Bacterial contamination of hemodialysis water in three randomly selected centers in South Western Nigeria.

BACKGROUND: Hemodialysis (HD) is the most common method of renal replacement therapy for patients with either acute kidney injury in the failure stage or end stage kidney failure in Nigeria. The number of dialysis centers in Nigeria has risen exponentially from 10 centers two decades ago to more than 120 centers in 2015. The number of patients needing renal replacement therapy in the country in the form of HD has also risen close to a projected 2000/year. The outcome from HD in Nigeria is poor as a result of a myriad of interwoven factors such as complications of cardiovascular diseases and suboptimal dialysis dose primarily due to economic factors. These are often complicated by episodes of dialysis water related bacteremia, possibly as a result of the apparent lack of a standardized guideline or protocol for monitoring dialysis water treatment system which is the driving force of dialysis units. OBJECTIVES: This is a multicenter laboratory-based study designed to determine the microbiological quality of samples of HD water and dialysate in randomly selected dialysis units in three major government teaching hospitals in Nigeria. METHODOLOGY: Water samples were aseptically and serially collected from three HD units. The samples were taken from 6 points at each center coded A, B, and C over a 6-month period. RESULTS: The water system in the three dialysis centers were grossly contaminated with Gram-negative aerobic bacteria such as Pseudomonas species and Moraxella species at all the points in the three centers. CONCLUSION: Conventionally, water treatment is a major determinant of morbidity and mortality in HD units, and the microbial quality is a major factor involved. There is evidence of bacterial contamination in the dialysis units sampled in this study. There is thus the compelling need for periodic microbiological monitoring of water after each treatment step. A uniform national guideline as part of an effective quality assurance protocol in infection surveillance is also advocated for dialysis units in Nigeria.

Sharp injuries among hospital waste handlers.

BACKGROUND: Health care workers are generally predisposed to injuries from sharps as a health hazard. This is more pronounced among waste handlers. OBJECTIVE: It is therefore important to assess these injuries among this group of people with a view to identifying the risk factors and suggesting preventive methods. METHODS: Questionnaires were administered to People handling wastes in our hospital to assess their level of education on injury prevention, immunization status and preventive methods used by them to prevent these injuries and subsequent infections. RESULTS: Forty three waste handlers were interviewed. Twenty eight (65.8%) of them received training before commencing on the job while 14 (32.5%) never received any training. Only thirty nine (90.7%) of them always use hand gloves before carrying wastes. Only three (7.0%) of the respondents have been screened for Hepatitis B, 19 (44.2%) for HIV, while 10 (23.3%) were screened for Hepatitis B, C, and HIV. Eleven (25.6%) of them have been injured with sharps. The finger was the most injured in 7 (93%) of them. CONCLUSION: Training and re-training of health workers is important and should be encouraged. All health workers should have pre-employment immunization against Hepatitis B, C as well as other before commencing on their jobs. Workers should be screened for infective diseases that can be of legal problem while at the job and the workers should be effectively immunized.

Comparative antibacterial activity of honey and gentamicin against Escherichia coli and pseudomonas aeruginosa.

The clinical significance of Pseudomonas aeruginosa and Escherichia coli is a strong factor for regular monitoring of their sensitivity to both established and novel antimicrobial compounds. Human isolates of these organisms were collected from different pathological sources and tested for their sensitivity to gentamicin - an established aminoglycoside antibiotic - and to honey, a natural product that is generating renewed interest for its therapeutic application. In an agar-cup diffusion method, three undiluted different samples of honey and their 1:2 to 1:6 aq. dilutions showed activity on 100% and 96.4% respectively of Pseudomonas aeruginosa isolates compared with 95.4% of Escherichia coli using either of the undiluted or 1:2 aq. dilutions of the honey samples. Gentamicin used in concentrations of 8.0 and 4.0 µg/ml varied in its activity against both organisms but was generally lower than the antibacterial activity of each undiluted honey and its 1:2 aq. dilution. In the event of therapeutic failure with gentamicin or any other related antibiotics, honey offers a suitable and better alternative in managing infected burn wounds and other forms of infected wounds as well as prophylaxis in trauma wounds.

Burns and scalds--epidemiology and prevention in a developing country.

BACKGROUND: Burns and scalds are common presentation to many of our health institutions. Most of these injuries are preventable. Many of the patients however end with severe morbidity or even death. People affected are mostly of poor socioeconomic status. The cost of managing these injuries is high. Coupled with this are poor facilities in most parts of the developing countries like Nigeria and insufficient personnel to take care of this group of people. Study of the epidemiology as well as suggestions on preventive measures are therefore overdue and hence this publication. METHODS: A review of the literature on this subject with emphasis on Nigeria was done bearing in mind the epidemiology and prevention of burn. Literature search was done using the medline as well as local journals. RESULTS: Causes of burn injuries are many in the developing countries. Most of these are however preventable. Some preventive measures have been suggested by workers in this part of the world. Some measures that have worked in reducing burn injuries in some advanced countries and that may be appropriate to our situation are noted and are also suggested in this paper. CONCLUSION: Prevention of burn injuries, based on the epidemiology of burn in developing countries, remains a major way of reducing the current spate of morbidity and mortality in our patients.

Attitude of nurses in a burn unit to hiv/aids burn patients.

The human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) have constituted a major challenge and concern worldwide. This is especially true among health workers who have to take care of such patients. This paper is aimed at studying the attitude to HIV/AID burn patients of nurses working in a burn unit. The work was carried out at the burns unit of the National Orthopaedics Hospital in Enugu, Nigeria. In a cross-sectional descriptive study, 125 questionnaires were distributed among nurses working in the burn unit. All the 120 nurses who responded were aware of HIV/AIDS: 80.8% of them believed that the prevalence was high, 93.3% that they could be infected while taking care of the patients, 91.5% that all burn patients should be screened for HIV, and 41.4% that their knowledge of the patients' HIV status would affect their professional duty to them; 31.1% would not want to dress the wounds of known HIV/AIDS burn patients. We conclude that there is a need to educate nurses and indeed all health care workers on adherence to universal precaution rather than routine screening for HIV of all burn patients as knowledge of the patients' HIV status may lead to discrimination against them.