Browsing by Author "Kansiime, Jackson"

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    919 Routine Hospital Acquired Infection surveys are feasible in low income health care settings and can inform quality improvement interventions
    (Oxford University Press, 2014) Ochola, Emmanuel; Okello, Tom Richard; Kansiime, Jackson; Praticò, Liliana; Greco, Donato
    Background. Prevention of acquisition of infection in the health care setting is imperative for reduction in morbidity and mortality for patients and health workers and improvement health care quality. However, data is scarce on prevalence and trends of hospital acquired infections (HAI) in low income settings, unlike in developed countries. We instituted annual surveys to determine HAI prevalence and determinants in a hospital in Gulu, Northern Uganda, an area recovering from over 20 years of war. Methods. An external expert mentored local hospital staff at the request of the Board, to do HAI surveys for 2 years after which a local team continues the exercise. Using standard WHO checklists. A one-day survey is done, recruiting all patients admitted in the hospital for 48hours or more. Data is collected by doctors and nurses on demographics, new diarrhea, Urinary Tract Infections (UTI), respiratory conditions, wound infection and intravenous catheter infections that were absent during admission. Urinalysis was done to confirm UTI. Results were analysed using SPSS, reporting basic statistics and p values of chi square tests comparisons. Results. A total 1174 clients were surveyed in four years, average 293 per survey. There was a 56% decline in HAI prevalence from 28% in 2010 to 14.2% in 2011 (p < 0.0001). Prevalence of HAI was 15.1% in 2013 and 14% in 2014. In different years, the key hospital acquired infections included UTI accounting for 39% (21.5-55%) of the total HAI, intravenous line infection 27% (18.2-30.4%), respiratory tract infections, 17.5% (5.5-25.5%), and surgical wound infections, 16.0% (8.7-20%). In 2013 which had UTI at 58%, UTI was present in 53.3% of catheterized clients, compared to 14.8% in 2011. Conclusion. The HAI surveys are practical, and feasible to perform, even in poor settings. The surveys prompted the institution of the hospital infection control committee. HAI surveys can generate glaring gaps, which when intervened on, like urinary catheter overstay, poor wound care, duration of iv lines, and hand washing practices, can improve care quality. The surveys can suggest corrective actions for good care practices. Nevertheless, prevention of HAI needs continuous efforts of all health workers.
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    Invasive procedures and Hospital Acquired Infection (HAI) in A large hospital in Northern Uganda.
    (East and Central African Journal of Surgery, 2014) Okello, Tom Richard; Kansiime, Jackson; Odora, J.
    Background: Hospital Acquired Infection (HAI) increases morbidity, mortality and decreases quality of life of patients. It also increases the cost of patient care, both direct and indirect, through the need for additional and expensive drugs, laboratory and other diagnostic test. Lacor hospital which, carries-out on average 16 major surgical operations per day and has C/section rate of 14% could provide a conducive hub for HAI unless it strictly adheres to universal procedure and Standard precautions. Hence there is need to continuously monitor HAI rate for all invasive procedure done in the hospital. Methods: Through a across sectional descriptive study done in March 2014 on all in patients in the hospital to determine HAI rates. Using WHO standards, HAI was determined in the following invasive procedures; intravenous line sepsis, surgical site infection, urinary tract infection, Lower respiratory tract infection. Data collected was entered and analyzed using SPSS version 15. Results: Approximately 129 patients fulfilled the WHO inclusion criteria for HAI survey out of which, 18 patients (14%) were found to be having HAI as according to WHO guideline. Of the 18, 10 had been catheterized and there was a significant correlation between catheterization and HAI (r=0.319, P=0.00) but Urinary tract infection (UTI) rate in hospital was 38%. The rate of surgical site infection (SSI) was 21.9% and there was significant correlation between surgical intervention and development of HAI (P value of 0.003, r=0.259). However, only 3 (3%) of the patients with intravenous (IV) line had IV line infection and the average duration of IV line in-situ in the hospital was 2.4days. Conclusion: Overall the HAI in Lacor hospital is 14% and is comparable to the levels seen in other regional facilities. Many hospitals can monitor their rate of hospital infection rate and use it to improve quality of services. Recommendation: All health facility should have an infection control committee which monitors rates of hospital acquired infection at least once a year and disseminate for critical reflection and decision making.