Coming Clean

Despite an alarming rate of healthcare associated infections in both public and private facilities, Egypt’s Ministry of Health is consolidating efforts to stem the contagions by partnering with local and international health organizations to get better results. By Ahmed Mansour In late January local newspapers ran a story about a cat giving birth to a litter at a government hospital in Alexandria. The heavily pregnant tabby had taken shelter from the icy winds lashing the coastal city in the hospital’s intensive care unit’s medical supply cabinet. The story quickly set off rights activists on social media, with many bemoaning poor service and conditions at public hospitals and decrying the generally rampant negligence in the nation’s health care facilities. But the issue of healthcare associated infections (HAI) is not limited to Egypt. HAI is one of the biggest issues hospitals face worldwide, with up to 13 percent of patients admitted to hospitals catching infectious diseases during their period of treatment resulting in at least an additional week of medical treatment to the patient according to the World Health Organization (WHO). HAI poses a huge financial burden to hospitals all over the world; in the United States alone, between $28 billion and $34 billion is spent each year to treat victims of HAI, while in developing countries such as Egypt, the financial burden is two to three times higher according to WHO findings. Egypt is no stranger to negligence in hospitals, with the WHO estimating the rate of HAI in the nation’s intensive care units and operating rooms to be 15 percent. The most commonly contracted HAI diseases in Egypt are MRSA, VRSA, Salmonella, HIV, Hepatitis C and E. coli. “The main cause of healthcare associated infections in Egypt, and worldwide, is human behavior,” says Dr. Abdel-Karim Kamel, assistant professor of medical biochemistry at Cairo University. Kamel, who is also a healthcare consultant, explains that, “hospital staff sometimes don’t put into consideration the fact that when dealing with a patient, washing their hands can [slash] the possibility of HAI down to 50 percent. For example, if the operating doctor touched his patient’s skin while he is wearing gloves, he is not supposed to continue the operation until he changes the gloves; unfortunately doctors here in Egypt barely do that, thus the rate of HAI is very high.” Although infections are frequent at public hospitals in Egypt, Kamel does commend local government efforts to combat their occurrence. “The Ministry of Health plays a major role in preventing HAI, by sending doctors abroad to Germany and the United States to take workshops and courses to learn new techniques so that they can apply them in the ER and the OR to prevent getting infected or infecting the patients.” The Center of Disease Control and Prevention (CDC) has worked with public health institutions in Egypt in collaboration with the Naval Medical Research Unit No. 3 (NAMRU-3) for over 20 years. In 2009 the CDC worked with the Egyptian government, WHO, local partners and other United States Government agencies to reduce the impact of HAI in public and private hospitals around Egypt by creating the Global Disease Detection Program (GDD). According to the GDD’s website, the body’s main goals are the “reduction of the impact of emerging diseases, building capacity in areas such as laboratory systems and epidemiology, strengthening immunization services, responding to public health emergencies and conducting surveillance, surveys and studies. GDD supports efforts to protect the public’s health by developing and strengthening the ability of Egypt and the region to rapidly detect and respond to emerging Healthcare associated infectious diseases.” Since 2009, 3,963 Egyptian nationals and 2,273 Ministry of Health staff have been trained in collaboration with NAMRU-3 to decrease the rate of HAI in hospitals and in surveillance and laboratory diagnostics, according to the CDC, which emphasizes that the impact of the program saw a 20 percent drop in the rate of HAI in the first month it was applied. The efforts thus far may be admirable, Kamel says, but they are not enough. “[Even] after the efforts of the CDC and the Ministry of Health, HAI rates are still very high and more work should be done to decrease this number. Egyptian hospitals should be able to spend money on products that work on decreasing the rate of HAI and training not only doctors, but nurses as well so that they are able to keep themselves and the patients safe. This way hospitals will also be able to save money in the long run,” Kamel stresses. At the end of November 2014, the Ministry of Health and Population and the Supreme Council of Universities met with the U.S. Agency for International Development (USAID) and NAMRU-3 to scale up the programs in place for monitoring the level of antibiotic-resistant infections in Egyptian hospitals nationwide. “If a doctor subscribes a weak or wrong antibiotic to cure a certain bacterial infection, the patient might be subjected to bacterial antibiotic resistance, which means that the bacteria will have immunity against the antibiotic and the patient will not be cured,” says neurosurgeon and Minia University Professor Dr. Ahmed El-Narsh. “Each bacterium has a certain antibiotic that is considered to be the most effective when it comes to defeating it and if the wrong antibiotic is subscribed, this might subject the patient to a longer period of treatment, thus allowing the bacteria to take its toll on the patient and eventually leading to a permanent infection or death.” El-Narsh believes the USAID initiative is very positive, given what he describes as a “massive increase” the rate of HAI today. “The education regarding the use of the right antibiotic is very important and experts should always be consulted when it comes to fighting bacteria with antibiotics. The fact that Egypt is hosting international experts for this matter is great. Weeks after the USAID negotiations, a local family-owned fabrics company announced the official launch of a new product called Guard Textile, an anti-microbial textile which provides protection against transition of microbial infections. Hani Salam, the owner and Managing Director of Salamtex, which was established in 1936, explains that the technology behind Guard integrates silver and metallic silver antibacterial agents into the fabric thus killing bacteria immediately. Guard is also extremely hydrophobic, so when it comes into contact with any liquid, it simply slides off without being sucked into it. “This technology has the potential to help hospitals reduce the spread of infections. Prevention methods requiring active participation are always difficult due to human nature. The hospital staff is always busy responding to emergencies, giving little attention to not infecting the patient or being infected by the patient or by their surroundings. Guard serves as a passive system that immediately kills bacteria, and requires the least attention,” Salam adds. Salamtex claims replacing all soft surfaces in a hospital, such as lab coats, scrubs, uniforms, privacy curtains, patient apparel and bed linens with Guard could help reduce the rate of HAI by 99.96 percent. Guard Technology has earned the Oeko-Tex Standard 100 accreditation from Europe; meaning that it supports human ecology through bio-compatibility and the absence of harmful substances in the manufacturing process. Guard is also Federal Drug Authority (FDA) and Environmental Protection Agency (EPA) approved. “Hospitals continue to make procedural improvements in an effort to reduce the number of accidents resulting from bacterial cross-contamination, but textiles and clothing have largely been ignored until now. Infection control depends on washing and sterilization of textiles, but unfortunately this method has been proven to be ineffective since they quickly become infected again as soon as they leave the laundry room. Our product doesn’t require this much attention and it would be extremely beneficial when it comes to controlling HAI, especially that it costs less than the traditional textiles hospitals currently use,” Salam adds. Salamtex is currently receiving offers for the groundbreaking textile — branded as “self cleaning and continuing to provide antimicrobial protection after over 160 washes” — in the hope that it will aid in curbing the spread of MRSA, E. coli, VRE and Salmonella.