THE EFFECT OF SKIN ANTISEPSIS AFTER PRIMARY SKIN CLOSURE ON THE INCIDENCE OF SURGICAL SITE INFECTION AFTER ABDOMINAL SURGERY FOR SEPSIS: A PRELIMINARY REPORT OF A RANDOMISED CONTROLLED TRIAL.

Background: The role of skin antisepsis after skin closure in abdominal surgery for sepsis is not well reported. This study assessed the effect of skin antisepsis following primary skin closure on surgical site infection (SSI) after contaminated and dirty abdominal surgery. Methods: This was a randomised controlled trial involving adult patients undergoing laparotomy for sepsis. Patients were randomised into a Control (C) group where the wound edge was cleaned once with 70% isopropyl alcohol before being covered with a dry sterile gauze dressing and a Povidone-iodine (PI) group in whom the wound edge was cleaned once with 70% isopropyl alcohol, then covered with a 10% povidone iodine-soaked gauze dressing. Both groups were compared for the presence of SSI. Statistical significance was set at a p value of < 0.05. Results: Thirty-seven patients (C group = 18; PI group = 19) were recruited. The median age was 36 years (Interquartile range, IQR = 72) with a male-to-female ratio of 2.7:1. The overall incidence of SSI was 48.6% (n = 18), comparable between the C group (n=10, 55.6%) and PI group (n = 8; 42.1%) (p = 0.413). In-hospital mortality rate was 10.8 % (n = 4), equally distributed between the groups (p = 1.000). The length of hospital stay was 8 days (IQR = 15) in the C group and 7 days in the PI group (IQR =9) (p = 0.169). Conclusion: In laparotomy for sepsis, skin antisepsis after primary skin closure had no effect on the incidence of surgical site infection.

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.

Comparative Analysis of Rapid Test and Enzyme Linked Immunosorbent Assay for Screening of Blood Donors for Hepatitis B Surface Antigen Seropositivity.

BACKGROUND: The Hepatitis B surface Antigen (HBsAg) is the most utilized indicator marker of hepatitis B infection. This study assesses the accuracy of the two most common screening assays used to detect HBsAg among blood donors. MATERIALS AND METHODS: A total of 350 eligible blood donors were screened for HBsAg using both Bio-Check HBsAg Rapid screening kit (BioCheck Inc, South San Francisco, USA) and a fourth-generation Enzyme-Linked Immunoassays (ELISA) kit, MonolisaTM HBs Ag Ultra (Bio-Rad Laboratories, Marnes-la-Coquette-France). Questionnaires were used to inquire about risk factors for HBV infection among blood donors. The calculation of sensitivity, specificity, negative predictive and positive predictive values were carried out by comparing the performance of the rapid kit with ELISA test as the reference standard. RESULTS: The prevalence of HBV infection using Rapid Diagnostic Test (RDT) was 5.7% but was 14.6% by ELISA. Using ELISA as a reference, the sensitivity and specificity of RDT were 31.4% and 98.7% respectively. The positive predictive value and negative predictive value for RDT were 80.0% and 89.4% respectively. Overall non-compliance with transfusion-transmitted infection (TTI) risk-related deferral criteria was 38%. CONCLUSION: The low sensitivity of RDT kits precludes its continuous use in high HBV endemic regions where many donors fail to disclose full and truthful information about their risk for TTI. It is suggested that blood banks should complement the use of RDT with a more sensitive assay such as ELISA.

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.

Measles vaccine potency and sero-conversion rates among infants receiving measles immunization in Ilorin, Kwara State, Nigeria.

This study was designed to assess the seroconversion rate of measles vaccine among infants receiving measles immunization in Ilorin, Nigeria. The pre- and post-measles vaccination sera of the children were tested using the Haemagglutination Inhibition test. The measles vaccines administered at the immunization centre were also tested for their potency using in-vitro titration method. Only 286 (71.5%) of the vacinees returned to give post-vaccination samples. All the infants screened had low pre-vaccination measles antibody titers. Thirty one (8.0%) of the infants had measles prior to vaccination. The seroconversion pattern showed that 196 (68.6%) of the infants developed protective antibody titers. Low seroconversion rate reported in this study was due to low vaccine potency. The titers of vaccines with low potency ranged between log10(-1.0)-log10(-2.25) TCID/per dose. This was beside other non specific antiviral substances exhibited virus neutralizing activity. Only 3 (50%) of the 6 vaccine vials tested had virus titers of log10(-3.25) to log10(-3.5), which fell above the cut-off point recommended by the World Health Organization for measles vaccines. The sero-conversion rate of 68.6% observed among vaccinees is far lower than the immunity level of 95% required stopping measles transmission in an endemic community. Failure of 31.4% of these infants to sero-convert post vaccination can be attributed partly to administration of sub-potent vaccines. There is need for improvement and maintenance of effective vaccine cold chain system in Nigeria. There is need also for periodic monitoring of post-vaccination antibody titers as well as vaccine potency status in order to ensure development of protective seroconversion rates.

A rare case of salmonella typhi meningitis in an eleven month old infant: a case report.

Non-typhoidal Salmonella are infrequent causes of childhood meningitis. Most reports of Salmonella typhi meningeal infections are confined to neonates. A rare instance of S. typhi in an otherwise healthy eleven month old infant is being reported.

Awareness and practice of safety precautions among healthcare workers in the laboratories of two public health facilities in Nigeria.

AIMS AND OBJECTIVES: To determine the level of awareness and practice of SP among laboratory workers at two tertiary public health facilities in Nigeria. METHODS: A semi-structured, self-administered questionnaire was used to assess the awareness, attitude and adherence to SP among laboratory workers. Information on the availability of safety equipment was also sought. The laboratory safety practice of respondents was assessed based on self-reported observance of basic principles of universal precautions in clinical settings. RESULTS: Study participants were 130, mean age: 28.2 years (SD±6.6), number of years in hospital employment: 3.7 years (SD±2.4) and the male to female ratio was 1.8:1. Many (41.5%) were unaware and 25.4% do not observe SP. Participants attest to availability of various safety devices and equipment including hand gloves (86.2%), disinfectants (84.6%), HBV immunisation (46.2%) and post exposure prophylaxis (PEP) for HIV and HBV (79.6%). Attitude to safety is unsatisfactory as 60.0% eat and drink in the laboratory, 50.8% recap needles and 56.9% use sharps box. Even though 83.1% are willing to take PEP, only 1.5% will present self following laboratory injury. CONCLUSION: This study shows the deficit in the awareness of SP among laboratory personnel and demonstrates that attitude and practice of safety rules are unsatisfactory. Training and re-training on SP is therefore desired. Counselling to induce a positive attitudinal change on HBV immunisation and PEP is similarly necessary.

Methicillin resistant Staphylococcus aureus: awareness, knowledge and disposition to screening among healthcare workers in critical care units of a Nigerian hospital.

BACKGROUND: Awareness level about methicillin resistant Staphylococcus aureus (MRSA) is high in the western world but the status in developing countries is not well defined. OBJECTIVE: To assess MRSA awareness level, knowledge and disposition to screening among critical healthcare givers (HCGs) in Nigeria. METHODS: A self-administered questionnaire was used to assess the level of awareness and knowledge of HCGs in critical care units of the University of Ilorin Teaching Hospital, Ilorin, Nigeria on MRSA and their willingness to submit to screening. RESULTS: Only 103 (52.0%) of the 198 participants were aware of MRSA but all were favourably disposed to screening for the organism. Awareness was through hospital rounds 65(63.1%) and journals/ textbooks 35(34.0%), and Many, 120 (60.6%) considered MRSA as a threat in the hospital, while only 27 (13.6%) thought otherwise and 51(25.8%) were indifferent. Most HCGs, 124 (87.9%) reported that there were no MRSA control measures in their respective duty post. The age, cadre of work, and number of years in the hospital's critical care units correlated positively with awareness level. CONCLUSION: Methicillin resistant Staphylococcus aureus awareness level among the HCGs in our hospital is just a little above 50.0% with substantial proportion of them not realizing the medical implication of the organism. However, majority are well disposed to MRSA screening. Inadequate publicity is a major contributor to poor knowledge and awareness. There is need for educational intervention and sensitization programs on MRSA and other infection control techniques for HCGs in developing nations especially Nigeria.

Reliability of urine multistix and gram stain in the detection of asymptomatic bacteriuria in pregnancy.

BACKGROUND: urinary tract infection is a common problem during pregnancy. Asymptomatic bacteriuria can cause the development of serious complications affecting both the mother and foetus. Urine culture, the traditional screening test is relatively expensive, time consuming and requires a microbiology laboratory and trained staff. However simpler, less expensive tests which include urine multistix and urine gramstain better suited for developing countries are available. OBJECTIVE: to determine the sensitivity, specificity and predictive values of multistix nitrite, leucocyte esterase (LE) and urine gram staining for asymptomatic bacteriuria in pregnancy. METHODS: A cross-sectional study was carried out from 1st July to 31st October 2007, at the University of Ilorin Teaching Hospital (UITH) on 125 consenting asymptomatic pregnant women. A structured proforma was used to collect information from the women and a midstream urine specimen collected in two sterile bottles. One was tested with Multistix® for the presence of nitrite and leucocyte esterase and the other for bacteriological culture and urine gram stain. RESULTS: using the gold standard of urine culture, the sensitivities of Multistix® nitrite and leucocyte esterase were each 14% and the specificity 100% and 96% respectively. Urine gram stain had a sensitivity of 98% and a specificity of 74.7%. CONCLUSION: multistix® nitrite and leucocyte esterase are not sufficiently sensitive to be used as a screening tool for asymptomatic bacteriuria. Urine gram stain can be used in areas where facilities are inadequate for culture but cannot replace it. More studies are required to determine the accuracy of urine gram-stain.

Lassa Fever: another infectious menace

Nigeria is presently suffering from another Lassa fever epidemic. This was confirmed in the statement of the Minister of Health of the Federation in which he said; ""There has been an upsurge in the reported cases of Lassa fever since the beginning of this year; especially in the Federal Capital Territory and its environs. Within two weeks; 12 cases with five deaths due to the disease were recorded. 25 contacts are confirmed by laboratory investigations to have been infected; including 4 health staff working in the National Hospital; Abuja.""1 Lassa fever is an acute viral haemorrhagic fever first described in 1969 in the town of Lassa in Borno state; Nigeria.2 It is endemic in West African countries; and causes 300;000 cases annually with 5000 deaths.3 Lassa fever epidemics occur in Nigeria; Liberia; Sierra Leone; Guinea and the Central African Republic.4 Lassa virus; the agent of the disease is a member of the Arenaviridae family. The virus is pleomorphic with single-stranded and bisegmented RNA genome.3 Its primary host is Natal Multimammate Mouse (Mastomys natalensis). Transmission to man occurs via exposure to the rat excrement through respiratory or gastrointestinal tracts5; exposure of broken skin or mucus membrane to infected material; direct contact; sexually and transplacentally. The prevalence of antibodies to the virus is 8-229 in Sierra Leone; 4-55in Guinea;12 and 21in Nigeria.13 The disease is mild or asymptomatic in 80of infected people; but 20have a severe multisystemic disease. Clinical features are difficult to differentiate from that of other viral haemorrhagic fevers and common febrile illness such as Malaria; Typhoid fever and so on. Definitive diagnosis is by viral isolation; Antigen and Antibody detection and Reverse Transcriptase PCR. Treatment is with Ribavirin; an antiviral agent. No vaccine is currently available. Prevention is by keeping rats away from homes

Cryptococcal meningitis in a newly diagnosed AIDS patient: a case report.

BACKGROUND: Cryptococcus neoformans is a very important cause of fungal meningitis in immunosuppressed patients OBJECTIVE: To describe a case of cryptococcal meningoencephalitis in an HIV/AIDS patient from the University of Ilorin Teaching Hospital. METHODS: An 18 -year -old male student presented with cough, weight loss, and fever. He was clinically assessed and had full laboratory investigations including cerebrospinal fluid CSF and then started on chemotherapy. Both the clinical and neurological evaluation of the patient was described along with the laboratory analyses of his CSF. Outcome of how he was managed was also reported. RESULTS: Cryptococcus neoformans presented as an AIDS defining fungal infection for the first time in this 18 year old undergraduate who was infected probably from transfusion of unscreened blood He had advanced HIV infection (CD4+ count of 29 cells/ul) and severe cryptococcal meningoencephalitis. He was unsuccessfully managed with fluconazole, a second choice drug for this condition, amphotericin B being not available. CONCLUSION: Nigerians should have access to effective blood transfusion services at all public and private hospitals across the country. The National Essential Drug list should be expanded to include drugs such as amphotericin B which hitherto were considered exotic.