KNH NEWSLINE ED 3 2022

Newsline

25/2/2022

We Listen, We Care

PHOTO | BIZSURE

Issue 3

ISSUE 3| Kenyatta National Hospital Newsline

25/2/2022

Let’s talk about Pension

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Contents

Editor’s note

ISSUE 3 Editor’s note p.2 Lets talk about pension p.3-4 Staff lactation room available for working mothers at KNH p.5-6 An overview of Haemato-oncology Unit p. 7 When words speak louder than actions p.8 Our story in pictures p.9 Breaking the chain of Infections p.10-11 Demystifying Stock taking p.12 KNH Social work: Succesful repartriation p.13 Positive mentions from KNH official Facebook page p.13 Thank you KPCC: Mukami’s C-Section recovery journey p.14 Taking a systematic approach to hospital policy development p.15 Celebrating our patients through charity p.16-17 Comic zone p.18

ON THE COVER Lets talk about pension... p. 3

Marketing & Communication Department Design Concept Team: Dave Opiyo, Edel Q. Mwende, Yvonne Gichuru & Collins Cheruiyot Editorial Team: Dave Opiyo, Edel Q. Mwende, Winfred Gumbo, Jacquline Ngure, Marian Moraa, Shiphrah Njeri, Verah Mugambi and Moses Njomo Stories: Edel Q. Mwende, Verah Mugambi, Winfred Gumbo, Luke G. Kung’u, Sheila Murithi, Yvonne Gichuru, Marian Moraa, Peter Githua, Barbara Otieno, Lucy Nganga, Neema Kemunto,Paul Muriuki & Petterson Njogu Design By: Collins Cheruiyot Photos: Nicholas Wamalwa, Winfred Gumbo, Yvonne Gichuru, Steve Mutuku, Petterson Njogu & Shawn Paul

Dear colleagues, Kenyatta National Hospital celebrates World Day of the Sick every year and this year, the Hospital engaged a higher gear and carried out a whole week’s celebration dubbed ‘KNH Patient Week’ on February 21- 25, 2022, themed ‘KNH remembering patients through charity.’

The charity activities included blood donation, free screening services for blood sugar and blood pressure, Covid-19 vaccination, adopt a bed drive and adopting NHIF registration for needy patients.

The culmination of the charity activities was on February 24, 2022, with the celebration of the Day of the Sick in a Holy Mass at Shrine of Mary Help of the Sick, Don Bosco Catholic Church by KNH staff and selected patients.

We thank all partners and participants for their various acts of healing through prayer and charity.

All the Newslines and Newsletters can be accessed online on: https://bit.ly/3uQGCcI Ms. Edel Q. Mwende, Manager, Marketing & Communication Kenyatta National Hospital

Tel: +254 20 2726300-9 Ext. 43121 or 43969 Fax: +254 20 272572 Email: caffairs@knh.or.ke knh.caffairs@gmail.com

To contribute or report on newsworthy items, please contact the Editorial team.

ISSUE 3| Kenyatta National Hospital Newsline

Find us on Social Media Kenyatta National Hospital

@CeoKnh @KNH_hospital

Kenyatta National Hospital Official Page

www.knh.or.ke

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Let’s talk about Pension…

By Verah Mugambi

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very time one is called for a job opportunity, their biggest hope is to be appointed under permanent and pensionable terms. The permanent part is obvious, work until the official retirement age. But how much do we know about the pension part?

Having a retirement plan is important. Pension is vital as it helps maintain and sustain the standard of living after retirement.

Pension enables one to cater for their basic needs and also provides a safety net as one no longer enjoys their monthly salary or allowance benefits given in employment.

To help us understand the pension schemes, we talked to Ms. Stella Githaiga, a senior nurse working in the Universal Health Coverage unit, which is within Affiliation and Institutional Development (AID) at KNH, and Mr. Peter Mureithi, an internal auditor who has worked in the hospital for over 22 years.

They are both elected trustees in the Defined Contribution (DC) pension scheme.

What are the different pension plans?

Stella Githaiga: There are two main types of pension schemes: the Defined Benefit (DB) and the Defined Contribution (DC) plan. A Defined Benefit plan guarantees a set monthly payment for life (or a lump sum payment on retiring) rather than depending directly on individual investment returns. A Defined Contribution plan creates an investment account that grows throughout the employee’s working years.

“Pension’s main mandate is for members to be able to save towards their old age. In KNH, one is eligible to start saving for pension as soon as they are appointed to permanent employment.”

“At KNH we have both pension schemes; Defined Benefit (DB) and the Defined Contribution (DC) plan.

The employee contributes at least 5% of their basic salary towards

PHOTO | FREEPIK A representation of growth in pension as a young man till old age when one retirees

their pension and the employer doubles their contribution.” Ms. Stella continued.

She states that each pension scheme has trustees; the DC scheme has eight (8) trustees; four (4) nominated by the employer or sponsor and they include the CEO, HR, Corporate Secretary and one board member. The other four (4) positions are competitive-elected by members. DB has nine (9) trustees; six (6) nominated by the sponsor and three (3) elected by members.

“The DC scheme was started in July 2011 after a directive from the National Treasury.

Pension is a benefit to the employees and the hospital is not obligated to contribute, but KNH our sponsor has done really well in

ISSUE 3| Kenyatta National Hospital Newsline

Pension’s main mandate is for members to be able to save towards their old age. In KNH, one is eligible to start saving for pension as soon as they are appointed to permanent employment.”

Stella Githaiga

terms of having a pension scheme.

After being elected, one undertakes a five-day mandatory training to qualify as a registered trustee.

The course is examinable and it enlightens one on the position’s expectations,” Mr. Peter Mureithi, told Newsline. DB is an old scheme that no longer accepts new members since 2011. The DB scheme calculates pension based on the employee’s last pay and some actuarial factors including; the economy, the market rate etc.

This was complicated and that is why the government made changes in order for members to be involved in contributing towards their schemes.

When the DC scheme was initiated in 2011, members who were 45 years old and above, remained automatically in the DB scheme until retirement and even past retirement.

“Members who were 45 years and

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below, had to move to DC scheme because they could not contribute to both schemes at the same time, but their savings in DB remained locked.

Upon retirement, the members get pension benefits from both schemes,” Stella explained.

The Retirement Benefits Authority (RBA) regulates the pension schemes in Kenya. The Authority has since its inception utilized compliance-based supervisory model to oversee the pension industry.

The RBA has an act that regulates how one should be paid and the period which you should be paid; currently, it is three (3) months after an employee’s last day of service.

Ms. Stella explained that after 3 months one gets a third of their savings. The other 2/3, one is required to buy an annuity from an insurance company that is recommended and regulated by RBA. The member receives the 2/3 on a monthly, quarterly, or annual basis depending on how they calculate & agree with the

“ The advantage of buying an annuity from an insurance company is that the member’s money earns interest. A lifetime annuity provides a regular income for life. insurance company. The advantage of buying an annuity from an insurance company is that the member’s money earns interest.

According to Mr. Peter, accessing the retirement benefits is a personal decision that is guided by RBA regulations. “A life time annuity provides a regular income for life.

Alternatively, there is an Income Drawdown Fund which has no guarantee that the income you draw will last for life since when you reinvest your retirement benefits, they become vulnerable to market performance,” Mr. Peter explained.

employees shall start the 7.5% pension savings effective July 2022.

This will enhance member savings and the sponsor (employer) is expected to double the contribution to enable the employee live a decent life upon retirement.

An individual can decide to enhance their monthly pension contribution, i.e., instead of the 7.5%, one saves even 10% of their salary, but the employer is not mandated to double their contribution.

Mr. Peter and Ms. Stella encourage members, especially the young employees, to embrace a saving culture and fill details of beneficiaries at the pension secretariat office opposite ward 1E.

The 7.5 addition In reference to the memo: KNH/HR/A/160 dated 2nd February 2022, to all members and DC scheme,

PHOTO | YVONNE GICHURU Ms Stella Githaiga, Senior Nurse Officer (SNO)-UHC

ISSUE 3| Kenyatta National Hospital Newsline

PHOTO | COURTESY Mr. Peter Mureithi, Internal Auditor KNH

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Staff lactation room available for working mothers at KNH

By Sheila Murithi

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reastfeeding is the best source for an infant’s nutrition and contributes to maternal health. The World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) recommend exclusive breastfeeding during the first six months of life and to continue breastfeeding with complementary foods at least until the age of 2. (Source: UNICEF, W., Global Breastfeeding Score Card, 2019.

2020, WHO & UNICEF: Geneva/ New York).

The numerous benefits of breastfeeding for both the mother and child cannot be ignored and this has driven the government to put in place laws to support and enforce a healthy environment for lactating mothers to express their milk.

Think about it, breastfeeding ensures we have a healthy nation; the decrease of infant death and increase of children with strong immunity and a healthy mental state due to sufficient bonding with the mother results in well-functioning adults in the society.

As well as mothers with a reduced risk of death resulting from reproductive and breast cancers will bring down the cost of healthcare.

The enactment of the Health Act of 2017 and Breastfeeding Mothers Bill of 2019 is a means of cutting the healthcare problems we face as a country at the bud.

Newsline met Ms. Agnes Sitati, Head of Nutrition Department and also the Chief Nutrition Officer in KNH to spotlight the already

functioning Staff Lactation Room in KNH with the hopes of creating more awareness to staff about its existence and encouraging its use.

Q: Tell us about the lactation room, when did it become functional?

A: The lactation room was operationalized in January 2019 and this was as a result of an initiative by the KNH management to comply with the Health Act of 2017 that requires all employers to establish lactation stations at the workplace to support female employees who are breastfeeding so that they can breastfeed successfully.

Following the enactment of the Health Act in 2017, the Head of Pediatrics Department then, Dr. Irene Inwani started the process of establishing the staff lactation station in KNH. Since breastfeeding entails an infant’s nutrition, the Nutrition Department was tasked to lead the process of setting up this facility.

Thereafter a multidisciplinary committee was formed comprising Affiliation and Institutional Development Department, Infection Prevention

Control (IPC) Unit, Nursing team, and the Pediatrics Departments that looked at the requirements of putting up the staff lactation room as stipulated in the Act.

PHOTO | SHEILA MURIITHI An inside view of the lactation room, located at KNH, Nutrition department

Q: Tell us about the equipment available for the mothers to use A: The equipment available in the staff lactation room includes: comfortable chairs, recliners to be precise, which help mothers relax. The process of milk let down is enhanced when mothers express their milk in a comfortable environment.

We also have coffee tables where the mother can place her breastfeeding pumps, storage cups, bags, and other utensils. Lockable cabinets are also available for the mothers to put their bags, pumps, and expressed milk.

We also have a refrigerator in the room. If a mother comes early in the day and wants to store their milk there until evening when this fridge will ensure that the milk will not spoil. The lactation room is also equipped with a sink with clean flowing water so that the mothers can clean their hands and utensils.

The lighting is adequate and power outlets are also available for mothers who use the electrical pump or if they need to use any

PHOTO | COURTESY Ms. Agnes Sitati, Head of Nutrition Department

ISSUE 3| Kenyatta National Hospital Newsline

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electrical device when they are using the facility. We also have a provision for a television set and we are hoping to get one soon through the support of well-wishers. The television set will be used to run educational material for the mothers but for now, we provide educational material through pamphlets and fliers available in the room.

Q: What was the gap being addressed before setting up the lactation room?

A: Before, staff who had cars would express in their cars or they would go express in the changing rooms or tea room areas. Other times the mother would not express their milk at all and wait until they leave for home.

This caused breast conditions such as engorgement and reduced milk production because the milk was not frequently removed from the breast. This resulted in the mothers not breastfeeding successfully and supplemented their children earlier on before the required 6 months.

The breastfeeding support room has changed this and is making the workplace more conducive for working lactating mothers.

Q: How is the uptake so far?

A: The uptake has been quite slow, probably due to the location as most of our staff work in the tower block and the staff lactation room is located at the old hospital.

The distance could be one of the challenges.

Another reason that can explain the low uptake is maybe our staff are not aware of the room. Besides displaying our fliers on notice boards and sending memos to other department and unit heads, we have done some awareness activities on our website and we are also working with the Marketing and Communications department to help share the information through their internal communication channels such as the Newsline.

We are continuously looking at ways to intensively increase the awareness among staff. Also, we are in the process of carrying out a study to fully understand why the uptake is low.

Q: What controls have you put in place to ensure there is no contamination of the breastmilk

expressed and also to avoid mix up of different milk from different mothers?

A: As I mentioned earlier, we work very closely with the IPC Unit and they have been instrumental in all matters that concern infection prevention in the facility. One of the controls I may have highlighted earlier is that we have lockable cabinets; so if a mother would like to lock up her milk, she will be assigned a cabinet and key which is returned when she picks her milk and is leaving for home.

Secondly, mothers are coming with their storage containers and pumps, we are not providing milk containers for them so they ensure their items are clean. If they consider storing the milk in the refrigerator, then we require the storage containers to be clearly labeled with a tight-fitting lid.

We also ensure the room is always locked and is only opened by the nutritionist on duty, so when a mother wants to access the room the officer will come and open it for them and once they are done it is locked again.

The fridge is also lockable and a register is maintained with details of the staff coming to use the facility.

When the mother is taking her milk home the nutritionist opens the fridge for them and ensures they take the milk belonging to them only because it is clearly labeled. The officer then locks the fridge again.

A sign-off on the register is also done by the mother. These controls not only prevent infection but also ensures there is no theft.

Q: When is the room available for use to the mothers?

If we still struggle to meet the needs, then we can approach the hospital management for them to allocate additional space as long as we can show that there is a dire need.

Q: Besides the convenient space, what other services are offered to our mothers when they come?

A: We also have lactation managers and counselors who possess insights, knowledge, and skills essential for successful breastfeeding and they are readily available to our staff. When a mother is facing any problems with breastfeeding or wants to improve and increase their breast milk production, they can easily access help and advice from our very able team.

PHOTO | SHEILA MURIITHI A fridge located inside the lactation room for preserving expressed milk

Q: How does the employer stand to benefit from having these lactation areas in the workplace?

A: A breastfeeding-friendly workplace greatly contributes to productivity in the workplace, higher staff retention, and job satisfaction.

The working mothers become more relaxed and can concentrate on their work because they can still fend for their little ones without any discomfort or stress.

We would like to encourage all staff in need of these services to come to our offices located in the old hospital on the second floor, the lactation room is housed in the Nutrition Department. We also appeal to all Heads of Departments and Units to support our lactating mothers by allowing them time off their duties to come and express milk for their babies.

PHOTO | SHEILA MURIITHI Lockable cabinets used by mothers to store their bags, pumps and expressed milk

A: The lactation room is available for use Monday to Friday from 8 a.m. to 5 p.m.

Q: Is the room sufficient in relation to the large number of staff we have?

A: At the moment the room is sufficient as we have not had a challenge with the numbers the room can accommodate at any one time. If we have more mothers coming to use the facility then we will schedule them at different times to ensure we avoid long waiting times and overcrowding.

ISSUE 3| Kenyatta National Hospital Newsline

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An overview of Haemato-oncology Unit

By Cynthia Cherono Cancer is the third leading cause of mortality in Kenya, accounting for 7% of annual deaths. Kenyatta National Hospital in collaboration with the Ministry of Health (MOH) is committed to reducing cancer mortality, as evidenced by policies such as the National Cancer Control Strategy.

Therefore, KNH came up with efficient ways to improve services in the haemato-oncology unit, through the collaboration of KNH oncology and UON. KNH Newsline team decided to get insights on haemato-oncology and what exactly happens in the unit and the services offered.

Hematology is the branch of medicine that deals with conditions affecting the blood and lymphatic systems.

Hematology-oncology is the diagnosis, treatment, and prevention of blood diseases (hematology) and cancer (oncology) and research into them. Hematology-oncology includes such diseases as anemia, Acute or chronic leukemia and lymphomas, Myeloma, or other blood disorders.

Hematological cancer affects the blood directly or the tissues that are responsible for blood formation.

The Kenyatta National Hospital Haemato-oncology Unit is one of the largest in Kenya and it is responsible for diagnosis, treatment, and research on blood cancers in adults and children as well as various forms of immunotherapy.

The clinic is based at the hospital Outpatient Oncology Clinic 23, which is fully equipped to provide all blood cancer treatment services.

Both adults and children with non-cancerous blood diseases like anemia and bleeding disorders are seen on others days on appointment only.

Emergency cases are either referrals or channeled through Pediatrics’ Emergency and Accident and Emergency Department from where the specialist is informed accordingly.

The types of cancers managed in this unit include: • multiple myeloma

• acute myeloid leukemia and myelodysplastic syndrome • chronic myeloid leukemia and related disorders • chronic lymphocytic leukemia and related disorders • lymphoma Types of blood cancer disorders • Leukemia is a type of cancer found in the blood and bone marrow and is caused by the rapid production of abnormal white blood cells. The high numbers of abnormal white blood cells are not able to fight infection, and they impair the ability of the bone marrow to produce red blood cells and platelets.

• Lymphoma is a type of blood cancer that affects the lymphatic system, which removes excess fluids from your body and produces immune cells. Lymphocytes are a type of white blood cell that fights infection.

Abnormal lymphocytes become lymphoma cells, which multiply and collect in your lymph nodes and other tissues.

• Myeloma is a cancer of the plasma cells. Plasma cells are white blood cells that produce disease- and infection-fighting antibodies in your body. Myeloma cells prevent the normal production of antibodies, leaving your body’s immune system weakened and susceptible to infection.

Some of the symptoms of blood cancer; Fever, chills, Persistent fatigue, weakness, loss of appetite, nausea, unexplained weight loss, night sweats, bone/joint pain, abdominal discomfort, headaches, shortness of breath, frequent infections, itchy skin, or skin rash and swollen lymph nodes in the neck or underarms.

Diagnosis At Kenyatta National Hospital, an integrated approach is used to diagnose blood cancers using multiple tests on blood, bone marrow, and lymph node samples. These tests can include: • histopathology to look at tissue biopsies at the microscopic level • cytogenetic to look for chromosomal changes in cancer cells • molecular tests to look for

ISSUE 3| Kenyatta National Hospital Newsline

mutations • immunopheno typing to look at proteins on the surface of cancer cells • PET and MRI scan to stage many lymphomas and myelomas.

PHOTO | CREDIHEALTH

Microscopic view of the blood

Treatment The clinic has many specialists who run weekly clinics and conduct ward rounds based on appointments with an overall consultant. Inpatients are managed in the adult wards 8C and 1E Children’s Ward, which have provisions for general ward beds as well as High Dependency Unit support.

Each type of blood cancer requires a different approach. Treatment decisions are made after a careful review of the diagnosis and staging tests at disease-specific multidisciplinary team meetings.

These multi-disciplinary experts include pathologists, radiologists, haematologists, medical oncologists, palliative care physicians, specialist nurses, and clinical oncologists.

Our hospitals both the main branch and Othaya branch and KPCC inpatient and outpatient care for haemato-oncology cancers provide treatment such as transplants, chemotherapy, and clinical trial.

Radiotherapy for this patient group is delivered by the Cancer Treatment Centre KNH Oncology team.

Our ambulatory services allow some patients undergoing relatively intensive therapies to receive some of their care without needing admission overnight.

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From the communication desk:

When words speak louder than actions

By Sheila Murithi Many times we have heard and used the phrase “Actions speak louder than words” we hastily throw it around and mostly in judgment; when a person’s actions show their real attitude, rather than what they say.

However, in some situations, words serve as the only lifeline to forming perceptions about individuals and understanding their intentions as well as their capabilities.

Words do matter so much that they can either build or destroy. For instance, the election season is upon us, campaigns are being held in every corner of the country. Our leaders are vocal on their promises and manifestos, we listen and decide and when the rubber meets the road we can only hope they do what they said they will do.

What we choose to communicate is very important. Words, when selected and delivered with courage and integrity, are the foundation of true leadership, teamwork, and relationships.

They create a gateway to the mind; people want to know more about you and what propels you to act.

We cannot depend on actions alone to be the judge of our character and capabilities. As much as people say “Kazi yangu itanitetea” it is not enough and if it was, then we would not need to have appraisals where we sit down with our supervisors to explain and show evidence of our work.

Neither would we go for interviews and try and sell our proficiencies in the hopes of securing a job. The reader of those documents typically has not seen you in action. Therefore, your words must speak about how effectively and creatively you work, about the special talents you bring to your work, and about what you have accomplished.

Too often, people place their focus on actions instead of words, while ignoring that words lead to actions.

There is a saying I heard

PHOTO | STOCK

ISSUE 3| Kenyatta National Hospital Newsline

frequently growing up “Maji yakimwagika hayazoleki.” When words harm or cause someone to lose face, they cannot be unsaid.

This is true even if the intentions behind our words are neutral or even positive.

Words spoken by people in leadership; managers or supervisors are weighty and can cause a desired reaction or effect and at the same time they can destroy the morale and outlook of the employees.

Consider a team leader who in disagreement with his staff uses phrases like, “what do you want me to do?” or “this is a joke, if not then it is quite stupid” his team members will feel down and disrespected.

Although the intent was not to demean the team members, the

MIND HOW YOU SP EA K Be deliberate and mindful with your word choice and make sure your message is clear and delivered with kindness and respect and this will have a great impact on our patient experience.

impact of the words did not align with the intent.

When we communicate to our patients, even if it is speaking our inner thoughts out loud or just making a casual comment, they may interpret it as orders or dismissive remarks because you are the authority in that situation.

This soon becomes a problem and can create confusion and stress.

It is wise to pause before reacting and be mindful and intentional about our words. While we think before we speak, ask: • How will my message be received or interpreted?

• What impact will it have on the other person?

• Is it useful or necessary?

• Is it kind?

Be deliberate and mindful with your word choice and make sure your message is clear and delivered with kindness and respect and this will have a great impact on our patient experience. Desire to clearly articulate yourself with confidence so that you do not miss out on opportunities or be misunderstood. Our words can make us compassionate, bold, and free.

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Our story in pictures

PHOTO | NICHOLAS WAMALWA

Norvatis Associates visited the KNH Transplant unit in the Renal Department getting a better understanding of what the hospital has achieved through interlife and digitalizing projects gaps

PHOTO |NICHOLAS WAMALWA

Director Human Resource Mrs. winnie Mwangi (left) accompanied by the department donated two beds which were received by KNH CEO Dr. Evanson Kamuri (right) in Championing the Adopt a Bed campaign

PHOTO | STEVE MUTUKU

PHOTO | NICHOLAS WAMALWA

Internal Quality Auditors Team in preparation for the 19th IQA, 11th Service Delivery Charter and 8th 5S-Kaizen, led by Management representative - DPS, Dr. Alfred Birichi and QA Manager Ms. Agnes Chika

Some of the patients who took part in World Day of the sick celebrations being given snacks at Shrine of Mary Help of the Sick Don Bosco church in Upperhill

PHOTO | NICHOLAS WAMALWA

KHN Supply Chain Management staff donated two beds in championing the Adopt A Bed campaign to help support the patients

ISSUE 3| Kenyatta National Hospital Newsline

PHOTO | NICHOLAS WAMALWA

KNH FC during their practice at KMTC grounds

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Breaking the chain of infections

By Barbara Otieno and Lucy Nganga Inadequate sterilization can be costly to hospitals. The Antibiotic-Resistant Bacterial Infection outbreak in 2015, was a consequence of improper sterilization of contaminated duodenoscopes that resulted in 400 people being infected with superbugs and further led to 35 deaths.

Emphasis on the importance of proper decontamination methods and increased awareness of Healthcare-Acquired Infections (e.g. Hepatitis B or HIV) after surgical procedures is key.

According to the Centers for Disease Control and Prevention, decontamination of tools and objects ensures that all pathogenic microorganisms are removed so that they are safe to handle and use on another patient.

Centralizing the reprocessing of single-use patient items helps ensure that high standards of sterilization practices are upheld.

Decontamination of medium and high-risk instruments that are in contact with a break in skin or body fluids is performed at the Central Sterilization Service Department (CSSD).

Single-use items such as hypodermic needles and syringes are not reprocessed in the hospital - they pose a high risk of infection transmission since they cannot be thoroughly cleaned,” explained Mr. Nazarino Kithaka, Senior Nursing Officer, Theatre Sterile Surgical Unit.

The success of surgical departments at Kenyatta National Hospital (KNH) is dependent on the CSSD’S complimentary unit; Theatre Sterile Surgical Unit (TSSU), which is located right next to the main theatres. Ms. Lilian Kabua, Assistant Chief Nurse, Head of Central Sterilization Service Department points out; “The department is the hospital’s backbone, and without it, the dayto-day hospital operations will be disabled.”

TSSU’s sole focus is intently

to decontaminate surgical instruments prepared for surgical procedures.

The CSSD is mapped out to streamline the movement of items through 4 main central process areas; decontamination, packaging or assembly, sterilization, and

ISSUE 3| Kenyatta National Hospital Newsline

storage. Access to the processing area is strictly controlled and staff has to comply with the department’s dress code policy.

They are provided with appropriate Personal Protective Equipment (PPEs) that are laundered and donned at the

PHOTO | BARBARA OTIENO A Supportive staff at the TSSU unloading a high priority set from the autoclave for the Main theatre.

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PHOTO | BARBARA OTIENO Roselida Sunguri(right), Theatre Sterile Assistant,TSSU demonstrating to Lucy Nganga, Volunteer - M&C (left) how Sterile supplies are transported in transparent bag to minimize crosscontamimation from the Sterile storage area to the place of usage.

facility.

The purpose is to minimize microbial dispersal from undergarments and to protect them from exposure to microorganisms.

CSSD has a total of 100* trained staff; thirty-five at the TSSU to support the operating theatres seven days a week.

From the staff entrance, a long corridor leads the Newsline team to the receiving area. After each use, patient items from the wards, operating rooms, and outpatient clinics are handed over in covered carts at the dirty area counter.

The hospital generates 13 tonnes of contaminated patient care supplies daily. The functionality and intactness of instruments sets must be checked and disassembled to eliminate 80% of microbial contamination. Low, medium, and high-risk items are cleaned before disinfection and sterilization.

CSSD ensures satisfactory quality control by observing Physical parameters, chemical and biological indicators in line

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with the International Standards Organization (ISO) and Association for the Advancement of Medical Instrumentation to ensure each step in the reprocessing cycle is carried out effectively.

Disinfected, inspected and assembled items are double wrapped in blue polypropylene plastic in the parcel fold technique for heavier sets allowing steam or sterilizing agent (stem or hydrogen peroxide gas plasma) to penetrate and aeration poststerilization. Paper-plastic peel pouches are designed for packaging small single instruments used in theatres.

Before loading packaged sets in the sterilizer, identification labels are placed outside the wrap and must include the name of the product, wrapper, the sterilization, and expiration date (28 days). Chemical indicators e.g.

Sterilization indicator sealing tape must be affixed outside of each load placed in the autoclave.

Steam sterilization (Autoclaving) is the final step in the decontamination of heat-stable high-risk items. According to specific instructions provided by the device manufacturer, saturated steam flows around heat-stable items to achieve a chamber temperature of at least 134°C for 10 minutes to complete one successful cycle.

Diagonal Black stripes on autoclave tape indicate that steam has penetrated the packs however this alone is not a satisfactory standard of efficacy.

Use of appropriate biological indicators ((B. stearothermophilus spore strips) to monitor autoclave sterility is conducted every month.

Evaluation of the performance of pre-vacuum sterilizers is performed daily before the first process load using the Bowie Dick. Gases often

“The department is the hospital’s backbone, and without it, the day-to-day hospital operations will be disabled.”

shield bacteria from the steam and the items after numerous autoclaving cycles preventing proper sterilization. Results of chemical and biological monitoring and log sheet records (name of the operator, time of run, and amount being autoclaved) are filed in the CSSD logbook.

Sterilized items are transferred and each instrument set is stacked on its shelf in the sterile storage area. Surgical instrument trays must be delivered shortly before they are needed in the theatres.

All sterile items from patient care areas are returned to the applicable departments in transparent paper plastic sterilization bags to prevent microbial contamination during handling.

Since 2021, five support staff have undergone the Theatre Sterile Assistant training program at the affiliated KNH School of Nursing.

KNH is dedicated to assisting the department and its staff in improving the quality of sterilized items used on patients. “I’m grateful to KNH for the theoretical and practical knowledge acquired on decontamination” expressed Rosalida Sunguri, Theatre Sterile Assistant. She adds “I have a fresh approach towards infection control.”

Decontamination of singleuse patient items is crucial to controlling healthcareassociated infections in hospitals and its processes are not as straightforward as many presume.

Despite little or no interaction with patients, CSSD’s final output is used directly by the patients. Minimizing the environmental impact that the facility and its operations have is a concern of the department alongside patient and staff safety.

The replacement of Ethylene oxide (ETO) to hydrogen peroxide plasma as a low-temperature sterilant is a prime example. Toxic by-products of ETO are carcinogenic and may harm personnel in the long run.

Before exiting the processing area, we had to adhere to the department’s guidelines on the safe disposal of recyclable PPE’s.

We discarded our cover apparel, face masks, and shoe covers into separate designated bins.

Ms. Lilian Kabua, Assistant Chief Nurse, Head of Central Sterilization Service Department

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Demystifying stock taking

By Peter Githua and Marian Moraa Stock-taking is the physical verification of the quantities and conditions of items held in an inventory or warehouse in an organization. Kenyatta National Hospital is no exception.

Newsline spoke to Mr. Abdallah Ali Ofula – Ag. Director Supply Chain Management to get more insight on the stock-taking process within the hospital.

Q: Why is stock-taking important in KNH? Mr. Abdallah: There are various ways in which this process benefits the organization namely: • To provide an audit on existing stock • To establish discrepancies in stock value-i.e. surplus or deficiencies • To enable the hospital to establish the value of expiries • To establish the changing pattern in consumption of items • To enable the hospital to identify items that are obsolete or dormant • For financial purposes as the inventory, value forms part of the financial statement.

Q: When and for how long is stocktaking done in KNH? Mr. Abdallah: The physical stock count takes a maximum of two (2) days.

Q: What objectives are anticipated to be met during the stock-taking process?

Mr. Abdallah: • To establish the physical value of stocks • To establish the condition of the inventory i.e. whether there could be some expired items.

• To determine the changes in consumption patterns of items • To determine whether there are dormant or obsolete items Q: When is stock-taking carried out?

Mr. Abdallah: It is carried out end of January and the end of June every year. However, according to the Public Procurement and Asset Disposal Act 2015 Clause 162 (2), there is a requirement to have it done every quarter; hence the hospital has begun

transitioning to comply with this requirement.

Q: How is stock-taking prepared and carried out?

Mr. Abdallah: Preparation Process • A request is sent to all departments to nominate people to participate in the exercise.

The participants nominated have technical input on items being counted, or can help in the verification process. The officers in stores (stockholders) indicate current prices on stock counting forms known as S16 forms.

• An appointment for coordinators of the exercise is submitted for the CEO’s approval.

• A request for budget approval for meals based on catering department assessment is also sent for the CEO’s approval.

• Requests are made to the director HR to approve the hiring of casuals that help in the arrangement and cleaning of stores as most stocks are bulky and movement is not easy.

• The coordinators meet and using the list of nominated members assign the officers to the various teams. The hospital has divided the various stores into 14 active stock-taking teams.

• Each team has a team leader who reports to a coordinator who manages the operations of various teams. The overall exercise is managed by a chief coordinator.

taken: • The users are informed through a memo before the start of stocktaking and advised to take enough stock to cover the period.

• The suppliers are also informed of the impending exercise and request to deliver all required items before the commencement of the exercise.

• Should there be an emergency; the Director of Supply Chain Management can authorize receipt and issue of a specific item.

• On completion of the physical counting within two (2) days, the chief coordinator can approve specific items required in an emergency.

PHOTO | NICHOLASWAMALWA The KNH main store

PHOTO | NICHOLAS WAMALWA Mr. Abdallah Ali Ofula – Ag. Director Supply Chain Management

Actual Exercise • The team leaders organize their members to carry out physical counting within two days.

Thereafter, the figures are inserted on the ledger cards (S3 cards) in a process called a ruling. Once this is completed, the document used for the physical count -S16 form is typed and a final report prepared for all the teams, showing the value of the stock.

Q: How does stock take affect the daily hospital operations?

Mr. Abdallah: This exercise does not affect the functions of the hospital because the following measures are

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KNH Social work: Successful repatriation

By Paul Murimi Muriuki One of the mandates of Medical Social work is the repatriation of indigent patients to their families or loved ones and there have been many successful repatriations.

One of the interesting cases we have handled is that of a patient we will call K.M to conceal his identity.

Mr. K. M was presented at Accident & Emergency on December 26, 2020, by a well-wisher who abandoned him without giving any information on who the patient was, where he came from, or next of kin.

The patient was diagnosed with an Ischemic stroke that had affected his memory, rendering him unable to give information that could assist in contact tracing.

It had also partially affected him physically; he was not able to walk thus making him a total nursing care patient. His condition was

successfully treated and he was discharged on January 25, 2021.

The patient contact tracing commenced by taking his fingerprints and the results were relayed to the Social Work Department on March 30, 2021, and that is when the patient’s real names and place of origin were determined; he hailed from Kathoka Sub-location.

Through the information gathered, the sub-chief was contacted and it was later established that his family had relocated 100kms from Kathoka, Makueni County to Kyuso in Kitui County.

His sister’s mobile number was found and she helped the social worker trace the father. The 83-years-old destitute father by the name of M.M, could not raise the money to offset the medical bill nor cater for logistics to repatriate his son.

The KNH social workers made all the

PHOTO | NICHOLAS WAMALWA Paul Murimi Muriuki - Social Worker

necessary arrangements for possible repatriation and Mr. K. M was successfully repatriated on July 16, 2021 (six months after discharge under KNH care) at Kyuso village.

The social worker was accompanied by a nurse and social work interns so that they could also learn the process of repatriation.

There have been several follow-up visits that have indicated that the patient has settled well with his family who can observe him closely.

Mr. Muriuki is a Medical Social Worker III who works in Ward 7B, Infections Disease Unit (IDU), and Multi Drug Resistance (MDR).

PHOTO | MILSPOUSE Family re -united

Positive mentions from KNH official facebook page

By Luke Kung’u 1. Simon Kuria Njoroge Having gone to different hospitals and not getting help, we landed at KNH. My son was admitted and after a while, he had a major surgery and was discovered to have cancer of the Kidney. He was well taken care of even after the surgery stayed at ward 1E for a long time. After discharge the clinic visits were well organized. Today our miracle boy is grown and in final year at the university. The oncology doctors are the best.

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2. Samir Mukuria: As a kid, I spent time at KNH ward 3D. It takes a toll on a child having to adjust to having classes in a hospital. The employees at ward 3D made my stay there close to home. Well done guys!

3. Macharia Gaitho: I just want to thank God for the treatment I received from KNH. Those doctors and nurses went out of their way.

Be blessed beyond expectations.

4. Celly Minanga: Very true. I can confirm how you people are dedicated to serve our nation.

5. Rayuoi Lilian: May God’s mercies and favour follow you all the days of your lives. God bless KNH. 6. Alice Bacia: I personally salute you, though there is still room for improvement. No one is perfect, it calls for hard work. Well done and may the Lord fill you with His goodness. Keep it up!

7. Hillary Nyandiki: We value your service, keep up!

8. Anita Ann: I appreciate your medics so much. My son is back to normal. ENT team thank you!

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Thank you KPCC: Mukami’s C-Section recovery journey

By Petterson Njogu Every birth is a life-changing event and many parents, especially mothers like Ms. Francesca Mukami, enjoy sharing detailed birth accounts.

When she was admitted on December 2, 2021, she underwent a successful cesarean section delivery and after the four days of care and monitoring at Kenyatta Prime Care Centre maternity wing as per standard, she was cleared for discharge together with her new bundle of joy in her arms.

After three weeks, she started feeling unwell and called her doctor who advised her to come for tests and review.

“Three weeks in, I had non-stop vomiting and nausea, intense stomach pains and I immediately knew something was amiss,” said Mukami.

Her primary doctor, Peter Michoma, M.D, KNH resident consultant obstetrician and gynecologist ordered for Magnetic Resonance Imaging (MRI) and ultrasound examinations.

The scans revealed that there was abscess accumulation in her lower abdomen; her intestines were also infected and contained pus.

To correct this, laparotomy (a surgical incision into the abdominal cavity to examine abdominal organs and aid diagnosis of any problems) had to be done.

After the successful surgery, she could only feed on liquid foods via drips for a whole week.

All this while, Mukami, and her one-month-old baby had been separated and her husband stepped up, becoming the father and the mother of their relatively young family of three children.

“Sometimes the nights were long and I missed my family a lot and couldn’t stop wondering how my husband was managing the situation at home, especially our onemonth-old baby,” Mukami confessed.

One day during the routine dressing of the wound, the wetness of the

Francisca Mukami during her recovery after undergoing surgery PHOTO | PETTERSON NJOGU

Dr. Dan Kiptoo consultant General Surgeon at KPCC PHOTO | SHAWN PAUL

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Francisca Mukami holding her infant daughter, Aviah Katriel at home few days after discharge PHOTO | COURTESY

wound caught the nurse on duty’s attention.

“Wound infection was noted requiring re-operation and placement of a drainage tube and prolonged broad-spectrum antimicrobial drug treatment,” said Dr. Dan Kiptoon, KPCC consultant general surgeon.

News that she would be operated on again in less than three weeks, did not sit well with Mukami. “I didn’t want to go ahead with the surgery, I got tired of the whole process”, she narrated to Newsline. “It took a lot of convincing from my husband, the friendly doctors, and nurses for me to agree to it.”

Finally, she understood it was for her own sake and accepted to undergo the surgery. The doctors with her at the operating table revealed that it was such an intricate procedure. It was somewhat complicated and it took longer than expected. But she was resilient and fought through it all.

At some point, her health had deteriorated and Dr. Ngare, general physician stepped in and she was put on strong antibiotics,

despite extreme side effects, the medicines helped her and hastened her recovery.

“I would like to appreciate Dr. Michoma and Dr. Kiptoon for their exceptional treatment that made my pain go away, KPCC maternity nurses who have the biggest of hearts, the cleaners, the catering section, and every single person that made my stay comfortable and tolerable. My experience has shifted my perception of Kenyatta National Hospital. Thank you!” concluded Francesca.

Francesca has long since reunited with her newborn daughter and they are both recuperating well at home with only positive remarks on her lips concerning KNH. At KPCC we endeavor to offer quality and world-class health care to our patients and Mukami’s story is a testament to that. A multidisciplinary medical team comprising of gynecologists, general surgeons, general physicians, wound specialists, nurses, counselors, nutritionists, and physiotherapists were at her disposal throughout her 52 day stay at the facility.

KNH Prime Care offers consultant OBS/Gynae daily at the Corporate Outpatient Centre (COC). In addition, it offers very competitive maternity packages for expectant women.

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Taking a systematic approach to hospital policy development

By Neema Kemunto Policy and procedure are two terms that are sometimes used interchangeably, and while they do go hand in hand, they are not the same.

A Policy is a general principle that governs behavior in an organization or a government, to achieve rational outcomes. It describes principles, requirements, and limitations and is characterized by indicating “what” needs to be done rather than how to do it.

Procedures on the other hand describe the steps necessary to implement policies and achieve organizational goals. They are written documents providing specific “howto” information and will normally be developed by the office responsible for the administration of a policy.

Policy formulation is the development of effective and acceptable courses of action for addressing what has been placed on the policy agenda. Kenyatta National Hospital has over the years developed 30 policies as listed below; 1. KNH Prescribing Policy 2. KNH E-Waste Management Policy 3. KNH Energy Management Policy 4. Information and Communication Technology Policy 5. KNH Workplace Alcohol, Drug, and Substance Abuse Policy 6. KNH Workplace Policy on HIV & AIDS

17. Memorandum of Understanding Policy 18. Patient Credit Policy 19. KNH Prescribing Policy 20. Public-Private Partnership Policy 21. KNH Energy Management Policy 22. Corporate Social Responsibility Policy 23. KNH Disaster Management Policy 2012 24. Knowledge Management and Innovation Policy 2015 25. February 2014 KNH Buy Kenya Build Kenya Policy

7. KNH Anti-Corruption Policy

26. Disability Mainstreaming Policy for KNH, June 2010

8. KNH Whistle Blowing Policy.

27. Environmental Policy 2014

9. Per Diem Policy

28. HR Policy

10. Housing and Property Development and Management Policy

29. Infection Prevention and Control

11. Policy on Management of Tuberculosis Infected Health Care Workers.

12. KNH Fixed Assets Management Policy 13. KNH Credit Policy and Procedure Manual 14. Security and Safety Policy 15. Gender Mainstreaming Policy for KNH, June 2012 16. KNH Anti-Microbial Policy

30. KNH Research Policy

While this has been the practice, the hospital has deficient policies and procedures which have failed to meet the intended objectives.

According to the Director of Planning & Strategy Mr. Job Makanga, this has been instigated by inconsistency in the style and format of the policies, poorly written policies, inaccessibility of the Policies by all staff, and out-of-

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date policies.

To avoid these and other hitches, the director adds that it is time the Hospital takes a systematic look at its policies and policy-management processes. “Effective policy management begins with a policy and procedure document that outlines the policy-development, Monitoring & Evaluation process. The Hospital is in the process of formulating a welloutlined Policy guideline that will provide general direction on policy formulation and implementation” Stated Mr. Makanga.

In its quest to streamline the policy development and implementation process, the Planning, Monitoring & Evaluation department has developed a Hospital-wide Policy Formulation, implementation, and Evaluation Guideline that will provide a clear roadmap on the formulation, implementation, monitoring & Evaluation of Hospital-wide policies.

“All Hospital policies will now be centrally developed, monitored and evaluated from the department using the developed Hospital-wide Policy Development, Implementation and Evaluation Guidelines” affirmed Mr. Samuel Wainaina, the Chief Manager, Planning Monitoring & Evaluation.

The policy guideline will apply to policies that endure across

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time and administrations; change infrequently and set the course for the foreseeable future; manifest and operationalize the Hospital’s mission, vision, core values, and Strategic objectives; apply broadly across the hospital; address compliance with applicable laws and regulations; promote operational efficiency; and/ or manage institutional risk.

Using a standard format for all Hospital policies will make it easier for staff to read and retain information, as well as scan the documents later for specific guidelines and rules. To ensure the

policies are easily accessible by all staff, the Planning, Monitoring & Evaluation department has developed a database of the policies that exist in the Hospital. Mr. Felix Kilumbi, the Manager Monitoring & Evaluation told the Newsline that the department is looking to partner with the Marketing & Communication and ICT Departments to have the Database incorporated in the Hospital Website.

“Regular Monitoring & evaluating of the policies is an exercise that the department has commenced in this 2021/2022 FY.” Ms. Kemunto, the Principal, Planning Monitoring &

Evaluation officer told the Newsline.

She added that the department will ensure that policies are reviewed regularly and updated as necessary, with archiving of the expired policies being done per the legal requirements and Hospital recordsretention policies. The department is looking at reviewing the policies that are due for review even as they guide the Hospital in formulating policies that will be instrumental in the smooth running of the Hospital operations.

Celebrating our patients through charity KNH marks Patient Week to observe World Day of the Sick

By: Yvonne Gichuru & Winfred Gumbo Kenyatta National Hospital celebrates patients every year by observing the World Day of the Sick.

This year, we celebrated the patients for an entire week as a way to give back to them.

Various services were offered throughout the week such as free screening services, for blood sugar, blood pressure, blood donation drive, and adopting NHIF registration for needy patients as well as promoting the adopt-a-bed campaign.

KNH nurses came out and

voluntarily participated in the noble cause by donating their off days to help out in the activities. The event

“Celebrating the community not only those within our facility but also our environment. Staff remembering patients through charity is going beyond what we are paid to do, it’s renewing our call to serve.”

Dr. Irene Inwani, Senior. Director Clinical Services.

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dubbed ‘Patient Week’, was launched on Monday, February 21, 2022 with pomp and color whereby invited guests included Fr. Adoko Mahoussi who represented Arch Bishop Nairobi Diocese – His Lordship Phillip Arnold Subira Anyolo as the Chief Guest for the day.

“Part of the activities will be encouraging blood donation drive by our staff, free COVID-19 vaccination, free blood sugar & blood pressure checkups along with championing the AdoptA-Bed campaign,” said Mrs. Rose Wafubwa, Deputy Chief Nurse (DCN) – Administration as she

PHOTO | WINFRED GUMBO KNH staff and patients take part in a mass led by John Cardinal Njue to mark the Day of the Sick at Shrine of Mary Help of the Sick Don Bosco Church Upperhill

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gave the opening remarks during the launch.

Mrs. Wafubwa who is also the Chairperson of the Day of the Sick Committee urged staff to participate in whatever way they can in order to help our patients as this would go a long way in giving back to the society.

Dr. Judith Awinja, Director Nursing Services, MOH & Ms. Edna Tallam, CEO Nursing Council were also in attendance and both promised to support our patients through joining our adopta-bed campaign. Both have experienced firsthand the impact good patient care can have on a patient’s outcome.

“Celebrating the community not only those within our facility but also our environment. Staff remembering patients through charity is going beyond what we are paid to do, it’s renewing our call to serve.” said Dr. Irene Inwani, Senior. Director Clinical Services.

The Don Bosco Boys; a group of boys rescued from the street and are now in school, entertained the guests with an outstanding performance as well as the launch came to an end.

A clear demonstration of the impact reaching out can have on the community. Some of the KNH staff and selected patients also attended mass at Shrine of Mary Help of the Sick Don Bosco Catholic Church to mark the celebration of the Day of the Sick on Thursday, February 24, 2022.

“May God be with all the Healthcare workers at KNH and all over the world that tirelessly take care of the sick by ensuring they are comfortable during

PHOTO | YVONNE GICHURU Mrs. Rose Wafumbwa - DCN Administration (standing infront of John Cardinal Njue, Front row R) during the offertory session to mark World Day of the Sick

their hospital stay,” said Cardinal John Njue as he presided over the mass.

Mrs. Rose Wafubwa who represented the CEO, Dr. Evanson Kamuri, EBS thanked the staff for their dedication and ensuring the event took place.

“It is my pleasure that today we are here to celebrate and pray together with our patients as they look forward to their recovery. Additionally, I would like to thank the KNH management for releasing a few stable patients to come to the church as spirituality is important during treatment and recovery,” she said.

PHOTO | WINFRED GUMBO KNH Catholic St. Camillus choir perform a hymn during the mass to mark Day of the Sick

PHOTO | NICHOLAS WAMALWA Rose Wafumbwa DCN administration and Mr. Richard Koisok - DCN Nursing standards (R) handing over an assortment of gifts donated by KNH staff to mark World Day of the Sick

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Comic Zone Laughter, the best medicine!!

By Edel Q. Mwende

A woman is walking home with her three daughtersRose, Lily, and Cinderblock.

Rose asks her mother, “Mom, why did you name me Rose?”

To which her mother replies, “Well sweetie, when we were coming home from the hospital with you a rose fell on your head!”

Lily, curious now, asks her mother “Mom, why did you name me after a flower too?”

To which her mother replies, “Well sweetie, when we were coming home from the hospital with you a lily fell on your head!”

Cinderblock says to her mother, “hghghdnbgh!!? dnbgh!??!”

This one might take a lot of thought Question: I have hundreds of wheels, but move, I do not.

Call me what I am: Call me a lot. What am I? Answer: A parking garage/”lot” Source: Playbuzz Cosmetic surgery A sign on a cosmetic surgery clinic says: “If life gives you lemons, a simple operation can give you melons.”

Healthy living tips Question: Does an apple a day keep the doctor away?

Answer: Only if you aim it well enough.

Inspirational Quotes “There are two ways of spreading light: to be the candle or the mirror that reflects it.” – Edith Wharton “You do not find the happy life. You make it.” – Camilla Eyring Kimball “The most wasted of days is one without laughter.”

OUR VISION A world class patient-centered specialized care hospital OUR MISSION To optimize patient experience through innovative healthcare; facilitate training and research; and participate in national health policy formulation

– E.E. Cummings “Stay close to anything that makes you glad you are alive.” – Hafez “Make each day your masterpiece.” – John Wooden “Happiness often sneaks in through a door you didn’t know you left open.” – John Barrymore “Happiness is not by chance, but by choice.”

OUR MOTTO We Listen, We Care

ISO 15189 ACCREDITED

✓

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– Jim Rohn “Life changes very quickly, in a very positive way, if you let it.” – Lindsey Vonn “Keep your face to the sunshine and you cannot see a shadow.” – Helen Keller “Believe you can and you’re halfway there.” – Theodore Roosevelt

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