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.

A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats

A mixture of 2% lignocaine (LIG) and 0.5% bupivacaine (BUP), at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP), was compared to LIG (4 mg/kg) and BUP (1 mg/kg) for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg) and ketamine hydrochloride (10 mg/kg). Onset and duration of analgesia, and time to walking were determined. Associated changes in heart rate (HR), respiratory frequency (ƒR) and rectal temperature (RT) were recorded. Onset of analgesia with epidurally administered LIG-BUP (4.5 ± 0.7 min), LIG (3.9 ± 1.0 min) and BUP (5.0 ± 1.0 min) was similar. Duration of analgesia with LIG-BUP (49.4 ± 4.5 min) was significantly (P 0.05) longer than with LIG (40.2 ± 1.0 min) but shorter than with BUP (79.4 ± 6.3 min). There were no significant differences in times to standing with LIG-BUP (26.3 ± 6.4 min), LIG (20.4 ± 4.7 min) and BUP (22.6 ± 10.3 min). Minimal changes were observed in HR, ƒR and RT. In conclusion, duration of analgesia produced by LIG-BUP was shorter compared with BUP but longer compared with LIG. Neither LIG nor LIG-BUP has any advantage over epidural BUP in terms of onset of analgesia, time to standing and physiological responses. Therefore, lumbosacral epidural administration of BUP appears to be the best choice for a long surgical procedure lasting more than 1 hour when compared with either LIG or LIG-BUP.

Influence of dosage and chemical restraints on feline excretory urography

Three series of trials involving 10 domestic short-haired cats were carried out to determine the influence of dosage of contrast media or type of chemical restraint on feline excretory urography. The 1st series (group A) involved 5 cats sedated with 2.0 mg/kg intramuscular (i.m) injection of 2% xylazine and receiving 800 mg/kg of 76 % meglumine diatrizoate (urografin). The 2nd series (group B) involved another 5 cats sedated with 2.0 mg/kg (i.m) injection of 2% xylazine and receiving 1200 mg/kg of 76% urografin. The 3rd series (group C) involved the repeat urography of the group B cats but sedated with 15 mg/kg (i.m) injection of 5% ketamine hydrochloride. Ventrodorsal radiographs were obtained immediately, 5, 15 and 40 minutes after the injection of 76% urografin. Scores were assigned to nephrographic opacification as described in the literature. The heart rates, respiratory rates and rectal temperatures of the cats were also determined before sedation, after sedation, immediately after the injection of 76% urografin and at 15-minute intervals over a period of 60 minutes. In this study, there were significant differences (P < 0.05) in the nephrographic opacification scores between the group A and group B cats at times 0 and 40 minutes post-administration of urografin. Group A cats had good initial nephrographic opacification which faded later while the nephrographic opacification of group B cats progressively increased. Similarly, nephrographic opacification was significantly (P < 0.05) higher in the xylazine-sedated cats (groups A and B) than the ketamine-sedated cats (group C). However, there were no significant differences (P > 0.05) in heart rates, respiratory rates and rectal temperatures between the 3 groups of cats. It was therefore concluded that increasing the dosage of urografin above 800 mg/kg in cats does not provide additional beneficial effects on the nephrograms produced. Xylazine sedation was observed to produce better nephrographic opacification, however, with delayed nephrographic fading compared to ketamine sedation.

Retrospective evaluation of xylazine/halothane anesthesia in 125 cattle

A retrospective morbidity and mortality study was carried out on 125 case records of cattle involving xylazine/halothane anesthesia at the Ontario Veterinary College, Guelph between May 1979 and February 1983.One hundred and six animals were given xylazine intramuscularly with a mean dose of 0.22 mg/kg and the remaining 19 were given a mean dose of 0.17 mg/kg intravenously. When the animals became recumbent, they were intubated and connected to an anesthetic machine which delivered halothane in oxygen.Anesthetic complications were recorded for ten cattle (8%) in the series and were mainly associated with regurgitation of ruminal contents, with or without aspiration. Three animals died as a result of the anesthetic procedure and in three other instances there were complications which were potentially fatal. Two of the anesthetic deaths were directly attributable to faulty technique rather than a specific drug response.The use of xylazine/halothane was judged to be clinically satisfactory and did not produce an unacceptable complication rate, although it is evident there is a significant risk associated with general anesthesia in ruminants.

Pathogenicity of Eperythrozoon suis alone and when mixed with Babesia trautmanni in experimentally-infected pigs

The pathogenicity of a single infection with Eperythrozoon suis and of a mixed infection of E. suis and Babesia trautmanni in experimentally-infected pigs, was described. In the pigs with a single infection, parasitaemia of E. suis was observed 4 days after blood inoculation. Although parasitaemia with this parasite was also observed on the 4th day in a mixed infection, the parasitaemia of B. trautmanni was not noted until 14 days after inoculation at a period when that of E. suis had started to fall. No parasitaemia was observed in any of the pigs in the splenectomized and unsplenectomized uninoculated control animals. The pigs carrying either single or mixed infections had pyrexia and their temperatures were consistently higher than those of the control animals. Infected pigs also showed anaemia with significant decline in Pcv, Hb and RBC values. The total WBC count rose in the infected pigs and the rise was more pronounced in pigs carrying E. suis alone. In addition, it was only in pigs infected by E. suis alone that a decline in the percentage of neutrophils and a rise in percentage lymphocytes was observed.