Healthcare Professionals should follow SOPs and ensure ethical practice to prevent infections


 Medical Considerations while using Intravenous Infusions

Healthcare Professionals should follow SOPs
and ensure ethical practice to prevent infections

There is a need to promote rational use of Intravenous
Infusions and avoid pricking IV infusion bottles

KARACHI: Mir Khalilur Rehman Memorial Society from Jang Group of Publications in collaboration with PMA and Otsuka Pakistan organized a seminar on March 21st to create awareness about measures which can prevent infections. Speakers in their presentations highlighted the importance of ethical medical practice and hazards associated with pricking of Intravenous Infusion bottles which is considered as one of the major risk factor for spread of hepatitis and other infections. The session was moderated by Mr. Wasif Ngai who in his introductory remarks said that quality of IV infusions matters. Chemists sell preparations of those companies which give them more commission and often compromise on quality. Doctors and nurses, he opined, should be educated about using quality products and dangers of substandard drugs, pricking of IV infusion bottles, contaminated with bacteria should be highlighted and all efforts should be made to promote rationale use of these preparations.

Mir Khalilur Rehman Memorial Society in collaboration with PMA and Otsuka Pakistan organized a
seminar on Medical Aspects of IV Infusions at Karachi recently. Picture taken on the occasion
shows the host
Mr. Nagi alongwith speakers as well as senior executives of Otsuka Pakistan.

Speaking on the occasion Dr. Sher Shah Syed, a noted Obstetrician & Gynecologist said that late Dr. SJ Zuberi had identified the risk of hepatitis many years ago. Recently in interior for Sindh we did 250 operations and out of this 70-80 patients were HBV and HCV positive. Precautions should be kept in mind even while using Miswak in mosque and surgical instruments as all of them can spread infections. Re-use of syringes, improperly or unsterilized instruments were another major risk factor for spreading hepatitis. Source of supply of the intravenous infusions preparations should also be kept in mind. Doctors should be educated to promote ethical medical practice. Most important universities should give guidance, hospital administrators should not demand commission from the companies, and promote rational prescribing. Patient interest should be kept supreme and this should be told not only to the doctors but other members of the healthcare team as well including midwives, nurses and paramedics who all need to be educated.

Dr. Qaisar Sajjad who represented PMA in his speech said that in Pakistan health remains neglected. Public should also give importance to their health. There is a very high volume sale of IV solutions. We should not support doctors involved in unethical practices. Doctors should also guide their patients instead of misguiding them. Intravenous infusions should only be used if they are indicated. While buying these products do not go for lowest price but also look at quality. He also criticized the un-necessary use of injection by GPs. IV drips, he said, can also be dangerous. He also highlighted the importance of hand hygiene among doctors wherein many are lacking. Improper sterilization of instrument also spread hepatitis. Quacks were playing havoc. It should be emphasized again and again not to prick IV infusion bottles. Many medical stores do not have qualified pharmacists which at times leads to serious errors in dispensing.

Prof. Saeed Qureshi Vice Chancellor of Dow University of Health Sciences talked about Intravenous solutions, bottle and solution delivery system. He pointed out that once a drug manufacturer is licensed and drug is registered it is legal and we cannot differentiate between drugs. Procurement committee cannot refuse it. However, we need to make sure that the Cannula which deliver these solutions should not traumatize the patient. Infection and injury to the patient should be avoided. In swelling thrombosis should not develop in which we are always careful. Maintain and replacement of the fluids is important. Different types of combinations are available some are with additives in bottles. Some say they should be already added in the preparations but cost is also a consideration.

Prof. Tipu Sultan an eminent anesthetist and Vice Chancellor of Malir University of Science and Technology said that all these products are locally produced. It is our own people who indulge in unethical practices. There are about thirty brands of different intravenous solutions and all have same maximum retail price but then actually they sell at different price offering commissions. IV fluids, he opined, can be lifesaving but they can also take life. IV solutions administered to heart attack patient or patient with myopathies may lead to his death. Its half-life is half hour. Collides have 4-6 hours half-life. These preparations contain, sodium potassium magnesium. Fluids and salts are essential and they are lifesaving. Our patients are innocent. But it is doctors, pharmacists, drug manufacturer, nurses, paramedics, midwives, medial stores who are all the stake holders and they play with the patient. They all should play their role honestly. If there is no indication, do not give IV infusions even if the patient insists. Quackery is rampant in the country, the number of quacks in Sindh alone is over two lac of which eight thousand are practicing in Karachi. Then we have qualified quacks MBBS doctors. Paramedics also indulge in practice promoting quackery. He was of the view that we must ensure quality of Intravenous solutions. They must contain full quantity mentioned on the bottle, dispensing should be perfect and no one should play with the life of the patient.

Prof. Baddar Fayaz Zuberi Consultant Gastroenterologist at DUHS said that the first principle of medical ethics was do no harm which is our duty. We have many treatment options. There are many varieties of IV solutions. Pricking IV bottle is bad. Use them as per indications. He also laid emphasis on quality and felt at times it is also difficult to educate the patient.

Prof. Shams Nadeem Alam, Transplant Surgeon from DUHS stated that so far their team has done twelve liver transplants. We see end state patient’s which is due to IV solutions. As medical students we had no training and we learnt all this during practice. We had no training in quality assurance. We never knew about medical grade plastics. We are not taught all these things. We have learnt it all on duty and during training. He pointed out that undergraduates, postgraduates should be trained. The manufactures also indulge in certain practices in order to cut costs. Let us give emphasis to prevention of HBV and HCV. Out of twelve patients which had transplant, eight had hepatitis HBV and HCV. It can be and should be prevented. Doctors, he felt, should think about quality assurance.

Dr. Minjah Qidwai Chief Operating Officer of Sindh Healthcare Commission said that it was established in 2014. We have started registration of healthcare establishments. We have decided to register each and every healthcare facility. Patients, he said, should know their rights.

Syed Jafar Ali Pharmacists at AKUH talked about supply chain management. How IV solutions are delivered at hospitals needs to be checked. They are supplied in open vans with the result that they get sun exposure. Efforts should be made to ensure Supply chain quality. Look at the source from where these products are coming. Make sure it is authentic source and Dilution should be made better. Ms. Afifa a Nurse practitioner said that such meetings will enhance awareness. Nursing profession is getting better. Postgraduate nurses now know potential dangers. She hoped that all such efforts will bring some improvement in the years to come.

Prof. Ejaz Ahmad Vohra an eminent physician from Ziauddin Medical University criticized the politicians who are too fond of inaugurating new projects since they suffer from Takhti Syndrome. Doctors, he stated, should know about nutrition. They need to be educated. As regards ethical medical practice, we have serious problem. Doctors should be trained in ethics. We must keep interest of patient above our own. Do not add additives and make sure to protect patients from Hospital acquired infections. Patients come to hospital for treatment but we give them more and new infections, new diseases. A particular department in hospital, he stated, should monitor all this. Thyroxin heat stable products should be made available. DRAP should look after drug standards. India has prepared IV infusion guidelines. We doctors are also responsible for these unethical practices by running Drip clinics. Dispensing drips should be avoided, he remarked. Continuing Prof Ejaz Ahmad Vohra said that while the West reveals everything, we in the East conceal everything. There is a difference in our thinking and those in the West. Many tonics are registered in Pakistan which are not needed but were also harmful.

Mr. A.Waheed Sheikh Special Secretary Health in his speech laid emphasis on ethical medical practice. He was of the view that the doctors need to work on prevention side. But prevention is not their priority. They have important role to play. My feelings are that doctors are sensitized, they are motivated to work. Media has to play a role. Patients have economic problems. Should they buy good food or good drugs? His advice to the healthcare professionals was to keep their limited budget in mind while prescribing drugs.