RESPONSE TO THE COVID-19 OUTBREAK: LESSONS FROM A TERTIARY HEALTHCARE FACILITY IN SOUTHWEST NIGERIA.

Background: Mitigating the risk of nosocomial infection is one of the core functions of healthcare managers in hospital environments. This study aimed to describe the COVID-19 outbreak response in a tertiary healthcare facility in Nigeria. Methods: A qualitative cross-sectional study was conducted among representatives of Heads of Infection Control Committees and units, the Accident and Emergency unit, Family Medicine unit, and Private Suites on the COVID-19 outbreak response at the University College Hospital, Ibadan, Nigeria. Data were analyzed using Colaizzi's phenomenological method. Results: Overall, seven (six physicians and one nurse) HCWs were interviewed; six (71.4%) males and two (28.6%) females. The average age of the key informants was 45 ± 4.73 years. Four themes were identified. Theme one "Essentials of screening protocol and screening area" described the development of screening protocol, and dedication of a triage area. Theme two "Infection prevention and control within consultation premises" detailed adequate spacing; hand hygiene, use of personal protective equipment; environmental sanitation; and waste management. Theme three "Mounting up surveillance in the response activity" specified communication with the Disease Surveillance Unit; and surveillance activities. Theme four "Training and psychosocial support for staff " described staff training, and provision of psychosocial care to infected staff. Conclusion: The COVID-19 outbreak measures implemented by the management of the University College Hospital, Ibadan were aimed at ensuring that the hospital does not get overwhelmed by the surge in COVID-19 cases. In order to improve outbreak response in hospital settings, it is important to undertake training, modify hospital practices, and evaluate implemented measures.

Association of Diabetes Mellitus with Coronavirus Disease 2019 Severity: A Retrospective Study from a Center in South Western Nigeria.

BACKGROUND AND OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a novel viral infection, now a pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Diabetes mellitus (DM) has been associated with severe COVID-19 and poor glycaemic control is reportedly the link between these conditions. This study aimed to determine the association between DM and the severity of COVID-19. METHODS: This was a retrospective study involving 86 patients with COVID-19 admitted to a tertiary hospital in South-Western Nigeria. Socio-demographic, clinical and laboratory data were extracted from their medical records. Ethical approval was obtained and descriptive and inferential statistics computed. RESULTS: The mean age of the patients was 61 ± 16.1 years and 61.6% were males. Fever was noted in 67.4% of patients and, similarly, 67.4% of the patients had an SpO2<94% in ambient air when admitted. Thirty-six percent (36%) of the study patients had DM. Amongst patients with DM and those without DM, 72.2% and 62%, respectively, had severe or critical COVID-19 (p=0.323). Patients with DM were older than those without DM (65.8 years vs 57.3 years; p=0.015). The frequency of oxygen desaturation, respiratory failure, acute kidney injury (AKI) and multi-organ failure were significantly higher in COVID-19 patients with DM (p=0.037, 0.043, 0.004 and 0.016, respectively). Mortality was higher in COVID-19 patients with DM but this was not statistically significant (p=0.214). The odds of a patient with diabetes and COVID-19 developing respiratory failure and acute kidney injury were 1.395 (95%CI 1.154-6.913) and 1.125 (95%CI 1.025-1.621), respectively. CONCLUSION: Diabetes mellitus was recorded in older patients with COVID-19 and associated with suboptimal oxygen saturation at presentation, respiratory failure, and acute kidney injury. There was no association found between DM and COVID-19 severity and mortality.

CONTEXTE ET OBJECTIFS: La maladie de coronavirus 2019 (COVID-19) est une nouvelle infection virale, aujourd'hui pandémique, causée par le coronavirus-2 du syndrome respiratoire aigu sévère (SARS-CoV-2). Le diabète sucré (DM) a été associé à une COVID-19 sévère et un mauvais contrôle glycémique serait le lien entre ces deux pathologies. Cette étude vise à déterminer l'association entre le DM et la sévérité du COVID-19. MÉTHODES: Il s'agit d'une étude rétrospective portant sur 86 patients atteints de COVID-19 admis dans un hôpital tertiaire du sud-ouest du Nigeria. Les données sociodémographiques, cliniques et de laboratoire ont été extraites de leurs dossiers médicaux. Une approbation éthique a été obtenue et des statistiques descriptives et inférentielles ont été calculées. RÉSULTATS: L'âge moyen des patients était de 61 ± 16,1 ans et 61,6% étaient des hommes. De la fièvre a été notée chez 67,4 % des patients et de même, 67,4 % des patients avaient une SpO2<94 % à l'air ambiant lors de leur admission. Trente-six pour cent (36 %) des patients de l'étude étaient atteints de diabète. Parmi les patients atteints de DM et ceux qui ne l'étaient pas, 72,2 % et 62 % respectivement présentaient un COVID-19 sévère ou critique (p=0,323). Les patients atteints de DM étaient plus âgés que ceux sans DM (65,8 vs 57,3 ; p=0,015). La fréquence de la désaturation en oxygène, de l'insuffisance respiratoire, de l'insuffisance rénale aiguë (IRA) et de la défaillance multi-organique était significativement plus élevée chez les patients atteints de diabète de type 1 (p=0,037, 0,043, 0,004 et 0,016 respectivement). La mortalité était plus élevée chez les patients diabétiques de COVID-19, mais cela n'était pas statistiquement significatif (p=0,214). Les probabilités qu'un patient diabétique et COVID-19 développe une insuffisance respiratoire et une lésion rénale aiguë étaient de 1,395 (95%CI 1,154-6,913) et 1,125 (95%CI 1,025-1,621). CONCLUSION: Le diabète sucré a été enregistré chez les patients âgés atteints de COVID-19 et associé à une saturation en oxygène sous-optimale à la présentation, à une insuffisance respiratoire et à des lésions rénales aiguës. Aucune association n'a été trouvée entre le DM et la sévérité du COVID-19 et la mortalité. Mots clés: COVID-19 ; Diabète Mellitus ; SRAS- CoV-2.

Impact of Impaired Kidney Function on Outcomes of Nigerians with COVID-9 Infection: Report of Two Cases from the University College Hospital, Ibadan.

COVID-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak.

L'infection au COVID-19 affecte principalement les voies respiratoires système; cependant, d'autres systèmes et organes sont également affectés. Les reins font partie des organes les plus fréquemment touchés par SRAS-CoV-2 et cela a été rapporté comme étant un prédicteur de gravité accrue, besoin de soins intensifs (USI),l'admission, et la mort. Nous avons présenté deux cas de COVID-19 associés avec des comorbidités qui incluent le diabète sucré, systémique hypertension et le rénale affaibli. La relation des comorbidités multiples en particulier le rénale affaibli fonction des résultats de l'infection au COVID-19 et de la défis de l'offre de dialyse aux patients atteints de COVID-19 une infection avec insuffisance rénale a été discutée. Les deux cas présentés ont également mis en évidence l'état de préparation à la gestion du COVID-19 et de ses divers complications et comorbidités, en particulier insuffisance rénale dans un hôpital tertiaire au Nigéria au début du COVID-19 épidémie. Mots clés: lésion rénale aiguë, maladie rénale chronique, comorbidité, COVID-19.

Point Prevalence Survey of Antimicrobial Prescribing in a Nigerian Hospital: Findings and Implications on Antimicrobial Resistance.

BACKGROUND: Antimicrobial resistance is a global health challenge. There is inadequate information on antimicrobial prescribing practices in many sub-Saharan African countries including Nigeria. A standardized method for surveillance of antimicrobial use in hospitals was employed to assess the antimicrobial prescribing practices in UCH, Ibadan, Nigeria. METHODS: A point prevalence survey (PPS) was conducted in December 15, 2017 at the UCH Ibadan. The survey included all in-patients receiving an antimicrobial on the day of PPS. Data collected included details on the antimicrobial agents, reasons and indications for treatment as well as a set of quality indicators. A web-based application was used for data-entry, validation and reporting as designed by the University of Antwerp (www.global-pps.be). RESULTS: This survey included 451 patients from 38 different wards of which 59.6% received at least one antimicrobial. The neonatal medical wards contributed the highest number of patients who received antibiotics. A total of 172 therapeutic antibiotic prescriptions were issued, mainly for Community Acquired Infections (n=119; 69.2%). Most prescriptions for Healthcare Associated Infections (n=53) were intervention related (47.2%). Frequently used antibiotics include third generation cephalosporins (23.9%; mainly ceftriaxone); followed by combination of penicillin's (17.4%; mainly amoxicillin with enzyme inhibitor) and fluoroquinolones (16.6%). Majority, 312(69.9%)of the patients had parenteral antibiotics and only 95 (21.3%) of all antibiotic prescriptions had a documented stop or review date. Although the reason for antibiotic prescription was indicated for 413 (92.4%) prescriptions, targeted therapy was the basis for only 17 (3.8%)of these prescriptions. For surgical prophylaxis, 98.7% of all prescriptions were given for more than one day. Compliance to guidelines was non-existent. CONCLUSION: Our findings showed high broad spectrum prescribing, high number of intervention related health care infections, high use of prolonged surgical prophylaxis, inexistence of local guidelines; and low utilization of laboratory facilities. Hospital related intervention should include development of antibiotic guideline and increased enlightenment on rational prescribing practices.

Trends in Mortality and Clinical Characteristics of Hospitalized Hiv/Aids Patients at the University College Hospital, Ibadan 2010 to 2016.

OBJECTIVE: The purpose of this study was to examine trends in clinical characteristics and in-hospital mortality of HIV patients in a low resource setting in the period 2010 to 2016. METHODS: Data on socio-demographic and clinical characteristics of 313 hospitalized HIV positive patients at the University College Hospital, Ibadan, Nigeria were retrospectively extracted, described and examined for trends. Factors independently associated with mortality were identified using multiple logistic regression. RESULTS: The mean age was 39 years (SD = 9.8) and about two thirds were female. The proportion of females decreased significantly from 83.3% in 2010-2011 to 39.8% in 2016. There was a significant reduction in the diagnosis of disseminated tuberculosis and mortality from 19.4% and 42.9% in 2010-2011 to 4.8% and 27.9% in 2016 respectively. On multiple logistic regression, being male, having neurological features, meningitis, and shorter stay in hospital had significantly higher odds of mortality. CONCLUSION: There was a reduction in in-hospital mortality of HIV patients over the period from 2010 to 2016. Being male and presence of neurological features were associated with mortality. Larger prospective studies are needed to further investigate this observed reduction in mortality among hospitalised patients.

Hand Hygiene Practice Among Health Care Workers in a Tertiary Hospital in Sub-Saharan Africa (Handy Study).

BACKGROUND: Hand hygiene (HH) practices are emphasized as the single most important way of reducing HealthCare-Associated Infection (HCAIs). This study was done to assess the compliance with hand hygiene and knowledge about standard HH practices by health care workers as well as to assess the availability of HH materials in the largest tertiary Hospital in Nigeria. METHODS: A cross-sectional, observational study involving consecutive observations during routine patient care in various units of the University College Hospital (UCH), Ibadan; using a checklist and compliance forms adapted from the WHO guidelines was done. HH knowledge scores were categorized as < 4 = poor, 4-6=fair and >7 = good. RESULTS: A total of 559 HH opportunities were identified and overall compliance was 30.4% (170/ 559). Compliance differed by units: Neonatology SCBU (68.2%), Intensive Care Unit (41.8%), Obstetrics & Gynaecology (39.4%), Adult emergency (26.7%), Children emergency (24.6%), Medicine (22.4%), Surgery (14.9%) and Paediatrics (12.8%). Nurses were more likely to practice hand hygiene (33.2%) compared to doctors (29.0%) [c2 = 33.270, CI= 95%, P<0.001]. Female HCWs had higher hand hygiene compliance (30.6% vs. 25.4%) [c2= 2.129, CI= 95%, P= 0.345]. Soap and water were employed more (95.5%) compared to alcohol-based hand rub (4.5%). Only 12.1% had good HH knowledge scores (>7). CONCLUSION: Poor HH compliance is observed at the facility and is attributable to inadequate education, poor knowledge of standard HH practices and unavailability of HH materials in most of the units. A multidimensional approach is advocated to tackle these issues.