Bad practices

Way back during my training, we were sent to the Island Maternity hospital in Lagos for a labour ward posting. This was sometime in the late 80’s before we left medical school. I swear we were sewing women up with used needles from a big bowl in the labour ward. The bowl was filled with blood and Dettol antiseptic solution. You need to imagine this and visualise the dirty concoction in which the needles were kept.

Okay, if this was way back then, can you believe it is still happening now? In public and private hospitals! In 2016 and in Abuja, FCT! Let me explain this properly.

Episiotomy

Sometimes when women are delivering babies, there may be a tear of the vagina or sometimes doctors and midwives deliberately cut the wall of the vagina to ease the passage of the head of the baby. A deliberate cut by the doctors is called an episiotomy. So an episiotomy is a surgical incision made in the area between the vagina and anus (perineum). This is done during the last stages of labour and delivery to expand the opening of the vagina to prevent tearing during the delivery of the baby. The area we cut then needs to be sewn up again. Did you get that?

The sewing is done by midwives in some places and by doctors in other places. It is often done by junior doctors in many situations as it is considered beneath the consultant. I was taught how to do it by a midwife and then you are told to get on with it. There are usually a few women waiting for this procedure after the delivery of their baby! It is often done late and done in a hurry to get through the waiting list of screaming women!

Big bad job

Therefore, it is often a job not done properly! It is also one area where hygiene is thrown to the winds. Not done in an aseptic manner means we can cause minor or even serious infections for the mother. It is likely we were ‘inadvertently’ infecting women with hepatitis and HIV that many years ago at the Island Maternity Hospital! If you can see through the mirror, you can therefore imagine that with the mother infected, the baby can get infected through the milk and the father, of course, through sex later on.

Of course, if it not sewn properly and the tissue of the vagina lined up edge to edge, it can lead to a lax vagina or perhaps even a vagina that is too tight causing problems later. Some cuts can be so bad that it leads to a weak anus and inability to control the passage of stool. This can become a serious and permanent problem for the woman.

Poor sterilisation techniques

Another major area of concern is also the actual sterilization of equipment used in our hospitals. Many hospitals do not have a working sterilization unit. In fact, a hospital in Enugu uses a cooking pot and a stove to boil equipments used in theatre. Unbelievable! This is why many patients develop broken, gaping and infected wounds in many of our public hospitals.

Some hospitals and doctors even reuse gloves and other materials especially plastic that costs so little and should be discarded after each patient. Many hospitals and most especially government hospitals reuse items expressly SPECIFIED as single use only. These are cleaned, washed under the tap and dumped into antiseptic solution for use later, on as many patients as they can, before the equipment gives up the ghost.

Don’t reuse needles

Are you using unsterile needles and syringes on your patients? What does a new needle cost that you have to reuse them? This practice must be investigated by the regulatory bodies and stopped. It is likely to be increasing the incidence of HIV and hepatitis in the community apart from the obvious high risk to life and limb for all concerned. All doctors and nurses need to take stock today and review their practices and actively prevent infections.

Blow the whistle

If you are going to a crummy hospital and you close your eyes to the dirty environment, well, it might end up in your wound. If you are not aware, you may end up paying for much more than you bargained for! The fact is that often the environment of the hospital, the level of cleanliness on the wards and its surrounding areas are a very good clue to the level of hygiene in theatre and the care in general.

Nurses, midwives, doctors and even cleaners in hospitals need to review these types of bad practises and blow the whistle on the hospitals. The first thing to do is to point out the issue to your line manager and the hospital management. If they fail to act, then please call attention to the problem in any way you can, till a solution is found.

Hospitals should review their own surgeons for rate of infection, morbidity and mortality. Hospitals should also be rated on the number of hospital acquired infections and wound infections in particular. Bad performing surgeons should be retrained and bad hospitals should be sanctioned.

Now, please wash your hands and do all you can to prevent infections!

NB: Patients must also insist that nurses and doctors wash their hands before touching you. See them do it!

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