Understanding and Tackling Hospital-Acquired Infections

By Dr. Grace A. John-Ugwuanya

Every time you walk into a hospital, you expect healing. But what if the very place meant to restore health becomes the source of a new, life-threatening condition?

In the heart of Kaduna in Nigeria, a young boy admitted for a simple appendectomy developed a high fever on day five. His wound had become infected not from home, not from school, but right there in the hospital.

His case wasn’t unique. It is a classic example of a nosocomial infection, a silent epidemic affecting thousands across Nigeria and many parts of the world.

What Are Nosocomial Infections?

Also known as hospital-acquired infections (HAIs), nosocomial infections are infections that

• develop 48 hours or more after hospital admission,
• up to 3 days after discharge, or
• within 30 days of a surgical procedure.

These infections are not brought into the hospital by the patient. It is acquired within the hospital environment. Common examples include:

• Surgical site infections (SSIs)
• Urinary tract infections (UTIs) from catheters
• Ventilator-associated pneumonia (VAP)
• Central line-associated bloodstream infections (CLABSI)

These infections typically occur 48 hours or more after admission and are often caused by pathogens like Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli.

A Local Snapshot: The Kaduna Case

In a government hospital in Kaduna, records over a 6-month period showed that 1 in 8 post-surgical patients developed some form of nosocomial infection. The causes ranged from poor hand hygiene among healthcare workers to delayed sterilization of surgical equipment and reuse of catheters without appropriate protocols.

This isn't just a data point. These are real people battling more than they signed up for. In some cases, what should have been a 3-day admission turned into a 3-week struggle.

Impact in Nigeria and Globally

Nosocomial infections are:

• Deadly: WHO estimates that over 15% of hospitalized patients in low- and middle-income countries will contract a hospital-acquired infection. According to WHO, 7 out of 100 hospitalized patients in high-income countries and 15 out of 100 in low- and middle-income countries (LMICs) develop at least one hospital-acquired infection..
• Costly: They prolong hospital stays, increase the use of antibiotics, and drain already-limited resources.
• A breeding ground for AMR: When antibiotics are used indiscriminately to treat these infections, antimicrobial resistance (AMR) is amplified making future infections harder to treat.

In Nigeria, local studies estimate that hospital-acquired infections affect 20–30% of inpatients, particularly in neonatal and ICU units. These infections prolong hospital stays, increase healthcare costs, and raise mortality rates especially when caused by resistant organisms.

What Causes These Infections?

Several factors predispose hospitals and patients to hospital-acquired infections:

• Lack of infection control protocols
• Poor hand hygiene
• Overcrowded wards
• Reuse of medical devices without proper sterilization
• Inadequate waste management
• Overuse or misuse of antibiotics
• Compromised patient immunity
• Poor ventilation and infrastructure
• Overcrowding and understaffing
• Lack of surveillance systems and standard operating procedures

We don’t have to accept nosocomial or hospital-acquired infections as inevitable.

Using the case study in Kaduna (located in northern Nigeria), during the dry season, dust accumulation on unscreened windows and cracked hospital floors further contributes to air and surface contamination creating the nosocomial storm.

In many facilities, quality assurance systems are weak or non-existent, and data on infection rates is rarely collected or analyzed.

The Antimicrobial resistance Factor

When nosocomial infections are caused by antimicrobial-resistant (AMR) organisms, treatment becomes harder and outcomes worsen. For example, resistant Acinetobacter or Klebsiella infections may no longer respond to first-line antibiotics. Patients are left battling infections with expensive, toxic, or even ineffective options.

Hospitals are becoming hotspots for AMR transmission

Ways to Tackle Hospital Acquired Infections

1. Strengthen Infection Prevention and Control (IPC) practices
2. Introduce and enforce Quality Assurance (QA) systems
3. Combat antimicrobial resistance
4. Empower hospital leadership
5. Engage patients and families

How Quality Assurance Can Help

Most hospitals wait for outbreaks before acting. But a well implemented quality assurance system helps us to become proactive rather than reactive. It is not about paperwork but understanding that real lives are involved. The following ways can help:

• Infection Control SOPs: Ensure strict guidelines on sterilization, hand hygiene, and equipment use.
• Surveillance Systems: Monitor infection patterns and trigger early interventions.
• Staff Training: Regular education on infection control protocols.
• Antibiotic Stewardship: Enforce rational use of antimicrobials through evidence-based prescribing.
• Facility Audits: Assess environmental hygiene, ventilation, and water supply regularly.

When QA is embedded into the hospital culture, the risk of nosocomial infection drastically reduces. Quality Assurance is simply about:

• Standardizing care
• Reducing variation
• Holding the system accountable

When Quality Assurance and Infection, Prevention & Control walk hand in hand, the result is fewer infections, faster recoveries, lower costs, and stronger trust between patients and providers.

Practical Steps for Healthcare Facilities

• Conduct baseline infection rate assessments.
• Establish an Infection Prevention and Control (IPC) committee.
• Implement continuous quality improvement cycles.
• Train staff on the WHO's “Five Moments for Hand Hygiene.”
• Track and report antimicrobial resistance trends.
• Invest in IPC supplies (gloves, gowns, hand sanitizers, sterilizers).

Nosocomial infections are preventable.

📌 If you're a healthcare leader, invest in infection prevention and quality systems.

📌 If you're a policymaker, prioritise hospital hygiene in funding and oversight.

📌 If you're a healthcare worker, commit to the small routines that save lives like handwashing.

Every life saved is a reminder that hospitals are places of healing, not harm.

Let’s Talk Solutions

I’m Dr. Grace A. John-Ugwuanya, a pharmaceutical microbiologist and quality consultant passionate about safer healthcare systems. I help facilities integrate quality, regulatory, and infection control solutions that are locally relevant and globally compliant.

If you're working on hospital improvement projects, infection control, quality management frameworks or AMR policy design, I’d love to collaborate, speak, or consult on driving meaningful change in healthcare systems across Africa. 📩 Feel free to connect or send a message if you’re building infection control systems or .

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