Response of Healthcare Workers to COVID-19 Protocols after the Index Case at 37 Military Hospital, Ghana.

The diagnosis and management of COVID-19 are much dependent on the adherence to standardized protocols. Healthcare workers play a crucial role in the case management of COVID-19 in many institutions. Globally, the disease burden is increasing, and the mortality has reached over 2 041 426 compared with 323 000 in May 2020. In West Africa, the pandemic has shown a slow but steady rise in many countries. Existing protocols and their utilization are best assessed after the occurrence of the index case. General aim. The study assessed the health worker's response to COVID-19 protocols at three designated areas of the in-hospital management care triaging, holding area, and treatment centers. Method. A qualitative design was used to assess the response of healthcare workers with regards to early case detection, infection prevention, risk communication to clients and compliance to protocols. The study conducted observational visits and purposively selected healthcare workers comprising of clinicians, nurses, emergency medical technicians, and laboratory technicians who perform routine duties at the triaging, holding, and treatment centers. A total of 41 observations were made over two weeks. Results. Participants comprised 23 males and 18 females. At all observed units, the case definition was being used to screen attendants presenting, and appropriate categorization of patients was ensured. The use of temperature in screening for COVID-19 at the units was generally adhered to. Only 50% of participants used the prescribed PPEs. The physical distancing between healthcare workers and client and between clients and caregivers were not enforced; however, hand hygiene was practiced. Disinfection of working surfaces and equipment with 0.5% chlorine or 70% alcohol-based rubs were used most of the time. It was observed however that no psychological counselling was given to suspected cases or their relatives. Conclusion. Healthcare workers showed discordant response to different parts of the protocols for COVID-19 especially appropriate distancing. There was an enhanced awareness among healthcare workers and improvement in infection prevention protocols. The study also observed that as the risk of infection increased from triaging to holding area and to treatment centers, the response of healthcare workers to COVID-19 protocols also improved. Risk communication is an essential part of the COVID-19 management strategy. At the treatment centers, healthcare workers adhered to this protocol, whereas it was a major gap at the triaging and holding areas.

Audit of diabetic soft tissue infection and foot disease in Accra.

BACKGROUND: Soft tissue infection and foot disease are well known complications among diabetes mellitus patients. With an increasing prevalence of diabetes mellitus in Africa, management of these complications is expected to become a major problem. OBJECTIVE: To audit the surgical management of diabetic soft tissue infection and foot disease over a two-year period in Accra, Ghana. METHODS: A prospective study of all patients admitted to the General Surgical Unit of the 37 Military Hospital between May 2005 and April 2007 was conducted. Diabetic patients with soft tissue infections and foot disease were selected for study. Doppler studies using a monopolar 8 MHz Nicolet vascular probe was used in assessing the ankle to brachial pressure index (ABPI). Patients were managed based on admitting diagnosis and outcomes were noted. RESULTS: Eighty (8.3%) of 966 surgical patients had diabetes mellitus and soft tissue infection or foot disease. The peak age of presentation of diabetics with soft tissue infection or foot disease was 50-59 years. Diabetic foot disease (53.0%) was the commonest followed by cellulitis of the leg and other soft tissue infections. Overall amputation rate was 33.3% while mortality was 8.8%. CONCLUSION: Foot infections, cellulitis, abscesses and gangrene are the common surgical complications of diabetes mellitus patients in Ghana. Abscess of the hand is the commonest non-foot soft tissue surgical complication and had good outcomes. Overall, females presented earlier and had better outcomes than males.

Audit of Diabetic Soft Tissue Infection and Foot Disease in Accra

BACKGROUND: Soft tissue infection and foot disease are well known complications among diabetes mellitus patients. With an increasing prevalence of diabetes mellitus in Africa; management of these complications is expected to become a major problem. OBJECTIVE: To audit the surgical management of diabetic soft tissue infection and foot disease over a two-year period in Accra; Ghana. METHODS: A prospective study of all patients admitted to the General Surgical Unit of the 37 Military Hospital between May 2005 and April 2007 was conducted. Diabetic patients with soft tissue infections and foot disease were selected for study. Doppler studies using a monopolar 8 MHz Nicolet vascular probe was used in assessing the ankle to brachial pressure index (ABPI). Patients were managed based on admitting diagnosis and outcomes were noted. RESULTS: Eighty (8.3) of 966 surgical patients had diabetes mellitus and soft tissue infection or foot disease. The peak age of presentation of diabetics with soft tissue infection or foot disease was 50-59 years. Diabetic foot disease (53.0) was the commonest followed by cellulitis of the leg and other soft tissue infections. Overall amputation rate was 33.3while mortality was 8.8. CONCLUSION: Foot infections; cellulitis; abscesses and gangrene are the common surgical complications of diabetes mellitus patients in Ghana. Abscess of the hand is the commonest non-foot soft tissue surgical complication and had good outcomes. Overall; females presented earlier and had better outcomes than males

Improving emergency attendance and mortality--the case for unit separation.

BACKGROUND: Emergency attendance and mortality which are reliable indicators of quality of care, have been of concern to many health institutions. Different models are being proposed to improve emergency outcomes in different parts of the world. A model to separate a single emergency unit into multiple emergency units has been tried in Ghana. OBJECTIVE: The objective of the study was to find the effect of the Unit Separation Model (USM) on the quality of emergency care delivery in a developing country. METHODS: The study compared the outcomes (attendance and mortality) in a Single Emergency Model (SEM) with a USM, over a two-year period. Two groups of patients were studied--the SEM phase comprising 809 patients, and the USM phase comprising 3,505 patients. Data on patients' attendance and mortality in the two groups were analysed. RESULTS: Attendance increased four fold in the USM period compared to the SEM period. This also reflected in increases in individual unit attendance. There was almost a three fold increase in medical and surgical emergencies, over ten fold increase in gynaecological emergencies and over twenty fold increase in paediatric emergencies. There was a statistically significant reduction in emergency mortality in the USM period compared to the SEM period. Reductions in mortality were from 27.8% to 7.9% for Surgery, 46.3% to 23.2% for Medicine, 17.5% to 0.8% for Gynaecology, and 50.0% to 8.4% for Paediatrics (p-value < 0.001 for each unit); and overall from 36.7% to 10.9%. CONCLUSION: It is concluded that Unit Separation Model with Specialty based emergency care has a positive impact of increasing emergency admissions and reducing mortality, without compromising quality. This also means that avoidable mortalities occur in the Single Emergency Model system.

Intestinal obstruction caused by retained surgical sponge: two case reports.

SummaryWe present two cases of intestinal obstruction from retained laparotomy packs and their management. Attention to detail in theatre procedure should reduce such occurrence.