The Ebola Virus Disease (EVD) imported into the country in July showed the high risk health workers are exposed to. The index case, the late American-Liberian Patrick Sawyer, infected several health workers, including the late Dr Stella Adadevoh. How can health workers tackle infections? This was the thrust of a two-day training in Lagos. OYEYEMI GBENGA-MUSTAPHA reports.
Prof Agbaje Onini (not real names), a Consultant Paediatrician at the Lagos University Teaching Hospital (LUTH), Idi-Araba, with over 20 years experience, had a close shave with HIV when a two-year old child living with the virus was brought for treatment.
There was the need to take some blood samples for analysis and the determination of the viral load. The resident doctor and the nurses had a huge task of obtaining the sample because the child was throwing tantrums. At a point, the needle was inserted into the arm of the child, but the vein was missed. The needle with some blood was withdrawn.
Prof Onini, drawing from his experience, then offered to calm the child, to facilitate the drawing of the blood sample. He succeeded. He held her arm, asked the mother to hold her well and beckoned on the resident doctor to take the sample. As the doctor was about inserting the needle, after ascertaining the point of the vein, the child, obviously scared of the needle, jerked its arm twisted her body, and the blood stained needle went into the professor’s arm.
He immediately washed his hands and other skin surfaces, and observed other Post-Exposure Prophylaxis (PEP), which involved taking anti-HIV medications. A few weeks later, he went for screening and, luckily, he tested negative to HIV.
A Professor of Medical Microbiology and Parasitology, Prof Folasade Ogunsola, said that was a close shave.
“For the consultant paediatrician should have asked the blood stained needle to be discarded, in a provided box, not minding the cost of purchase and go for a new one. And in spite of his wealth of experience and exposure, he skipped some global best practices,” said Prof Ogunsola.
Mrs Ogunsola, the Provost, College of Medicine, University of Lagos (CMUL), said occupational transmission of infections to health care workers is common because fewer people observe infection control guidelines in their workplaces.
Speaking as a resource person at the two-day workshop for healthcare practitioners drawn from across the country, on global best practices, Mrs Ogunsola told the participants: “As a health care worker, you may be exposed to many sources of infection. Infections may be transmitted by blood, body fluids, air, respiratory secretions or by direct contact with other infectious materials. You can protect yourself from infection by following the infection control guidelines in your workplace, by using personal protective equipment (such as gloves and masks) and by treating all blood and body fluids as though they are infectious.”
According to her, diligence in the following areas is needed to help reduce the risk of occupational transmission of infections to health care workers.
She said: “Administrative efforts are needed. Here in Nigeria, some infection control guidelines are not put in place in some workplaces. And sometimes, when these provisions are made, they got stolen or vandalised out of ignorance or sheer carelessness. Hence, all health care organisations should train health care workers in infection control procedures and the importance of reporting occupational exposures. Organisations should develop and distribute written policies for the management of occupational exposures.
“Development and promotion of safety devices should be prioritised. Effective and competitively priced devices, engineered to prevent sharps injuries should continue to be developed for health care workers who frequently come into contact with, for example potentially HIV-infected blood. Proper and consistent use of such safety devices should be continuously evaluated.
“Monitoring the effects of Post Exposure Prophylaxis (PEP) is important. Data on the safety and acceptability of different regimens of PEP, particularly regimens that include new antiretroviral agents, should be monitored and evaluated continuously. Furthermore, health professionals who administer PEP should communicate possible side effects before treatment starts and should follow patients closely to make sure they take their medicine correctly. Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting.”
The convener, Dr Efunbo Dosekun, president of Anu Dosekun Healthcare Foundation, spoke on part of the reasons for the event, with the theme: ‘Introductory workshop on infection prevention and control’ said: “Though these recommendations by Prof Ogunsola focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting.
Dr Dosekun said: “Healthcare personnel (HCP) refers to all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures. HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients.
“Simple life-saving techniques of hand washing, cleaning with bleach or disinfectants are fast fading away. That is why, more HCPs are contracting infection. It is amazing how people don’t protect themselves again from airborne and aerosol diseases. As a health care worker, you may be exposed to many different sources of infection. Infections may be transmitted by blood, body fluids, air, respiratory secretions or by direct contact with other infectious materials. You can protect yourself from infection by following the infection control guidelines in your workplace, by using personal protective equipment (such as gloves and masks) and by treating all blood and body fluids as though they are infectious. This workshop discusses some of the infections that may be transmitted at workplaces and ways HCP can avoid getting them. And what to do when exposed.”
She said the basics are: “Consider every patient to be infected and avoid contact with his or her blood or body fluids. Avoid risky behavior when using needles and other sharp instruments (including scissors, scalpels, blades and knives). For example, do not attempt to recap needles. Carefully dispose of sharp instruments in appropriate contain, (including gloves and face shields), to avoid getting blood on your skin or in your eyes when you are performing procedures that may cause splashes or spills. And be certain you are immunised against hepatitis B. Get tetanus vaccine as well. This vaccine should be offered to you in your workplace.”
