MICROBACTERIAL PROFILE OF SURGICAL SITE INFECTION AND THEIR PATTERN OF SENSITIVITY IN TERTIARY HOSPITAL IN NORTH CENTRAL HOSPITAL, NIGERIA.

Background: Surgical site infections (SSI) remain a problem in surgical practice despite the improvement in advanced technology and the use of antibiotics. Also, there is also a growing menace of antibiotic resistance which poses a great challenge in treating SSI. The study aimed to find out the most common bacterial pathogens responsible for surgical site infection and their antibiotic sensitivity profile. Material and Methods: It was a descriptive study carried out in Federal Medical Centre, Bida. 500 surgical procedures were carried out and samples were obtained from 73 patients that showed clinical evidence of SSI for culture and susceptibility test. Samples were collected from each patient using a swab stick. Bacteriological culture examination and identification were done following standard microbiological techniques. Susceptibility testing was performed by Kirby-Bauer technique according to Clinical and Laboratory Standards institute 26th edition. Data were analysed using SPSS 26. Results: Out of the 73 samples taken, 83 isolates were obtained while five samples yielded no growth. Gram-negative bacteria (GNB) were predominant in 73(88.1%) with the dominant being E. Coli species (38.6%). From the strains that were isolated, there were 9(10.8%) Staph aureus was the only Gram-positive organism. Concerning antibiotic susceptibility, the results demonstrated remarkably high multidrug resistance. However, the meropenems and amikacin demonstrated good activities against all gram-negative isolates. The resistance pattern of enterobacteriaceae to tested antibiotics were to ciprofloxacin (90.2%) levofloxacin (82.2%) augmentin (88.5%) ceftriaxone (85.2%) ceftazidime (80.3%), gentamicin (80.3%) meropenems (14.8%) amikacin (16.4%.). Conclusion: The study demonstrated a high alarming rate of multidrug resistance following SSI and this should call for concerns and surveillance among surgeons.

Patients' satisfaction with the healthcare services at a north central Nigerian tertiary hospital.

BACKGROUND: This study sought to determine the level of satisfaction of patients with the healthcare services at Federal Medical Centre, Bida (FMCB) Nigeria and the factors associated with patients' satisfaction. METHODS: The study utilized exit interview of 480 patients, sampled at the 9 service points of the Centre. The questions covered socio-demographic factors and the 3 core elements of healthcare service delivery namely quality, access and interpersonal issues. The evaluation of satisfaction on the 5 point Likert scale were categorized into dissatisfied {very dissatisfied, dissatisfied and Neutral} and satisfied {satisfied and very satisfied}, setting the threshold for satisfaction at a relatively higher level. RESULTS: On the overall, 78.5% of them were satisfied with the hospital services and 78.3% had their expectations met. Satisfaction was lowest (72.7%) at the revenue section and highest (96.1%) at the maternity section. Nine of every 10 respondents (91.7%) would recommend the facility to a friend. The patients' satisfaction had significant positive correlation with promptness of staff, communication level of staff, staff relationship with patients, environmental cleanliness and comfort facilities. Cost of services and delay in obtaining services had negative but relatively weak correlation with satisfaction. CONCLUSION: The observed level of patients' satisfaction at FMC Bida is high. This can be maintained and enhanced by improvement in waiting time, sustenance of the satisfactory hospital ambiance and staff attitude/aptitude. However, enlightenment of the hospital patients on the status of the hospital and the nature of services offered is necessary.

Knowledge, attitudes and practice of confidentiality of patients' health records among health care professionals at Federal Medical Centre, Bida.

BACKGROUND: The quality of information shared with health care professionals depends on their ability to keep it confidential especially in this information technology age when unguided access is imminent. In view ofthis, the study described knowledge, attitude and practice of confidentiality of patients' health records amongst health care professionals at Federal Medical Centre Bida, Nigeria. METHODS: A semi-structured self-administered.questionnaire on the subject was administered to 313 health professionals chosen by stratified random sampling in the hospital. RESULTS: Majority (161, 66.8%) of the participants were less than ten years in practice. Virtually, all (232, 96.3%) have heard about confidentiality mostly from schools (134, 55.6%), on-the-job (61, 25.3%) and from multiple sources (18, 7.5%). On responsibility for confidentiality; only 35 (14.5%) knew it is the responsibility of every health professional, while the majority; 117 (48.5%) felt it was exclusively meant for health information management professionals. Responses to issues on confidentiality range from 58.1% (revelation of documented next of kin to relatives of dead patients by staff) to 94.2% (employing the service of untrained interpreter). Very few (28, 11.6%) argued that confidentiality and privacy are not synonymous. Recommendations given to improve the practice of confidentiality include among others, observance of good health records practice by all professionals/stakeholders, continuing sensitisation of all staffandsanction against erring staff. CONCLUSIONS: Although, most professionals were aware of confidentiality, there appears a gap of in-depth knowledge and lack of awareness of respective responsibility towards it. However, they will do better if given the enabling environment and continuing education on the subject.

Early endoscopic realignment of traumatic anterior and posterior urethral disruptions under caudal anaesthesia - a 5-year review.

OBJECTIVE: We recently described early rigid retrograde endoscopic realignment of the disrupted urethra under caudal anaesthesia in the outpatient setting. This retrospective study was performed to evaluate our medium-term results. PATIENTS AND METHODS: A retrospective review of patients who had early rigid retrograde endoscopic realignment of traumatic urethral disruptions in our institution over a 5-year period was done and the relevant data extracted and analyzed. RESULTS: Fourteen acutely ruptured urethras (10 posterior and four anterior) were endoscopically realigned early in the study period. Nine (90%) of the posterior disruptions occurred at bulbo-membranous urethra (distal to the external sphincter mechanism). Thirteen of the ruptured urethras (93%) were successfully realigned (nine posterior and four anterior) and postoperative clean intermittent self-calibration (CIC) was instituted in 10 patients. The mean follow-up period was 36.6 months (range 18-54 months). The mean operating time and the median hospital stay were 22 min (range 8-68 min) and 3 days (range 1-10 days), respectively, and were shorter in patients with injuries of the anterior urethra than those with posterior urethral tears (p < or = 0.0001). Post-realignment, all 13 patients were potent and continent. Two patients required additional procedures (direct vision internal urethrotomy or urethral dilation) and one patient has remained on CIC i.e. a stricture rate of 21%. CONCLUSION: Early retrograde endoscopic realignment under caudal analgesia is suitable and cost-effective for patients with acute traumatic urethral disruptions and has good medium-term results. In addition, an early postoperative regimen of CIC significantly reduced stricture-formation in our series.

Pre-hospital care in Nigeria: a country without emergency medical services.

OBJECTIVES: Efficient pre-hospital transport (emergency medical services, EMS) is associated with improved outcomes in road traffic injuries (RTI). This study aims to discover possible interventions in the existing mode of transport. METHODS: Persons bringing all RTI victims to the Emergency room (ER) over a 4-year period and the injury arrival intervals were noted prospectively. FINDINGS: There were 2,624 patients (1,886 males and 738 females); only 2,046 (78%) had clear documentations of three categories of persons bringing victims to ER: Relatives (REL, 1,081, 52.83%); Police/Federal Road Safety Corps (P/F, 827, 40.42%) and Bystanders (BS, 138, 6.74%). No intervention was provided during transport: Within 1 hour, 986 victims (48.2% of 2,046) arrived ERbrought by P/F (448, 21.9%), REL (439, 21.5% of 2,046), and BS (99, 4.8%). These figures, in each instance, represent 40.6 % of total victims brought by REL; 54.2% by P/F and 71.7% by BS. However, after 6 hours, REL were the main active group as they brought 94.5% (359 of 380) patients of this period. In 91 victims (4.4%) the injury arrival time was not captured. CONCLUSION: This study has identified three groups of persons involved in pre-hospital transport with nearly 50% getting to ER within 1 hour without any intervention or prior notification of ER. Absence of EMS obscures pre-hospital death records. The P/F responsible for only 40% of transport should be trained and equipped to offer basic trauma life support (BTLS). The REL and BS (both responsible for 60% of transport) represent a pool of volunteers for BTLS to be trained.

Knowledge and practice of urethral catheterisation by newly qualified medical interns.

BACKGROUND: Urethral catheterisation is a procedure which is daily performed in clinical practice. Though, interns are expected to be proficient in this, the situation is always not so and complications have occurred due to inadequate knowledge of safe urethral catheterisation. AIMS AND OBJECTIVES: The study is intended to assess the knowledge and the practice of urethral catheterisation of prospective interns with a view of making suggestions for improvement in the teaching of this procedural skill to medical students and interns. METHODOLOGY: Questionnaires were administered to all prospective interns who had applied to do their compulsory one year internship in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The data were analysed using SPSS 11 statistical package. RESULTS: There were 96 respondents 65 (69.9%) of these were males. They graduated from 6 medical schools in Nigeria and 1 in the Sudan and they were aged between 23 and 36 years. They all had observed urethral catheterisation before while 92.5% have performed urethral catheterisation: 78.5 % under supervision and 14% under no supervision and 7 (7.5%) have not. Only 19.4% had good knowledge of the indications for urethral catheterisation and 53.9% had knowledge of appropriate list of materials for safe urethral catheterisation. Only 29.1% could describe well the steps of safe catheterisation and 31.2%.could list well the possible complications of catheterisation. Less than half had good knowledge of appropriate catheter sizes. CONCLUSION: Urethral catheterisation is yet to be well mastered by many newly qualified interns and improvement in the teaching of procedural skills in medical schools may likely improve the situation.

Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians.

At a Nigerian university hospital, none of the motorcyclists who presented over a 12 month period had been wearing a helmet, and of the eight patients who died, seven had head injuries. Of the five collision types described, the rate of motorcycle-other vehicle collisions was highest at 40.6%, while the motorcycle-pedestrian rate was 23.4%. Measures to prevent these collisions might reduce overall crashes by 64%; in addition, helmet law should be enforced.

Surgical emergencies in a Nigerian university hospital.

An audit of surgical emergencies was carried out to monitor acute trauma care and determine areas needing clinical improvement. This is essential for the development of institutional and national health policies on trauma and non-trauma diseases. All patients attending the surgical Accident and Emergency were studied prospectively from September 1999 to August 2000 to obtain their age, sex and diagnosis and to determine causes and injury-arrival time for trauma cases and the outcome of care for all cases. Out of 2,455 patients comprising 1,696 males and 759 females (M:F = 2.2:1) age range two weeks to 95 years, trauma accounted for 1,679 (68.4%). The median age (and the mode) of presentation overall and in males was in the third decade. Females had a 'plateau' age of presentation for the first four decades before the gradual fall to zero. Superficial skin trauma (lacerations, abrasions and bruises) represents the commonest presentation (16.1%) followed by fractures (13.9%), acute abdominal conditions (7.6%), head injury, HI (5.5%), multiple injury (4.1%), urinary retention (3.3%), burns and scalds (3.3%) and others. Eight-one patients died, comprising 54 males and 27 females, out of which 64 were trauma related deaths. Most common causes of death were HI (35 patients, 43.2%) and septicaemia (13 patients, 16.0%). Late presentation and poor finances contributed to the deaths in patients with septicaemia. Trauma is an important entity in our emergency practice. Prompt access to surgical care should reduce the morbidity and mortality from acute abdominal conditions and HI. The high incidence of urinary retention requires further analysis. Statistics of this nature can aid planning of care delivery and study of preventable deaths.

Epidemiology of trauma deaths.

OBJECTIVES: This study was done to highlight the pattern and distribution of trauma deaths in a Nigerian teaching hospital in order to enhance trauma research, improve treatment strategies and prevent trauma deaths. PATIENTS AND METHODS: a prospective data collection was done for 24 months beginning September 1999 detailing the age, sex, occupation, diagnosis, mechanism of trauma, injury-arrival time, and circumstances of death and determining retrospectively the severity of trauma using Revised Trauma Score (RTS), Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS). RESULTS: There were 129 deaths but 84 (65.1%) had sufficient data for trauma scoring. Male:Female ratio was 60:24 = 2.5:1. The age range was 2.95 years, mean 36.8 +/- 15.2 years for males and 45.5 +/- 23.0 years for females. Two thirds (66.7%) of the deaths occurred among traders/business 27.4%, artisans 20.2%, drivers and students 9.5% each. Three quarters of the deaths (75.0%, 63) were in patients involved in road traffic accidents (RTA) followed by violent trauma (10.7%), falls 9.5% and burns 4.8%. The trauma deaths include head injury (26 deaths, 31.0%), multiple injuries (30.0%), fractures (13.1%), cervical spine injury (10.7), gunshot injuries (8.3%), burns (4.8%) and others (5.0%). Sixty-two patients (73.8%) reached the hospital within 6 hours of the injury. The patients were brought by the Police, Good Samaritans or relatives in nearly equal proportions. The mean RTS, ISS and TRISS probability of survival scores were 5.16, 25 and 67% for males but 6.0, 22 and 75% for females, respectively. CONCLUSIONS: The pattern and distribution of trauma revealed a typical trauma death is a male aged below 40 years, who is a trader/businessman involved in RTA or violent trauma. Despite a probability of survival above 60% and majority of the patients getting to hospital within 6 hours, the inadequate A and E care has thrown up possibilities for prevention of trauma death, improving treatment strategies and enhancing trauma research.

Surgical morbidity and mortality pattern in the accident and emergency room--a preliminary report.

BACKGROUND AND PURPOSE: A prospective review of surgical patients attending the Accident and Emergency room was carried out to determine the pattern of morbidity and mortality in order to guide planning and provision of surgical services and improve on the quality of care available. METHODS: Patients were entered into a data sheet from September 1999; a preliminary report of the first six months is presented. RESULTS: There were 1,209 patients (850 males and 359 females, M:F = 2.2:1) with 46 different presentations. Age range was 2 weeks to 95 years. The mode and median age was in the third decade. Morbidity from trauma was 70.5%, 44.5% from Road Traffic Accident while mortality from trauma was 2.6% (32 patients). Nearly half of the mortality (47.2%) was head injury related. CONCLUSION: The commonest presentation was lacerations (19.4%) from which there was no mortality while head injury, multiple injury and multiple fractures that accounted for 14.7% morbidity had 61.1% mortality. These figures are helpful in planning services delivery and in focusing and improving on the mortality-prone presentations.