Inadequate Minimal Hygiene

It is recommended that all medical staff wash their hands before and after all hands-on medical examinations and procedures. Yet, in the many years i have been at Teaching Hospital i have never seen a doctor wash their hands whilst on ward rounds. They examine a patient and go right ahead onto the next, completely oblivious to the fact that they are aiding in the transmission of nosocomial pathogens. 

Not only does the hospital administration seem to disregard the shortcomings by its staff failing to meet the the most basic of medical practices they have gone as far enough as to close off the hand washing basins that are present in wards and public cabins. I cannot help but contemplate in abhorrence how the country’s most coveted tertiary hospital seems to blatantly disregard the safety and well being of its patients by putting them in harms way. 

The administrators of the hospital must ensure that patient well being and safety is prioritized by demanding all medical staff follow the most basic practices like ensuring adequate hand hygiene before and after each hands-on interaction. 

It saddens me that the TUTH administration does not have the foresight to realize that by demanding its staff follow sufficient hand hygiene, it will actually lessen the burden of nosocomial infections. A simple act as washing their before and after hands-on interactions will lessen the burden of disease on patients and make the hospital more efficient as it will redistribute medical resources to areas it is most demanded. 

DOs and DONTs of sharps disposal

DOs and DONTs of sharps disposal 

Unsafe disposal of sharps

Used needles and other sharps are dangerous to people if not disposed of safely because they can injure people and spread infections that cause serious health conditions.

The following picture was taken at one of the In-patient wards on the 3rd of April 2014. 

At first glance, the picture is as it appears...

What you see is a hypodermic needle lying on the floor beside a patients bed. There is only once place that suits a used needle, and that is a sharps bin. 

The hospital administration must ensure that medical staff have safe disposal for all sharps and that all medical staff are educated about the importance of proper disposal of sharps. Failing to educate the hospital staff of safe disposal of hazardous waste which puts patients and hospital staff in harms way falls under medical negligence. 

Sharps Disposal

“Sharps” is a medical term for devices with sharp points or edges that can puncture or cut skin.  

Examples of sharps include:

Needles – hollow needles used to inject drugs (medication) under the skin

Syringes – devices used to inject medication into or withdraw fluid from the body

Lancets, also called “fingerstick” devices – instruments with a short, two-edged blade used to get drops of blood for testing. 

Auto Injectors, including epinephrine and insulin pens – syringes pre-filled with fluid medication designed to be self-injected into the body

Infusion sets – tubing systems with a needle used to deliver drugs to the body.

Connection needles/sets – needles that connect to a tube used to transfer fluids in and out of the body. 

Importance of safe disposal 

Used needles and other sharps are dangerous to people and pets if not disposed of safely because they can injure people and spread infections that cause serious health conditions. The most common infections are:

Hepatitis B (HBV),

Hepatitis C (HCV), and

Human Immunodeficiency Virus (HIV).

Safe sharps disposal is important whether you are at home, at work, at school, traveling, or in other public places such as hotels, parks, and restaurants.

Never place loose needles and other sharps (those that are not placed in a sharps disposal container) in the household or public trash cans or recycling bins, and never flush them down the toilet. This puts trash and sewage workers, janitors, housekeepers, household members, and children at risk of being harmed.

Improper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually. For each year, these infections are modeled to cost society over 270,000 lives between 2000 and 2030.

Extreme care must be taken in the management and disposal of sharps waste. The main goal in sharps waste management is to safely handle all materials until they can be properly disposed. From the moment sharps waste is produced, it is to be handled as little as possible. Health care workers are to minimize their interaction with sharps waste by disposing of it in a sealable container. The self-locking and sealable containers are made of plastic so that the sharps waste can not easily penetrate through the sides. The unit is designed so that the whole container can be disposed of with the other bio-hazardous waste. Single use sharps containers of various sizes are sold throughout the world.

References- 

1- www.fda.gov

2- The cost effectiveness of policies for the safe and appropriate use of injection in healthcare settings, WHO, Dziekan et al

3- http://en.wikipedia.org/wiki/File:Sharps_Container.jpg

Ingenuity, Innovation and cost-effectiveness

One of the things i recall from when i was small was how expensive wheelchairs are. I remember how often wheelchairs would be donated by donors from more affluent parts of society and the world, to nursing homes, orphanages and hospitals. 

I am exposed to a lot of things at Teaching Hospital. I wanted to show and share with you one such thing I’ve come across.

This is a picture of one of the wheelchairs that is used at Teaching Hospital. I marveled at how innovative and ingenious this wheelchair is. To use a plastic chair attached to a steel frame. 

An unfortunate reality in the third world (including Nepal) is the lack of an effective support system for those with special needs. But with a great deal of ingenuity and innovation and a little bit of money, a successful support system can be introduced and maintained. 

This wheelchair is proof of that!

Hospital incinerator at TUTH

Incineration is a high-temperature dry oxidation process that reduces organic and combustible waste to inorganic, incombustible matter and results in a very significant reduction of waste volume and weight. This process is usually selected to treat wastes that cannot be recycled, reused, or disposed of in a landfill site. 

The combustion of organic compounds produces mainly gaseous emissions, including steam, carbon dioxide, nitrogen oxides, and certain toxic substances (e.g. metals, halogenic acids), and particulate matter, plus solid residues in the form of ashes. If the conditions of combustion are not properly controlled, toxic carbon monoxide will also be produced. The ash and wastewater produced by the process also contain toxic compounds, which have to be treated to avoid adverse effects on health and the environment.  

Incineration of waste materials converts the waste into ash, flue gas and heat. The ash is mostly formed by the inorganic constituents of the waste, and may take the form of solid lumps or particulates carried by the flue gas. The flue gases must be cleaned of gaseous and particulate pollutants before they are dispersed into the atmosphere.   

Incineration is unquestionably effective but it is associated with serious air quality concerns. Because atmospheric oxygen is used as the reagent, a large volume of air must constantly pass through the system. Unless the exhaust air passes through a control device, all substances that are volatile at the operating temperature of the system will be emitted with the exhaust stream. For example, hospital incinerators were once significant sources of environmental mercury contamination. In addition, the operating conditions inside incinerators can lead to the formation of organochlorine compounds such as dioxins. 

The location of an incinerator can significantly affect dispersion of the plume from the chimney,  which in turn affects ambient concentrations, deposition and exposures to workers and the community.  In addition to addressing the physical factors affecting dispersion, siting must also address issues of permissions/ownership, access, convenience, etc. Best practices siting has the goal of finding a location for the incinerator that minimizes potential risks to public health and the environment (EPA 

1997). 

This can be achieved by: 

• Minimizing ambient air concentrations and deposition of pollutants to soils, foods, and other 

surfaces, e.g., 

1- Open fields or hilltops without trees or tall vegetation are preferable. Siting within 

     forested areas is not advisable as dispersion will be significantly impaired. 

2- Valleys, areas near ridges, wooded areas should be avoided as these tend to channel 

    winds and/or plumes tend to impinge on elevated surfaces or downwash under some 

    conditions. 

• Minimizing the number of people potentially exposed, e.g., 

1- Areas near the incinerator should not be populated, e.g., containing housing, athletic 

    fields, markets or other areas where people congregate. 

2- Areas near the incinerators should not be used for agriculture purposes, e.g., leafy 

    crops, grasses or grains for animals. 

The following picture is of a incinerator located at the Teaching Hospital in Maharajgunj. The picture was taken from the pediatric ward of the hospital. On multiple occasions i have experienced the thick plume from the chimney make its way into the pediatric ward, at which point the nurses and the relatives of the patients close the windows. Its unfortunate the incinerator is not ideally located and the children at the pediatric ward are those that suffer the most. I urge the hospital administration to address this issue swiftly and decisively. 

References-

1- 'Treatment and disposal technologies for health-care waste’, www.who.int

2- www.hercenter.org

The Water supply

"Turbidity is a measure of the cloudiness of water, and an indication of filtration effectiveness. Cloudy water is a sign of the presence of microorganisms that can cause gastrointestinal illness. Although controlled at the original filtration source, soil runoff and other factors can affect turbidity levels by the time water reaches a faucet". 

www.freedrinkingwater.com 

A clean water supply in a hospital is of immeasurable importance. The following picture was taken a few weeks ago at the Dental OPD of the TUTH. 

I received these pictures a few weeks ago and i decided to add them to this blog because they show a grave shortcoming. I was informed that the brown water flowed for nearly half an hour and a few dentists were forced to wash their hands in this water after the dentists had completed the procedures. 

I urge the hospital administration to ensure clean water to be supplied throughout the hospital. And where infrastructure is lacking, they should be introduced.