By Bubala Muyovwe-Mumba
When my 7-month old son was recently unwell, I went to the largest medical facility in Zambia, the University Teaching Hospital (UTH), Children’s Hospital in the capitol city of Lusaka. What greeted me at the entrance was an unfortunate surprise.
Now anyone who has visited UTH will tell you the medical personnel do the best they can with limited resources. The demand for services has greatly increased as the population of Lusaka alone has grown exponentially since the hospital was opened in the mid-1960s. The hospital has been no stranger to water supply challenges and the Ministry of Health embarked some additional measures to ensure continuous supply of water.
On arrival, just a metre from the entrance, I was appropriately referred to a desk for COVID-19 screening, where we were asked routine questions relating to the “new normal”. Yet I was not been asked to do what has quickly become common practice across Lusaka.
Before one enters a supermarket, a private clinic or hospital, and many places of business, the “visitor” is required to sanitise or wash one’s hands. I found it disturbingly ironic that while the screening officer was ”swaddled” in protective clothing, the main hospital in Zambia was not paying extra attention to hand hygiene, widely recognised as an effective and inexpensive measure to mitigate transmission of the many infections that can be acquired within a health care facility, including COVID-19.
In the treatment room, a nurse carried out a check on my baby’s vitals without any gloves, and as is my recollection, without handwashing before attending to my baby. Keep in mind, I was not the only parent with a sick child; two infants had been brought for emergency treatment, one even requiring oxygen. Once we were done with the vitals, the nurse directed us to the treatment room where the paediatrician did reach into her pocket and used a hand rub sanitiser.
A few days later we were back at UTH as my son had shown little improvement and was still running a high fever. This time we were moved to the front of the line as we had already been screened for COVID-19 days earlier and were presumed to be COVID free. We were attended to by two nurses who wore no gloves, in a treatment room with no handwashing station. The paediatrician on duty, did put on gloves before commencing her exam, and later called in her superior, who had two bottles of hand sanitiser pinned to his lab coat, and a sink was available behind a mobile privacy screen.
We know that COVID-19 is a highly transmittable and pathogenic viral infection mainly transmitted through droplets, close contact with infected individuals, and contaminated surfaces. This makes health care workers a highly susceptible population both for contracting as well as for spreading the virus. We know that globally, health care workers have contracted COVID-19 from patients in their care. Similarly, in Zambia nurses and doctors have gotten sick through contact with infected patients.
What is clear to me is that the gap between knowledge and practice persists. I wondered what motivated the inconsistent practice of handwashing or the use of alcohol rub sanitisers for health care personnel at various stages of treatment. Is it motivated by personal need for cleanliness; concern about the cost of hand sanitiser (if not provided by Hospital Administration); proximity of a hand washing station; is walking to use one not an option because this disrupts the flow of work, or is it inconvenience?
Zambia is by no means alone. Despite hundreds of reports and research articles identifying the necessity of proper hand hygiene among those caring for hospital patients, global compliance rates are less than 50%. Healthcare workers’ hands are the most common vector in the transmission of microorganisms causing health-care-associated infections (HCAI). This fact should come as a surprise to no one since 150 years ago, the physician Ignaz Semmelweiz established the connection between mortality and contaminated hands.
A study in 2017 was conducted by the Centre for Infectious Disease Research in Zambia as part of an assessment of the effectiveness of existing hygiene and sanitation practices to determine the drug resistance patterns of potential pathogens in health care facilities in Zambia. Samples were collected from health care workers’ hands, surfaces, disinfectant buckets in delivery rooms, post-natal and paediatric wards, operation theatres, post-operation wards and outpatient departments. Of the 132 samples collected, 65 bacterial cultures were identified, including multiple pathogens that showed high-level drug resistance to commonly used anti-biotics.
In 2019, following the World Health Assembly’s unanimous passage of a resolution calling for water, sanitation and hygiene (WASH) in all healthcare facilities by 2030, Zambia hosted a major global conference on water, sanitation, and hygiene in health care facilities. Following the conference, the Honourable Minister of Health, Dr. Chitalu Chilufya wrote “getting WASH into health care facilities catalyses important health and social benefits beyond health care facilities themselves”.
The Ministry of Health in Zambia has invested a lot in infection prevention control measures during this pandemic as part of fostering public health; providing access to hand sanitiser and/or placing hand-washing stations within eye reach at points of care needs to be one of them. The need is more urgent than ever. As of mid-May, COVID-19 is dramatically surging in Zambia and other parts of Africa. Authorities must also ensure that all health care workers are adequately trained in hand hygiene protocols. Training will not only save much-needed national resources but also many lives. Going forward, the design of health care facilities in Zambia should be done with the needs of health care workers in mind by ensuring more handwashing stations are installed and maintained, as part of on-going infection prevention.
Patients and caregivers also need to help remind the health care worker to practice hand hygiene before commencing treatment or examination. Everyone deserves a safe health care environment that includes safe water, sanitation and hygiene facilities and we all have a role to play. The last thing a mother or care giver should worry about is getting an infection from a hospital or a health care worker.
About the author: Ms. Bubala Muyovwe-Mumba is the Coordinator of the Zambia NGO WASH Forum, a network of WASH Civil Society Organisations’ working to service delivery in Zambia.