPH students who are interested in carrying out a research in these identified areas of maternal and neo-natal health.

There is also (a) patient safety programme, which will ensure that our hospitals are patient friendly; and that can be achieved through very close monitoring of infection cases and documenting the cases of infections observed during a specific period of time.

There is equally this issue of gender; that means we will need to admit more females into our postgraduate programme; and there is a special grant for us. Essentially, the grant is entrusted in strengthening Ahmadu Bello University Department of Community Medicine towards becoming a centre of excellence for maternal and neo-natal health.

ABU is supposed to increase the enrolment of MPH postgraduate students in the Department of Community Medicine. There should be more enrolment of females as compared to what it used to obtain before under the grant. And also there is need for academic staff from the department to undertake some trips to understudy what the IMPACT research group is doing in Aberdeen; and thirdly, there is also a grant to encourage research in these areas by students of Ahmadu Bello University, preferably at postgraduate level, provided the Department will strengthen its capacity as far as maternal and neonatal health is concerned.

For how long would ABU continue to benefit from this grant?

The initial grant is about a million dollars and (is) for a three-year period; and it is renewable at the end of the three-year period if there is a satisfactory performance from the Department. Also, with effective collaboration, the grant is renewable for probably another three years. But for now, it is a three-year grant, which is about N160 million.

Can you share with us some of the personal experiences you and your colleagues had at Aberdeen?

To summarize it all, I'd say I have been to a place where things work well. Like I told you, I was so excited when I visited their maternity hospital, which is equivalent of our rural comprehensive health centre and saw how they were managing antenatal cases and simple delivery cases.

They had an excellent level of infection control. The patient safety is of paramount importance to these people. The hospital we have been to at Peter Head, which is supposed to be a rural area in Aberdeen has all that is required to provide comprehensive obstetric care. The hospital has 100 percent infection safety control measure. In fact, they won an award in 2013 for that.

We have been to their Aberdeen Royal Infirmary, which is equivalent to a teaching hospital, purportedly is the biggest teaching hospital in Europe; and we understudied their Scottish patient safety programme. The package of that programme is so comprehensive that it can be, if we are serious, replicated to some extent in our setting. There were very simple basic things that we make sure that a patient that goes to the hospital does not get hospital acquired infection. They don't acquire new infections in their hospitals because there were simple basic implantable approaches.

What are the measures of achieving infection-free hospitals?

All that we require is change of attitude from our medical personnel. For instance, I was talking to one of their safety control men; he told me that even the dress you wear sometimes contributes to infection. So, they rarely use long necktie. You can imagine our doctors here and say they should not use long necktie. They either don't use necktie at all or they can use small tie. They don't need to use long sleeve shirts, they can use short sleeve because some of these things are agents of infections; and as long as you would contact your patients with some of these things you are likely going to transfer some of these infections to them.

There is some antibiotic jelly, which a person entering a ward is expected to rob his hands with. It is just like Vaseline; you rob your hands and by so doing you get rid of the micro-organisms that are responsible for some of these things.

In fact, even in your house you can buy that jelly and keep for infection control; so virtually each ward in the hospital has this jelly where you can just press and get some of it and rob your hands and go in before handling patients.

They also have facilities in other wards, which I found disgusting in our setting. Sometimes you go into our teaching hospitals, and we don't have water. There is what we call scrubbing; you must scrub whenever you are going to handle patients; you wash your hands with soap and water; in a situation where there is no water you can't scrub; so that emphasizes the need to probably use that jelly because it is not water dependent.

Hand washing is one thing you can do to prevent infection even at family level, especially after coming out of the toilet or touching odd things. Some of these basic fundamental things can be done even at rural level. Their record system, investigation and follow-ups are excellent. Like I told you five of us went; so these are some of the things that we really did while at Aberdeen. It was a two-week visit; and it was really a very exciting and rewarding travel.

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