As a budding infectious diseases specialist I am interested in infection prevention. I am doing a two month rotation at The Fevers Unit at Korle-Bu Teaching Hospital in Ghana. It’s a separate building on the campus where people with HIV/AIDS are taken care of. The focus of my rotation is to get more experience taking care of patients with HIV/AIDS. I didn’t realize I would get a lesson too in the lack of isolation precautions at Korle-Bu. I have mentioned before the disturbing realization that malaria is a hospital acquired infection due to lack of mosquito nets.
The Fevers Unit is also the ward for other isolation patients but not those with pulmonary tuberculosis. They are in the Chest Clinic, another stand-alone facility. We have had one tetanus patient in the time I’ve been here. The outcome was fatal. The teen presented a couple of weeks after his injury, a puncture wound by a stick through the sole of his foot. The skin over the wound had already healed. He presented with lockjaw and muscle spasms especially of his back. He deteriorated quickly with worsening spasms and autonomic symptoms. I couldn’t believe there was not a single vial of tetanus immunoglobulin to be had. Of course, a mechanical ventilator to protect his airway was out of the question. So here’s my public service announcement: Tetanus is completely preventable so everybody must get booster vaccination every 10 years to ensure maintenance of adequate anti-toxin levels in the blood!
There is an outbreak of varicella zoster (chicken pox) on one of the medical wards. They have decided to house a few of the afflicted patients in the Fevers Unit. But there are no isolation rooms per se here let alone negative pressure rooms. No-one wears personal respirators not even in the Chest Clinic. Isolation gowns do not exist. At least gloves are used…at times. And what do you mean hand hygiene? Isn’t that what the gloves are for?
It doesn’t make sense to cohort patients with active chicken pox with immunosuppressed HIV/AIDS patients. Who else is more at risk for infection if not them? Time for another MKSAP lesson. Varicella zoster is spread by both contact and airborne routes. Fomites carry the virus and dust particles containing them are suspended in the air for hours and can travel widely. Thus to prevent nosocomial spread, both contact and airborne precautions must be used.
An unforeseen lesson from my time at Korle-Bu so far is that the burden of health-care associated infections is high. Doctors, nurses, and other healthcare workers who are not protected from the contagions the patients carry, patients not being protected from each other, and infrastructure that puts patients at risk for infections all a few culprits. In my discussions with my fellow medical officers, infection control and antibiotic stewardship is the least of their medical concerns. That needs to change. I can see that it will be a challenge to provide adequate infection control in such a resource-poor setting. But it doesn’t mean we cannot try.
Leave a Reply