The A to Z of best practices for patient safety

When one falls sick, naturally they seek medication from a health centre. Sadly, in the quest for medical attention, some people end up contracting new infections, especially if the health centre they have gone to doesn’t pay strict attention to patient safety. Significant numbers of patients are harmed during health care, either resulting in permanent injury, increased length of stay in health care facilities, or even death. Skilled health care professionals and effective involvement of patients in their care, are all needed to ensure sustainable and significant improvements in the safety of health care. Patient safety helps doctors, nurses and all other health care professionals practice safer and better medicine. Therefore, it is good not only for patients but for everyone in health care. A health worker arranging drugs. Having proper storage facilities and maintaining good hygiene promote the safety of patients. / Lydia Atieno. Francis Kazungu, a general practitioner in Kigali, says there are many contagious infections that can spread easily if patient safety is not strictly adhered to. These include common cold, sores, influenza, streptococcal sore throat, protozoal infections like giardiasis and amebiasis, among others. He explains that contagious infections are diseases that spread from person to another, either through air when one sneezes or coughs, and the notorious ones include pulmonary tuberculosis, respiratory infection of influenza (flu), measles, meningitis and mumps. Another way such infections can be transmitted is through getting in contact with faecal matter and not washing hands. Typhoid fever, cholera and shigellosis can also be transmitted between patients during health care, he says. “Other contagious diseases can also spread through blood or other body fluids such as HIV/AIDS, Hepatitis B and Hepatitis C, if strict safety measures are not taken in a health facility,” Kazungu adds. How infections can be transmitted Vianney Rusaro Byiringiro, the director of Tuberculosis Infection Control Unit at Rwanda Biomedical Centre (RBC), says although it’s not common for health workers to contract infections or patients to contract from others, still at some point some may be at risk depending on the condition being handled. To avoid transmission of diseases from one person to another, he says health workers should make sure they put in practice all the required hygiene measures. Byiringiro explains that this may occur through direct physical contact, for instance, when a physician is working on the wound of the patient. “Indirect contact through a formite such as changing wound dressings, using contaminated medical instruments, as well as through droplet contact whereby airborne infectious agents are spread in short distances through coughing or sneezing, can expose one to infections if safety measures are not followed,” he says. How to handle patients To avoid the spread of infections in health facilities, Yvan Ntwari, a general practitioner at Clinic Galien in Remera, Gasabo District, says vaccination, treatment as well as surveillance are important for both patients and health workers. He says wearing protective gears and masks is also another way to ensure the safety of the patients and healthcare providers. Ntwari says proper hand washing is critical in controlling spread of infections. “This is the most effective way to prevent the spread of infections, especially in hospitals. Covering one’s mouth while coughing and sneezing, availing tissue and hand cleaners is also important,” he says. When dealing with blood, Ntwari says following set guidelines is as well important to prevent contamination resulting from poor handling. He adds that health workers should wash their hands with antiseptic solution after physically examining each patient. Gloves should be used when doing any examination however minor it is. “For instance, intravenous catheters and urinary catheters are changed regularly, so these measures help to prevent transmission of infections,” he says. Basic home hygiene practices While at home, Byiringiro points out that people also need to take precautions, because in most cases, the spread of some diseases starts from there. He notes that the basic home hygiene practices to prevent spread infections include keeping the house clean and dust-free. The floor can be cleaned with antiseptic solution once in a while, he says. “Family members should avoid sharing utensils like plates and glasses with sick colleagues. Individuals should learn to keep their mouths covered while coughing. Disposable tissue should be used to clean if somebody has a running nose or is sneezing,” he says. On the other hand, Kazungu says objects shared by persons need to be cleaned thoroughly. Good hand washing before preparing, serving or eating food, is important. After doing some work, washing hands is also important in preventing spread of infections. The house should be well-ventilated with adequate sunlight coming in, he adds. “These safety measures mostly reduce the spread of diarrhoeal and respiratory illnesses,” he adds. Marie Ann Niyonizeye, a nurse at Clinic Galien, says it is also important to look out for food-borne infections such as food poisoning. This, she points out, can even happen at a hospital if the people serving patients don’t practice good hygiene. “Maintaining cleanness is the way forward in staying safe and healthy. People should not share personal items which can’t be disinfected like tooth brushes and razors,” she says. Niyonizeye, however adds that at home just like in hospitals, there should be no sharing of towels and sharp objects like needles. When nursing a sick person at home, she says one should avoid direct contact with body fluids. Any fluid on the ground should be covered with antiseptic solution and then cleaned. Niyonizeye adds that, the clothes used by a sick person should be washed separately and put to dry in hot sun, and then ironed very well. “A caretaker should use gloves while cleaning or feeding the sick person. Good hand washing after handling the sick person is important.” Alcohol hand sprays and solutions can be used as antiseptics where necessary. Why patient safety is important Byiringiro says patient safety is vital because health care professionals have a duty to protect their patients’ lives from injuries, accidents as well infections. This, he says, can be achieved if right precautions are taken. According to the World Health Organisation, patient safety is the absence of preventable harm to a patient during the process of health care. The discipline of patient safety is the coordinated efforts to prevent harm, caused by the process of health care itself, from occurring to patients. Additionally, Byiringiro says all health facilities have to prioritise infection control measures within their setting to avoid the spread of contagious infections. In general, he says health workers can improve the safety of any patient despite what they are suffering from by engaging with them and their families, following set safety procedures, learning from errors and communicating effectively with both patients and other health care givers. *************************************** Experts share tips John Muganda, gynecologist When attending to wounds, especially in case of C-section, maintaining cleanness is important to prevent the mother from getting infections. On the other hand, patients too should take precautions given to them by their caregivers carefully, especially when in hospital. *************************************** Janvier Rusizina, general practitioner For children, the most common infectious disease is colds, which spread through droplets in the air when a sick person sneezes. Avoiding close contact and not sharing utensils with infected people is important. *************************************** Immaculate Kiiza, nurse In case of sickness, people should seek medical attention as soon as possible to avoid complications. Additionally, at least each household should have a first aid kit so that in cases of emergencies like cuts and falls, it’s easier to prevent infections. *************************************** Erick Musengimana, nutritionist Good nutrition is important to keep infections at bay. Those in charge of taking care of patients especially at home like family members can help improve the patient safety by communicating to physicians if they observe something unusual with their patients.