Difficulty in controlling infections in hospitals

(Baonghean) -Overcrowding, degraded facilities, and failure to meet the needs of medical examination and treatment are common conditions in public hospitals in Nghe An province today. This worrying situation is the cause of the risk of cross-infection of infectious diseases to patients. Limiting hospital infections to ensure the safety of patients, medical staff and the community is a major challenge for hospitals.

Risk of cross-contamination

The Department of Infectious Diseases of Nghe An Obstetrics and Pediatrics Hospital, one of the departments that regularly gathers a large number of patients; on average, there are dozens of diseases, including some diseases that spread quickly such as measles, hand, foot and mouth disease, chickenpox, meningitis... With a small area, degraded facilities, the whole department has only 1 toilet, each bed has 2-3 children sharing, the corridor is less than 2m wide and has to add more beds, the space is always stuffy. Patients with different diseases are lying together, so the risk of cross-infection is inevitable.

The corridor of Nghe An Obstetrics and Pediatrics Hospital has become a sick room, so the risk of cross-infection is inevitable.

Similar is the case of Nguyen Thi Ngoc Anh from Giang Son Dong - Do Luong, who was admitted to the Respiratory Department to be treated for a respiratory illness but had to return because she later contracted measles and severe pneumonia. Her family said that 3 days after being discharged from the hospital, she developed a high fever, cough, red rash, and heavy breathing; she had to return to the hospital and be treated in the infectious diseases department. There are patients with diarrhea caused by Rotavirus, who, after being cured of diarrhea for a few days, had to be hospitalized again due to measles.

The risk of cross-infection in hospitals is explained by many reasons, but the most basic reason is the limitation of facilities. The Department of Infectious Diseases, Obstetrics and Pediatrics Hospital, after 20 years of use, has degraded facilities, while the number of patients is constantly increasing. According to the design, the department has 7 patient rooms, each room has 3 beds, but now each room has 4-5 beds. According to regulations, the infectious disease department of hospitals must be arranged separately from other departments and within the department, different diseases must also be isolated. The bed quota of the Department of Infectious Diseases, Obstetrics and Pediatrics Hospital is 35 beds, but currently the patient flow is always at 60-70 patients, at peak times up to 120 patients. At this time, measles is developing complicatedly, must be isolated and not brought out into the hallway. However, measles patients at Nghe An Obstetrics and Pediatrics Hospital do not have the conditions to be isolated in separate rooms, and even have to lie in the hallway, making infection control even more difficult.

Doctor CKII Nguyen Van Son - Head of the Department of Infectious Diseases, Obstetrics and Pediatrics Hospital said: In fact, the department is very overloaded, the facilities are limited, so it is impossible to properly implement infection control regulations. Although hygiene and disinfection are still maintained regularly, the risk of cross-infection is difficult to avoid. Because infectious diseases caused by viruses and bacteria are often spread through the environment. The only way to reduce the patient load is to discharge patients when the disease is in the remission stage, and treat them as outpatients." Doctors also recommend: When taking children to the doctor, to avoid cross-infection from other sources of disease in the hospital, the person going to the doctor and the pediatric patient should wear a medical mask and wash their hands with antibacterial soap.

Difficult to find a solution

There are currently 29 public hospitals in the province, including 12 provincial hospitals and 17 district hospitals, but only 7 hospitals: Maternity and Pediatrics Hospital, Psychiatric Hospital, Tay Bac General Hospital, Tay Nam General Hospital, Quynh Luu General Hospital, Nghi Loc, Tuberculosis and Lung Hospital have established an infection control department, while the remaining units have just established an infection control team. The Provincial General Hospital is one of the few medical units in the province that has a hospital infection control department. The department has established a team to inspect and remind medical staff to comply with disease control regulations in the hospital such as: wearing masks, protection, sorting dirty linen into separate bags... The department has 32 employees in charge of monitoring, fabric treatment, laundry, waste treatment... On average, more than 1 ton of linen is steamed and dried in the department every day. Although infection control work is carried out regularly, the department recommends preventive measures; patients will be classified when admitted to the hospital. However, the construction of the hospital's input and output treatment systems (doors for bringing in and out treatment items) is still shared, not in accordance with regulations. In addition, the most difficult thing at present is still the large number of patients and overload.

In fact, at the Tropical Diseases Department, the hospital has the most patients with a variety of diseases such as cholera, dysentery, diarrhea, liver disease, meningitis, etc. On average, there are 65 patients (at peak times, there are up to 110 patients) but there are only 45 beds. According to Master - Doctor Que Anh Tram - Head of the Tropical Diseases Department, Provincial General Hospital, in addition to implementing disinfection measures (under the support and supervision of infection control staff), the department also makes great efforts to classify and isolate patients with the same disease. There are cases where 2 - 3 patients have to be placed in one bed to make room for isolation of other patients (with contagious diseases). However, these diseases are often spread through the environment, through contact with the air, so cross-infection is inevitable. For example, patient Nguyen Thi Kiem (Thanh Thuy - Thanh Chuong) was admitted to the department and diagnosed with sepsis, meningitis, pneumonia, and after a period of treatment, she developed additional symptoms of measles. According to doctors, patients suspected of being cross-infected with this disease are more difficult to treat, and their response to treatment is also worse, so they have to stay in hospital for a longer period of time.

According to the provisions of Circular 18/2009, on the guidance on the organization and implementation of infection control in medical examination and treatment facilities of the Ministry of Health, the form of organization, infrastructure, and equipment for infection control work are clearly stipulated. However, in public hospitals in our province, ensuring compliance with the guidance of Circular 18 is very rare. According to Ms. Le Thi Hong Son, Deputy Head of the Medical Affairs Department, Department of Health, said: "The Department of Health organizes many training courses, training staff and source lecturers on infection control. The system of departments and infection control teams has been established and the hospital infection control network has gradually developed.

Infection control work has achieved initial results, but has not met the requirements. Although hospitals have established infection control councils and teams, they are mainly part-time so the efficiency of operations is not high. In addition, mainly hospitals have proactively invested in purchasing equipment, inspecting and supervising infection control at hospitals, but the infrastructure has not yet met the needs. Meanwhile, public hospitals are still overloaded up to 200%". The problem of hospital overload does not only occur in provincial hospitals but some district hospitals are also facing this situation such as: Nghi Loc General Hospital, Dien Chau, Quynh Luu, Anh Son... This increases the risk of cross-infection in the hospital environment.

Hospital infections are one of the top challenges and concerns in Vietnam as well as around the world, because these are infections acquired during the time patients are hospitalized. However, many studies show that hospital infections can be prevented through hospital infection control programs. Because a good hospital infection control program will introduce standards of quality care into clinical practices, helping clinicians limit the risks of care leading to infection. Hospitals must develop procedures related to infection control. This work requires the synchronous participation of members in the hospital. Importantly, to effectively implement hospital infections, it is necessary to limit overload, adjust bed quotas, and meet infrastructure and human resources. Patients entering the hospital must receive comprehensive care, only then can infection control be effectively implemented.

Dinh Nguyet - Thanh Le