The horror of hospital hygiene

2011-03-13 09:57

A potentially disastrous cocktail of faecal bacteria combined with an absence of soap and toilet paper could spark another outbreak of deadly disease at one of South ­Africa’s biggest hospitals.

Less than a year ago, hygiene control at the Charlotte Maxeke ­Johannesburg Academic Hospital (formerly ­Johannesburg General) was partly blamed for the death of six babies.

Now an undercover City Press investigation has revealed that conditions for another outbreak of ­potentially deadly disease at the hospital are again in place.

The investigation focused on ­hygiene in public areas of the ­hospital, as well as at Dr George Mukhari Hospital in Garankuwa, north of Pretoria, Gauteng’s ­second-largest hospital.

At Charlotte Maxeke we ­discovered:
» Faecal bacteria on walls and door handles in the casualty ­patients’ toilet and women’s toilet on the children’s floor, as well as around the patient washbasin in casualty, with a cockroach scurrying across the basin and wall;

» No soap or towels, and in some toilets no toilet paper at random times; and

» Some hand basins were rendered unusable, covered in plastic and taped up.

At Dr George Mukhari Hospital we found:
» Faecal bacteria on the wall tiles and edge of the hand basin in a ­general women’s ward and on counter surfaces in the dispensary waiting area; and

» An absence of toilet paper and soap in public and patient toilets.

City Press took swabs off surfaces that patients or visitors might touch when visiting the hospital.

We then contracted the Consulting and Analytical Services of the Council for Scientific and Industrial Research (CSIR) to test the swabs for the most common bacteria indicating a dirty environment.

Faecal bacteria is brought in on people’s hands and they should be able to wash them properly before touching patients or themselves.

Medical microbiologist Dr Org de Bruin, who has served on ­numerous infection control ­committees in the private and ­public sector, said it was alarming that people were not able to wash their hands properly.

“It is common sense,” said De Bruin; “70% of the dry mass of stool consists of bacteria. If you can’t wash your hands, you can undo the work of the best surgeons.”

The CSIR laboratory was not told where our numbered samples were taken from. Half the samples showed none of what we were ­looking for. The other half showed faecal bacteria and pseudomonas aeruginosa (see graphic above).

The bacteria occurred in places where we saw no soap or towels, near toilets without toilet paper.
George Mukhari chief executive Dr Trevor Fisher said that while some areas of the sprawling hospital had been modernised, others were old and difficult to clean.

He was confident, however, that his infection control and quality ­assurance teams had done a good job in minimising outbreaks, ­despite frequent overcrowding.

“In high-risk areas like the neonatal ICU we have two permanent security guards to restrict access and make visitors wash hands and put on protective caps,” he said.

The Charlotte Maxeke infant deaths report said it was not known how the virus had been ­introduced into the ward, but it could have come from “a mother, visitor or health ­worker”.

The report recommended attention be paid to “infection control practices such as hand-washing before and after each patient contact and use of alcoholic antiseptic spray”, and warned that “failure to attend to the matters . . . could ­result in further ­outbreaks”.

Professor Shaheen Mehtar, who heads the academic unit for infection prevention and control at ­Tygerberg Hospital and Stellenbosch University in Western Cape, said South Africa had good guidelines for hand hygiene, but the ­implementation was not monitored, nor were staff held accountable for not following protocol.

She said drying hands on clothing was no good and “driers make it worse” as they could scatter bacteria that had not been washed off.

“At R5 for about 50 squirts, ­alcohol spray is cheap if you ­consider that a serious infection could cost up to R250 000 to treat in hospital,” she said.

The health department’s spokesperson, Fidel Hadebe, said the absence of soap and ­towels was unacceptable. It was not just about what happened in the wards, but in the wider hospital ­environment ­outside wards, he said.

» At the time of going to press, Charlotte Maxeke had not responded ­despite being asked for comment since Monday – ­Additional reporting by ­Lebogang Mabusela

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