4 April 2019
The link between James Cook University Hospital (JCUH) in Middlesbrough and Kamuzu Central Hospital (KCH) in Lilongwe, Malawi is well established, having been set up by THET almost 20 years ago. The last five years has seen this link focus more on infection prevention and control as part of the African Partnerships for Patient Safety Programme. Healthcare workers from both hospitals have been involved in the training of staff, particularly through the promotion of more effective hand hygiene.
During a recent visit to the KCH, Shirley Westwood, one of our biomedical scientists, noticed that there was a low throughput of samples for investigation in the hospital microbiology laboratory. She discovered that this was partly due to a lack of laboratory consumables with which to process samples. The lack of equipment meant a low number of samples were being submitted for investigation by clinical staff, who were rarely able to receive results.
Shirley worked together with the KCH head of microbiology, Faheema Choonara, establishing what was essential and affordable and compiling a list of laboratory consumables. The JCH team then secured these supplies as far as possible and took them to Malawi on their next visit. An enthusiastic laboratory team at KCH were given training in how to use their new equipment, and clinical staff were encouraged to learn that one of the benefits of submitting and processing samples is that it can provide information that can assist with patient management. The outcome was positive – in the following months there was a marked increase in laboratory throughput.
Microbiological investigations of samples were carried out to identify isolated pathogens and to ascertain their antibiotic sensitivity. It became apparent that in those pathogens identified, there was often significant resistance to many of the antibiotics in use at KCH. This demonstrated clearly the need for a hospital antimicrobial drugs guide and – using the JCUH guide as a basis – I worked with Tadala Hamisi, (KCH head of pharmacy at the time) on a new guide that was adopted by the KCH management team and which has since been upgraded.
It soon became clear that there was a need to determine the extent of antibiotic resistance in the different wards and departments at KCH, as well as in the community hospitals in the Lilongwe area for which KCH is a tertiary referral centre. During our visit, the JCUH team was fortunate to be joined by both a medical microbiologist and an infectious disease specialist, who also happened to be control of infection doctor at a neighbouring hospital, which made for an amply qualified group!
Samples were obtained from as many wards and departments at KCH as possible and tested and the results provided management and clinical staff with up to date information on antibiotic resistance. Fortunately, our visit followed on from WHO World Antibiotic Awareness Week, so new suggestions were well received. I was part of a meeting that took place with Malawi Ministry of Health lead on antibiotic stewardship, Dr Watipaso Kasambara, and teams from both hospitals to ensure that the advice offered by the JCUH team to KCH clinicians was consistent with that of the Ministry.
The JCUH team – comprising consultant microbiologist Dr Jessica Martin, infectious disease specialist Dr Emma O’Cofaigh and biomedical scientist Shirley Westwood – delivered antibiotic stewardship training to doctors, nurses and other healthcare workers at KCH. The training was comprehensive, covering instruction in how to take samples, how to recognise and manage sepsis, outbreak management and risk assessment. Particular importance was given to infection prevention and control, which is vital to reducing the unnecessary use of antibiotics.
A pattern of antibiotic resistance similar to that demonstrated in the KCH samples was also found in samples from a community hospital in the neighbouring rural district of Dowa. Dowa currently has limited facilities for microbiological investigation, which is the case with many other community hospitals. For the majority of the population in rural areas of Malawi who need hospital care, such healthcare facilities are the only option. At the moment, discussions are under way to explore the possibility of transporting samples from Dowa hospital to the laboratory at KCH. If successful, this model could become a blueprint for other community hospitals.