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.

Use of tissue expansion to facilitate liver and small bowel transplant in young children with contracted abdominal cavities

Liver and small bowel transplant is an established treatment for infants with IFALD. Despite organ reduction techniques, mortality on the waiting list remains high due to shortage of size-matched pediatric donors. Small abdominal cavity volume due to previous intestinal resection poses a significant challenge to achieve abdominal closure post-transplant. Seven children underwent tissue expansion of abdominal skin prior to multiorgan transplant. In total, 17 tissue expanders were placed subcutaneously in seven children. All seven subjects underwent re-exploration to deal with complications: hematoma, extrusion, infection, or port related. Three expanders had to be removed. Four children went on to have successful combined liver and small bowel transplant. Two children died on the waiting list of causes not related to the expander and one child died from sepsis attributed to an infected expander. Tissue expansion can generate skin to facilitate closure of abdomen post-transplant, thus allowing infants with small abdominal volumes to be considered for transplant surgery. Tissue expansion in children with end-stage liver disease and portal hypertension is associated with a very high complication rate and needs to be closely monitored during the expansion process.

A rare pitfall in the diagnosis of oesophageal atresia

The diagnosis of oesophageal atresia (OA) is usually made soon after birth. Two diagnostic criteria are failure to pass a nasogastric (NG) tube and a chest radiograph demonstrating a curled NG tube in the upper oesophageal pouch. A 6-day-old neonate was referred to our institution with persistence of symptoms following exclusion of the diagnosis of OA on the basis of an NG tube radiologically confirmed to reach the stomach. Persistent oxygen desaturations and copious salivation led to further investigations, and a delayed diagnosis of oesophageal atresia and tracheo-oesophageal fistula was made. Radiological demonstration of an NG tube reaching the stomach does not exclude the diagnosis of oesophageal atresia and can be falsely reassuring and lead to diagnostic delay.