Wednesday, May 18, 2011

Low Figures for Hospital Acquired Infections Due to Lack of Research

The UN development news agency IRIN has an article entitled 'For want of a mask', about TB in health workers. Masks are cheap, but vital, to comply with all sorts of procedures. So why would health workers lack something so basic, something that can protect both health workers and patients?

The Service Provision Assessment for Kenya, produced by Demographic and Health Surveys, shows that masks are not all Kenyan health facilities lack. Running water is available in about half of all facilities, soap in 70%, latex gloves in 87%, sharps disposal box in 73% and chlorine solution in only 28% of facilities.

That's 15% who have all items for relevant service areas. When it comes to stocks of infection control items,things little better. While 89% have high level sterilization equipment, bleach and injecting equipment, only half have latex gloves and only 40% have all items in stock. So only 3% of Kenyan facilities have everything they need.

So it's not just TB infection that people need worry about, there are also blood borne infections, such as HIV, hepatitis and bacterial infections, amongst others. But TB is exceptionally high in Kenya considering it is so commonly associated with HIV. Because, while Kenya is fifth highest in Africa for TB burden, HIV prevalence there is a lot lower than in the five highest HIV prevalence countries.

The article on TB makes it clear that even where safety supplies are lacking, health services still have to be supplied. Health personnel and patients face considerable risks of being infected through the health facility and health related procedures, testing, treatment or preventative, rather than through normal person to person contact.

Apparently supply chains, funding, management, theft and corruption have all been blamed for shortages. Drugs also, are said to be in short supply, for similar reasons. Equipment, drugs and other items can even be sold off to private pharmacies.

In addition to shortages of supplies, there is also the problem of use. Even when masks are available they are not always used. Some supplies may be misused, with gloves and perhaps other items being reused. That certainly happens in wealthy countries, where such matters are routinely investigated, so it would be unsurprising if it didn't happen in destitute countries.

An article on safe injection practices finds that there have been 30 infectious disease outbreaks in the last ten years in the US and they call for education, research and better products to ensure safe injection. More than 125,000 patients have been notified about potential exposure due to reuse of syringes.

Even if injection equipment reuse in Africa was only as high as that in the US, that would mean about 400,000 people could have been exposed. But the number notified, apparently, is zero. Not only do Africans not get recalled under such circumstances, but injection reuse hardly ever occurs in African countries, according to UNAIDS and others. And that is despite the figures from the Kenyan Service Provision Assessment, cited above.

Given conditions in Kenyan health facilities, I think it is fair to say that there is far more scope for hospital transmitted infection there than in the worst US hospital. I can't cite any research to back up that claim because virtually no research has been done on infection control in African countries. And that's what makes me question the figure UNAIDS gives for the contribution of unsafe health care to Kenya's HIV epidemic, 2%. Where is their research?


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