Many hospitals in Kenya may look clean, but you should know better.
Some drug-resistant bacteria sit on the doorknobs, others live alongside patients in the bedding while some hang out on baby weighing scales —all threatening the health of patients.
A team of researchers in Nairobi recently swabbed select surfaces in Kenya’s top public hospitals and found colonies of drug-resistant bacteria.
Eliminating these germs is already difficult because some of them form biofilms that can withstand disinfection.
The findings, published on Wednesday, reveal that Kenya’s referral hospitals are not practising proper hygiene, as demanded by the National Infection Prevention and Control Guidelines for Health Care Services in Kenya.
As a result, nearly five in every 100 patients who visit hospitals contract new, difficult-to-treat infections from dirty surfaces.
“[There is] low compliance to infection prevention and control practices in Kenyan hospitals, which are already outstretched by challenges such as poor water supply, frequent electricity outages, sporadic supply of critical cleaning reagents and personnel, among others,” the researchers said.
They swabbed 617 high-touch surfaces in three level 6 and 5 hospitals, and two level 4 hospitals across surgical, general, maternity, newborn, outpatient and pediatric departments.
The swabs were then tested at the Kenya Medical Research Institute (Kemri) in Nairobi.
The eight researchers are from the United States Army Medical Research Directorate-Africa, the University of Nairobi and Kemri.
Tests identified the presence of pathogens that are the leading cause of hospital-acquired infections in Kenya and globally.
These are multidrug-resistant (MDR) Enterococcus faecalis/faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and Escherichia coli (all known collectively by the acronym “Escapee”).
“At least 78/617 (12.6 per cent) of the sampled high-touch surfaces across the study hospitals were contaminated with MDR Eskapee,” the researchers said in a report published by the Antimicrobial Resistance & Infection Control journal on Wednesday.
It is titled, “Environmental contamination across multiple hospital departments with multidrug-resistant bacteria pose an elevated risk of healthcare-associated infections in Kenyan hospitals”.
Four departments, newborn, surgical, maternity, and paediatrics, had particularly worrying contamination rates of at least 10 per cent, with the surgical and newborn having the highest rates of 25 per cent and 19.1 per cent, respectively.
The most frequently contaminated items were patient bedding, newborn incubators and baby cots, department sinks, door knobs, and tray table tops.
“Bathroom surfaces, bathroom sinks and a saline bathtub were also contaminated with MDR Eskapee,” they said.
The national referral hospital included in the study had the highest concentration of germs, followed by the level 5 facilities.
“The higher levels of MDR Eskapee contamination in higher-level hospitals than in lower-level hospitals may be linked to increased antibiotic selection pressure resulting from extensive use, particularly in critical care units or specialised departments such as the surgical departments,” the researchers said.
“Patients with severe infections, trauma and those referred from lower-level hospitals often seek medical care in higher-level hospitals. These patients often require surgical interventions and the administration of antibiotics for patient care,” they added.
The researchers from the US Army Medical Research Directorate-Africa are Lillian Musila, Erick Odoyo, Fredrick Tiria, Martin Georges, and Cecilia Kyanya. Others are independent researcher Samuel Wahome, Kemri’s Daniel Matano and Winnie Mutai of the UoN.
The most common pathogen was the opportunistic Acinetobacter baumannii, which attacks severely sick people.
It causes ventilator-associated pneumonia, skin and soft tissue infections, urinary tract infections, secondary meningitis and bloodstream, all of which have been associated with high mortality rates.
This bacteria is resistant to commonly prescribed antibiotics.
The researchers recommended that hospitals must enforce terminal cleaning of patients’ beds and newborn incubators.
This involves transferring patients to a different ward and then cleaning and fully disinfecting all surfaces in the room.
They also recommended biomonitoring around high-touch areas, antibiotic stewardship programmes, enforced hand hygiene, and adequate and frequent cleaning of high-touch areas.