REVIEW OF CASES OF NOSOCOMIAL LASSA FEVER IN NIGERIA - THE HIGH PRICE OF POOR MEDICAL-PRACTICE
REVIEW OF CASES OF NOSOCOMIAL LASSA FEVER IN NIGERIA - THE HIGH PRICE OF POOR MEDICAL-PRACTICE
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DOI：
10.1136/bmj.311.7009.857
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发表时间：
1995-09-30
影响因子：
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通讯作者：
MCCORMICK, JB
中科院分区：
文献类型：
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作者：
FISHERHOCH, SP;TOMORI, O;MCCORMICK, JB
目的-调查尼日利亚中南部两起医院拉沙热疫情。背景-尼日利亚伊莫州城乡地区的医院和诊所。设计-查阅这两个地区的医院和诊所的医疗记录。确定了推定的和实验室确认的拉沙热患者，并追踪了合同。对医院工作人员、患者和当地居民进行了询问，仔细审查了记录，并采集了血清样本。结果：34例拉沙热患者中，20例患者、6名护士、2名外科医生、1名内科医生和1名患者的儿子共死亡22例，病死率为65%。11例经实验室确诊，5例经病毒分离。大多数患者曾在医院暴露(一家医院患者的发病率为55%)。这两家暴发医院的设备和工作人员不足，医疗实践很差。令人信服的间接证据显示，由受过最低程度教育和监督的工作人员进行的共用注射器的非肠外药物查房助长了患者之间的流行。随后，工作人员在急诊手术和护理医院感染患者的过程中被感染。结论-这次疫情表明现代医学实践，特别是使用静脉注射和手术的高昂代价，而没有适当注意良好的医疗实践。必须高度重视发展中国家医务人员的教育以及诊所和医院安全运作的指导方针。如果做不到这一点，将会产生深远的、代价高昂的、最终是毁灭性的后果。
Objective-To investigate two hospital outbreaks of Lassa fever in southern central Nigeria.Setting-Hospitals and clinics in urban and rural areas of Imo State, Nigeria.Design-Medical records were reviewed in hospitals and clinics in both areas. Patients with presumed and laboratory confirmed Lassa fever were identified and contracts traced. Hospital staff, patients, and local residents were questioned, records were carefully reviewed, and serum samples were taken. Serum samples were assayed for antibody specific to Lassa virus, and isolates of Lassa virus were obtained.Results-Among 34 patients with Lassa fever, including 20 patients, six nurses, two surgeons, one physician, and the son of a patient, there were 22 deaths (65% fatality rate). Eleven cases were laboratory confirmed, five by isolation of virus. Most patients had been exposed in hospitals (attack rate in patients in one hospital 55%). Both outbreak hospitals were inadequately equipped and staffed, with poor medical practice. Compelling, indirect evidence revealed that parenteral drug rounds with sharing of syringes, conducted by minimally educated and supervised staff, fuelled the epidemic among patients. Staff were subsequently infected during emergency surgery and while caring for nosocomially infected patients.Conclusion-This outbreak illustrates the high price exacted by the practice of modern medicine, particularly use of parenteral injections and surgery, without due attention to good medical practice. High priority must be given to education of medical staff in developing countries and to guidelines for safe operation of clinics and hospitals. Failure to do so will have far reaching, costly, and ultimately devastating consequences.