Hospital infections breeding ground for drug resistance

After undergoing surgery to treat various conditions, patients usually look forward to getting well and being discharged from the hospital fast.

But that was not the case for Richard Otieno who underwent an operation to treat a leg fracture that resulted from a fall.

"I thought I would recover fast after the surgery. But a few days later, I developed a severe infection on the wound that kept me in hospital for months. The pain was too much. At some point, I actually thought I would lose my leg," he said.

Wound infections are common in health facilities, especially in overcrowded and understaffed hospitals where patients lack quality care.

This leads to the frequent use of antibiotics to treat infections that could have easily been prevented through proper wound management.

According to the World Health Organisation (WHO), such challenges contribute immensely to the overuse of antibiotics in hospital, which eventually leads to antibiotic resistance.

"When bacteria are exposed to certain antibiotics frequently, they get accustomed to the drugs and find ways of resisting them," said Evelyn Wesangula, Head of the Antimicrobial Resistance Programme at the Ministry of Health (MoH).

Antibiotic resistance results in decreased ability to treat infections and illnesses in people. This can lead to elevated human suffering or death, as well as increased cost and length of treatment.

Worse still, when patients are exposed to powerful antibiotics after milder ones become ineffective due to resistance, they end up with severe side effects that are detrimental to their health.

Due to the overuse of antibiotics in hospitals, numerous global studies show that some of the most virulent drug resistant bacteria originate from healthcare facilities before spreading to the wider population.

Locally, a recent study published in the Annals of African Surgery Journal compared bacteria types in wounds of patients with open fracture injuries before and after hospital admission at a major Kenyan public health facility.

The research, titled Early Bacterial Cultures from Open Fractures — Differences Before and After Debridement — revealed that out of the 98 patients assessed 52 per cent developed wound infections while at the facility. Laboratory tests showed that most of the wounds had infections caused by new bacteria that were different from the ones present when the patients were admitted.

Some of these bacteria were found to be more virulent and difficult to treat. They were less sensitive to commonly used antibiotics.

"We can see that a lot of patients are getting infections while at the hospital. This means that we need to do much more to prevent this from happening in our health facilities," said Fred Sitati, lead author of the study and a consultant orthopaedic surgeon based in Nairobi.

He stated that maintaining cleanliness at hospital environments as well as equipment could help reduce the infections.

According to Dr Wesangula, basic infection prevention and control measures such as hand hygiene can reduce hospital-acquired infections by 80 per cent, hence cutting down on the unnecessary use of antibiotics. "It’s really simple. Health workers just need to ensure that they wash hands with soap or a disinfectant before attending to a sick person or when they are moving from one patient to another,” Dr Sitati said.

He said that hospitals need required medical supplies at all times to enable them give quality care to patients and avert infections.

"With limited resources like a few nurses or wound dressing materials, there may be delays in cleaning patients’ wounds. This increases the infection rate."

Dr Sitati said that diet also plays a key role in infection prevention.

"If you eat well and get a balanced diet your body will have the right type of nutrients that will make wounds heal fast.

This will reduce hospital stay hence lowering infection risks and the need for antibiotics." In instances where antibiotics have to be used, Dr Wesangula noted that health workers should abide by recommended treatment guidelines to ensure that drugs are administered in the correct way hence forestalling resistance.

"You need to have enough antibiotics. If there are stock-outs then patients will end up not getting sufficient doses of the medicine. This leads to antibiotics resistance."

It is a common practice for hospitals to administer broad-spectrum antibiotics to patients suspected of suffering from bacterial infections.

Such treatments expose all bacteria in the body — not just the ones causing an illness — to antibiotics thus making it easy for the bacteria to acclimatise to the medicine and find ways of resisting it.

"To tackle this challenge, hospitals should invest in the construction of quality laboratories that can confirm disease causing bacteria before treatment is administered,” said Dr Wesangula.