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Top hospital alarmed over high death rate

By Gatonye Gathura | July 27th 2020

A first-class private hospital in Nairobi is alarmed by high death rate and facility acquired infections.

The rate of death at the hospital’s intensive care unit (ICU), the results show, is much higher than in faith-based local facilities as well as in comparable units in rich countries.

“This was unexpected given that ‘our hospital’ is significantly better-resourced than most facilities in Kenya, comparable in staffing and infrastructure to facilities in the US and Europe,” say doctors at the five-star facility.

That was not all. Investigators also found patients at a higher risk of acquiring life-threatening infections at the hospital.

Contamination of dialysis machines

At highest risk are patients undergoing dialysis with most of the infectious agents, found in the dialysis catheters - tubes used in the procedure.

The doctors warn that high rates of contamination of dialysis equipment should raise a red flag in the whole health sector. This, especially because of the dramatic increase in dialysis services in Kenya.

“With the expansion of kidney dialysis to regions throughout Kenya, infection control practices will need to address the risks of blood poisoning bacteria in these settings.”

The number of dialysis centres has risen from just about three in the public sector a decade ago to more than 50 today in 47 counties, with a similar number in private care.

About 10,000 patients are undergoing kidney dialysis in Kenya, supervised by only about 50 specialists.

The two studies were published in June and July in the scientific journal PLOS One, by teams from the hospital and their colleagues from American and Canadian universities.

The researchers, especially on the rate of death at the hospital’s ICU, say they had expected outcomes comparable to those in high-income countries.

“Outcomes in well-resourced hospital in Kenya are thought to be comparable to those in high-income countries,” said the authors.

Such thoughts are widely shared: “Kenya’s position as a regional resource for high quality healthcare is a huge advantage that needs to be leveraged further,” President Uhuru Kenyatta said in March while opening a private-sector health convention in Nairobi.

“My dream was to deliver at this hospital,” says Jane Kadenge, who has delivered twice through cesarean section.

 “Well, I did not hit the target and missed by quite a mark,” says Kadenge who gave birth at St Mary’s Hospital in Nairobi and tells of a great experience and a much leaner bill.

Bed alone at the facility’s ICU will put you back by about Sh45,000 per night with a deposit of about a million shillings on admission.

There are just about three or so such hospitals in Nairobi boasting of top-notch skills and state-of-the-art facilities. 

But good treatment outcomes, the researchers say, require more than world-class resources. This group had looked into the records of 543 critically ill patients admitted to the hospital’s ICU in a three-year period.

About a third, 31.7 per cent, of the patients, had died which was more than twice in similar facilities in rich countries and higher than the 27 per cent for faith-based hospitals in Kenya.

However, it was lower than 54 per cent recorded at a national referral hospital in western Kenya. The authors are alarmed that the rate of death at the facility was higher than they had expected in such a well-resourced ICU.

Over admission into ICU

“We suggest that achieving good outcomes in intensive care depends on more than the provision of world-class resources.”

The team, for example, observed that more than a third of patients admitted to the ICU did not meet the hospital’s criteria for admission to the unit.

This they say affects the staff-to-patient ratio and may negatively impact on the quality of care and hence treatment outcome.

In the second study, the doctors looked at records of 201 patients seen at the hospital for an eight-year period due to blood poisoning caused by the bacteria S. aureus.

S. aureus infection can lead to complications such as pneumonia, meningitis, inflamed heart tissue and even death.

The study found a significant number of patients were infected either during care or within the hospital environment.

Over half of the hospital acquired infections, the authors said, had been associated with dialysis catheters with one case linked to a pacemaker.

They warn that with an increasing number of Kenyans suffering from chronic diseases, there is need to pay more attention to hospital-acquired infections.

Last week, a study at the Kiambu District and Thika Level 5 hospitals in Kiambu County reported high levels of S. aureus with more than 60 per cent untreatable with common antibiotics.

This, the authors, from Mt Kenya University warn is alarming, especially at the Kiambu District Hospital which is congested hence putting many patients at great risk of infection.

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