Thursday, November 01, 2007

Monsters... Are they creeping inside Jordan?

Because of Halloween, most people in my hospital are dressed up in something. I decided to just be myself because that might be scary enough.

I saw one employee (hopefully not a nurse) dressed up in balloons that looked like a bacteria cluster and a big sign on one of them (MRSA Monster).

MRSA stands for Methcillin-resistant staphylococcus aureus, a bacteria that was the talk of the media recently as a "super bug" because it is resistant to the majority of the available antibiotics. It has been around for more than 20 years.

Despite the media's focus, there are many other bacteria that are behind some horror stories in many hospitals. These bacteria cause invasive infections in any place in the body. Not a single organ is an exception.

The sad fact is that health care employees mainly physicians and nurses are behind the evolution and spread of these deadly bugs. There are two major ways how this happened.

1- They forget to wash their hands after seeing patients. MRSA would not even be a problem today if all doctors and nurses have done that!

2- Doctors tend to use antibiotics when they do not need to. For some reason doctors and patients feel much better if an antibiotics is used to treat an illness. The results are disastrous. Bacteria have the ability to quickly, sometimes incredibly quickly, develop resistance to the most powerful antibiotics in the market.

Why do I think it's a major problem in Jordan?

1- Doctors rarely ever wash their hands after or wear gloves during patient examinations. One of these powerful bugs can be transmitted from one patient to another through the doctor's or nurse's hands.

2- Nonexistent or very poor infection control programs in almost all Jordanian hospitals, where you find a patient with very poor immunity from various illnesses being placed in the same room with someone who has a significant illness. Hospitals are not taking the measures needed to prevent the evolution and spread of fatal bacteria inside hospitals.

3- Doctors tend to overuse antibiotics. Even when an antibiotic is used physicians tend to use the most powerful one. Bacteria develop resistance to these antibiotics and quickly become resistant to all antibiotics.

4- Antibiotics are sold without a prescription in Jordan and people use them for the most trivial reasons from a runny nose to food poisoning. When the time comes for this person to get a serious infection the bacteria s/he has would be resistant to all antibiotics.

5- There are almost no infectious disease specialists in Jordan to guide other physicians and hospitals in the use of the right antibiotic to the right person at the right time and for the necessary duration. As far as I know there are only 7 specialists in the whole country, all of them working in Amman.

I have worked for a few months in King Hussein Cancer Center (Al-Amal) and I have seen some bacteria there that I have never seen In the US. In one day over there we had three patient die of an infection with the same bacteria (MDR Pseudomonas). They had to shut down the whole Intensive Care Unit to get cleaned out. Unfortunately that did not work and patients still got infections with these nasty bugs.

Like many health problems, infection is a major health problem in Jordan that is being neglected. Health care workers are the major attributers to this problem and they are not realizing this. The behavior of physicians and nurses in many hospitals is hazardous to patient care and needs to be controlled.


nido said...

You should also see the kind of food "prepared, cooked and served" to patients in some hospitals in Jordan...I got some training in 2 kitchens of 2 reputable hospitals and the degree of hygene there is almost zero!
and the formulas prepared for the ICU patients is ma2sah as well...So I can understand how easily it is for patients to get infected and die because of the lack of's so sad!!

tinkerbella said...

It will stop the day we stop helping students who barely passed tawjihi get into med school via wastat becuz its "prestigious" to be a dr... the day we stop passing failing, slacking med students and giving them and MD when they are not even qualified to be a janitor, but they get it anyway because they are the son/daughter of Mr. Bigshot... the day we stop covering up BS did by someone to avoid embarassment
the day we all start to be accountable for our actions, maybe then we will have decent healthcare in Jordan

And dont even get me started on Al-Amal hospital. I have horror stories from that hospital, at least 80% of that hopsital staff are inefficient mindless brutes.. you'd think we would have better doctors and nurses to care for such ill patients but noooooo.
jad wallahi haram.. it used to be we couldnt afford good medical facilities bs we have good med schools, we have good doctors, we have state-of-the-art facilities in some hospitals and yet we still have all this chaos

Ali said...

إغلاق 8 غرف عمليات في مستشفى حمزة
نشر: 31/10/2007 الساعة .GMT+3 ) 02:33 a.m )

حنان الكسواني

عمان - قرر مدير مستشفى الأمير حمزة الحكومي الدكتور سامي الدليمي أمس إغلاق ثماني من أصل 11 غرفة عمليات في قسم العمليات الواقع في الطابق الأرضي من المستشفى بعد أن تسربت إليه مياه عادمة من دورات مياه تمر خطوطها في سقف القسم.

وشكل الدليمي، الذي تولى إدارة المستشفى قبل أسبوعين فقط، لجنة فنية لتحديد سبب التسرب و"حل المشكلة جذريا"، في ظل تكرار مشكلة تسرب المياه العادمة إلى قسم العمليات ومواقع أخرى إدارية منذ افتتاح المستشفى في شهر ايار (مايو) من العام الماضي.

ومن المنتظر أن يتسلم الدليمي تقرير اللجنة الفنية اليوم، لتحديد الإجراءات الواجب اتخاذها فنيا وإداريا لحل المشكلة، وضمان عدم تكرارها مستقبلا.

وقبيل إغلاقها عملت إدارة المستشفى على تفريغ الغرف الثماني من الأجهزة والمعدات الطبية وتعقيمها حفاظا على صحة المرضى ومن ثم نقلها إلى المستودع في المستشفى حتى الانتهاء من حل مشكلة تسرب المياه العادمة إلى الغرف.

بيد أن إغلاق الغرف الثماني "لم يؤثر" على سير إجراء العمليات الطارئة والمبرمجة مسبقا في المستشفى، وفق تأكيد الدليمي الذي أشار إلى أن المستشفى مستمر في إجراء العمليات في الغرف الثلاث الأخرى.

لكن الدليمي لفت إلى احتمالية تحويل بعض المرضى إلى المستشفيات الحكومية إذا استدعت الحاجة لذلك. وكان المستشفى أجرى 269 عملية جراحية متنوعة خلال تشرين الأول (أكتوبر) الحالي.

Avery said...

The funny thing is that MDR Pseudomonas aeru is very easily eliminated and killed if you wash your hands or any body surface.
The initial problem arises when a terminal patient transfers her/his bugs to any surface and a bacterial biofilm would develop and the next immunocompromised patient is exposed to this already-resistant-unknown bug to this patient.

The other day at my work we had an outbreak of the very weak organism Acinetobacter baumani. This one is easily killed by any means of cleaning, yet it is Extremely resistant to almost all antibiotics once it's an established infection in an immunocompromised patient.

tell me Hareega, what to do?? what to do? people won't understand or learn till a massive widespread epidemic strikes!

Hani Obaid said...

Eeek, my friend went to a restroom at a Macdonalds the other day, and he saw one of the employees getting out without washing his hand and go straight to the food prepration counter !

That was scary enough. When even doctors/nurses who really should know better do something similar, its alarming.

Hareega said...

nido... well most ICU patients do not eat, but if they do then it's a disaster if the food is not "clean". But poor hygiene in preparing food should not be a reason for the spread of all these resistant microorganisms

In Jordan at least up to 2000 or 2001 most of those who entered medical schools were highly qualified. Not a single graduate is allowed if s/he scored lower than 85 in Tawjihi -and that's a pretty good score in Tawjihi. In my class everyone scored greater than 92% in Tawjihi. There's a problem in graduates from some countries whose medical knowledge is extremely poor and they allow them to practise medicine.
I totally agree with you that it's not only a financial problem behind our health system being the way it is now, corruption has leaked everywhere inside of it.

Hareega said...

Ali... that is a very interesting piece of news!

Avery... it appears that acenitobacter baumanii came to the US from Iraq (along with KPC which is a super nasty bug).
I don't think people need a lot of education with that. It's health care professionals who need to be educated better regarding the use of antibiotics, even in the US there are a lotttt of doctors who are not smart enough to know which antibiotic to use for which patient !

Hani Obaid....
Fortunately doctors are washing their hands more than they did before. There are committees that come and observe if doctors wash their hands after they see patients and if the percentages are not good they are allowed to shut down the hospital.

Hareega said...

hani obaid... i was referring to hopsitals in the US of course

wonders said...

Allah ybashrak bl 5er, so the only place where you can go to recover from diseases is the place that is most likely to get you more sick!
how ironic...

caroline said...

infection control in Jordan??nonexistant.
When I was doing imtiyaz in Al salt hospital for my imtiyaz srilankan maid came to the ER with a scrofula and the great 'specialist' docs there opened the scofula in the middle of the er with people going by including all of us...when we realized what was going on we ran out of the er minor room...that was i know one of many 'incidents' we don't even know is a real disgrace to have such docs working anywhere.the resistanceto antibiotics also in Jordan has to be one of the highest ever bec they just prescribe broad spectrum antibiotics to everyone 'prophylactically'.

Hareega said...

wonders, that is sometimes true, and it happens everywhere even in the most prestigeous hopsitals in the world, but all decent hospitals do measures to prevent these infections and our hospitals, the very rich one, do not.

Hareega said...

caroline, that's funny! sirlankiyyeh! the best experience i had in Al-Salt ER was when an elderly woman who sells Mlookhiyyeh came to the ER (the main office bi wejhek wenti dakhleh), and started naming doctor (i remember Ali kadda7 was one of them) who owe her money becayse they bought mlookhiyyeh from her and didn't pay her yet :D

Haven't been to the O/R there but my friend tells me they scrub in using Lux soaps, so patients might get horrible wound infections post-op but they will smell good at least

Avery said...

Man, Acinetobacter spp. is everywhere. with or without coming from Iraq.

Hareega said...

I understand it's always been there, but its incidence has dramatically increased especially in VA hospitals,
here's an interesting article from Lancet last year
Lancet Infect Dis. 2006 Jun;6(6):317-8
(Importation of multidrug-resistant Acinetobacter spp infections with casualties from Iraq)

Here's another one from Infection Control Hospital epidimeology in June 07 : Infect Control Hosp Epidemiol. 2007 Jun;28(6):720-2. Epub 2007 May 16
"Acinetobacter skin carriage among US army soldiers deployed in Iraq."

I'll be happy to email them to you if you're interested

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