A hospital is supposed to be a panacea of health. It is a place where those with ill health go to ‘reboot’ their life. However, what the majority of those who flock the precincts never know is that hospitals are harbingers of infections. It is in hospitals that you walk in healthy and return with all sorts of infections.They are called hospital-acquired infections (HAI), or, in medical terms, nosocomial infection. HAIs can be caused by viral, bacterial, and fungal pathogens; the most common types are bloodstream infection, pneumonia, urinary tract infection, diarrhoea, and surgical site infection.Transmission of drug-resistant bacteria among crowded hospital populations, where poor infection control practices may facilitate transmission, is another factor.The World Health Organisation says despite progress in public health and hospital care, infections continue to develop in hospitalised patients, and may also affect hospital staff or some unsuspecting visitors and caregivers. HAIs could knock on your health when you are attending to a patient, being treated or even when taking another patient to hospital. The sick can acquire more illnesses while the healthy will not be immune to infections lurking in hospital settings.Henry Murinzi, a nursing officer at Rutongo Hospital in Rulindo District, Northern Provice, said there are many diseases one can contract easily in hospital and one of them is superbugs. This is a strain of bacteria that is resistant to all antibiotics. They are invisible and can survive on surfaces for up to three days. This means that they can be transferred when one infected person simply touches another, or when a person touches something on which the pathogen resides like a stethoscope, a computer mouse, or shared athletic equipment. A 2010 study showed that hospital-acquired infections actually kill three times more Americans than HIV does. There might be no readily available finding in Rwanda, but this does not mean one should not take precautions.Dilemma in face of HAIsPeggy Umurerwa, a resident of Kimironko, says she has pathological fear for hospitals. This started when she was nursing her father, who had a long spell in admission at hospital and after some days, she also fell ill. "I used to walk around the wards, oblivious of the dangers I was exposing myself to. Then, suddenly, I started feeling mild headache and nausea. A test confirmed that I had contracted a disease in the hospital from a patient who had the same symptoms,” Umurerwa says.Dr Jean Bosco Harelimana, of Family Health Dispensary, Remera in Kigali, says there are many reasons people catch HAIs, including being too close to patients who may have infectious diseases. "That patient next to you in the waiting room may have flu. Your hospital roommate may have an undiagnosed infectious disease. A hospital staff member may have attended to a patient with an infection and not washed their hands… all these expose a healthy unsuspecting person to HAIs in the hospital,” Dr Harelimana says.The dilemma with HAIs is in pinpointing agents of infections. The diseases are silent, to the extent that few who ever fall sick after visiting hospitals hardly attach their ailments to the hospital. And, even if one did, it still would be another matter figuring what kind of germs caused the infection, unless the disease is a clear case from a patient."The specific organism needs to be identified and its sensitivity to a variety of antibiotics should be determined. The appropriate antibiotic, route, dose and duration of treatment need to be selected. The antibiotic therapy may need to be changed if necessary, depending on the patient’s response.” Dr Harelimana says.Prevention Benjamin Fikiri, a nurse at Polifam Clinique in Remera, says there are measures that can be put in place to ensure that the spread of Health care related Illnesses is minimised."Ensure that there are enough gloves, sterilised needles and clean, disinfected water for use,” he says.Fikiri says regular disinfection of surfaces is a measure health facilities ought to follow like a law. Most pathogens stay on both surfaces and in the air. Some pathogens can remain infectious for a reasonably long time under certain circumstances. It is only by regularly disinfecting against them that hospitals become safer.Fikiri also says hospitals can isolate patients with infectious diseases, restrict the number of visitors in the ward or in even in the waiting area to allow more aeration, among others.An important aspect is warning signs. Hospitals have many such communications at strategic locations but it is rare to find a facility with benign messages like, "Warning: Touching walls and other persons in hospital could expose you to hospital-acquired infections.”  Patients, visitors, staff all need to be instructed on how to help prevent HAIs. Healthcare institutions should  make use of infection control teams to monitor and sensitise the public. "When you are in a healthcare setting, be alert. Is a patient coughing or sneezing in the waiting room? Move away from them,” Murinzi, the nursing officer, says.He also calls upon people to seek timely vaccination against diseases such as pneumonia, shingles, hepatitis, measles, among others. "Make sure that any staff member who is going to touch you has washed his hands and is wearing gloves. If not, speak up,” Murinzi says.Patients and other persons visiting healthcare facilities should disinfect themselves by washing hands with soap or other detergents before leaving. This will limit chances of carrying germs that one later passes on to other persons they meet. Other precautions include ensuring that items such as waste bins are constantly disinfected. When a potential pathogen is discarded, the bin should be immediately cleared. This includes waste bins in washrooms.---------------------------------------------Psychosomatic illness: Free your mindBy Dr Rachna PandeThe boss of a company working in a remote area was complaining that his young workers have taken to feigning illness as that gives them opportunity to avoid work. Psychosomatic illness is one in which the individual fakes an illness. The person concerned might have something to gain from it like attention from others or escape from some unpleasant task.  Common psychosomatic symptoms are palpitations, abdominal pain, hiccoughs, body pain, paralysis  and unconsciousness. Mental stress aggravates the problem. It is common to see many students coming to the hospital around examination time with many vague problems.Although women are said to suffer more from these conditions, men are not immune. Psychosomatic problems occur in men also. An individual can have severe breathlessness, which is frightening to the onlooker, but in reality he may be normal. One may have excess fatigue for which there is no explanation. A psychosomatic condition is diagnosed by excluding physical illness by means of relevant exams.  It has to be differentiated from organic psychiatric problems like schizophrenia and maniac depressive illness which need treatment.Hypochondriac people are sick with anxiety related to imaginary diseases.   Even if they hear about some illness in another person, they start imagining to be suffering from it.Some persons have psychosomatic   problems episodically, but some have it frequently. Psychosomatisation always indicates a weak mind. Alcohol and other addictions add on the problem. Such individuals spend a lot of time visiting hospitals to seek treatment. It is not an individual problem but affects the society as a whole because overall productivity is affected. In a family, entire family gets disturbed if somebody becomes, "sick”. It also burdens the family financially. In hospitals, they add on the number of patients and work load of hospital staff. With limited number of medical personnel, these individuals divert the focus of health personnel, from really sick people.In institutions, such people avoid their share of work due to the supposed sickness. This reduces the entire productivity of that institute. Authorities also remain confused as to what to do with this employee? Moreover when they are really sick, people would not believe them.Majority of these people may be doing so unknowingly, without realizing that being in the hospital is not going to solve any problem for them. Rather they spend money unnecessarily and expose themselves to acquiring infections from other patients. Instead of attention and medicines, these people need good counseling. It is better to face the world bravely and find solutions for stressful situations, instead of getting sick. They need to learn and practice techniques for mental relaxation. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital