Routes of infections

The lack of investment in the sanitary units in KKUK, the management of hygiene by the private company and the complete lack of control of hospital infections are issues that require urgent solutions from the largest public hospital in the country. This institution has neither evidence nor plan on how to address these problems

On October 5 of this year, the first floor of the Orthopedics Clinic at KKUK became almost non-functional for a few minutes.

In the toilet of the second floor, a pipe burst, from which a large amount of water flowed and which ended up on the ground floor.

The maintenance workers at this clinic have daily encounters like this. The water system in these bathrooms is almost completely destroyed, so apart from their routine work, they are forced to maintain this system for which the institutions do not consider it important to invest.

Time has stopped for almost every toilet of the largest public hospital in the country - the University Clinical Center of Kosovo - the institution where the most complicated cases are treated in the country.

The toilets or sanitary facilities of each clinic are evidence of mismanagement over the years, endangering the lives of patients due to lack of hygiene and exploitation of workers by private companies precisely in the name of hygiene.

Maintenance workers are the first to face the harsh conditions of the hospital, and not only.

Some of the toilets, due to problems with the pipe network, are exposed to water flow. Workers need to spend part of their working hours mopping up the floor.

"Every 10 minutes we go to the bathroom. Bone there, the side comes, the water falls here... the patient is exposed. Vallain yes, it's not right", says a worker who has been facing the same situation for more than a decade.

Leakage from a large part of the bathrooms is not a new problem for the KKUK.

"This problem has been going on for a year. They don't have regular proof. I myself took the request to the main sister, I took it to the technical services", he says.

"We eat where the bathroom drips"

At mealtime, cleaning workers eat under the stairs, in the warehouse where the cleaning tools are kept. There is no place for them in the kitchens and places dedicated to food for health staff.

Often during mealtimes, dirty water dripped from the upper floor.

"Yes, you've been taking it for a while. Point from above. In a place where I live. No adjustments required. High point. Point qaty where I eat bread. In the morning, when I eat a muffin, even now, when we eat, says another worker.

Inside the largest hospital in the country, there is even room for birds. The ceiling of the highest floor is broken in some places, and their access becomes easier because of the broken windows.

"These were fixed by a family member of a patient because he felt guilty about me", says the woman who has been working as a hygiene maintenance worker for 15 years.

Working conditions have always been roughly the same. But this work ensures the survival of her 6-member family.

In the place where he works, the door is completely dislodged, mold is on the ceiling tiles, and lack of lighting and water are common. All these make his work more difficult and even cause health problems.

"I keep coughing. Are you seeing broken windows everywhere? It is a problem especially during the winter", she confesses.

Patient files in toilets

And one of the bathrooms has been transformed into an administrative space. The health documentation of the patients is "sheltered" there, and due to the bad conditions, the books with medical protocols are moldy.

Investments are lacking in most of the KKUK bathrooms, especially in the surgical part. Employees say the conditions have been the same for as long as they can remember.

The omission was not always due to a lack of budget. As KOHA has learned, last year SHSKUK had more than 200 euros available for the renovation of sanitary facilities. The tender was not opened and the funds went to surplus. Approximately that much was planned for this year as well. In KKUK they have confirmed that up to half of October no more than about 60 percent of the budget was spent on this issue.

The biggest challenge with these conditions are the workers of the company "Laguna" who have been contracted for the maintenance of the facility.

A maintenance worker indicates that he receives exactly 280 euros per month for the work he does.

"The cause of the children. They don't ask if you have it or not. They don't care about you. It's hard to tell someone that I'm addicted to anything. It's horrible," she says.

Another worker, on condition of anonymity, says that he spends the money he receives to help a family member diagnosed with cancer.

"I have a family member with cancer. When something is missing in the KKUK, we have expenses. Better with nothing than nothing," she says.

And someone rejoices in the fact that "there is no physical violence".

"These are not violent. There are times when they throw tanners with him without sitting down or eating," she said, referring to the conditions in which they worked earlier.

But according to a companion of a patient, one of them was "reprimanded" because he was seen talking to the television crew.

They have given her trouble. They interrogated him," he said. "What I talked to you about yesterday or the day before yesterday. I don't know what his name is. The cleaner".

Few workers

The company that is engaged in the maintenance of the hospital, tries to increase the profit, calculating the extra hours of the workers in its favor.

KOHA stayed for several days in different shifts - the morning and afternoon shifts at the KKUK premises. It has identified several cases where a worker takes care of more space than it should.

The illustrative example is Central Intensive Medicine, which is the most sensitive clinic in the entire SHSKUK. In addition to the first 8-hour shift, the contract states that there will be two workers in the second and third shifts as well.

However, every time KOHA has visited this space in the afternoon shift there has only been one worker.

This company operates on a 12-hour schedule per worker, which means that each worker works one day and rests one day. So in this clinic, three workers work in two shifts, not six, within 24 hours.

And when some of the workers take a break, the burden of cleaning is doubled for the workers.

"When the college is on break, I clean that part as well", confessed one of the workers

With more than 13 years of work experience, she says that she has 18 days of annual leave, and according to her, work experience is also calculated here.

In the contract of this company with SHSKUK, it is stated that they will have additional workers for weekends and holidays, but those that KOHA talked to said that depending on your schedule, they work on weekends and holidays as well. They have not indicated that there are additional workers for these days.

Just for weekend and holiday workers as he has stated, this company would have to pay about half a million euros for the entire contract.

Kaltrina Rexhepi-Dragusha, director at the Institute for Research and Human Rights, says that the treatment of workers differs in private companies.

"The difference in the condition of the workers is very big. In the private sector female workers are paid much better even if they may be contracted by the same company. They have better conditions, better salaries and generally better treatment, even though it should be the opposite since public institutions would have to monitor them", said Dragusha.

A health worker has emphasized that, in addition to the fact that the company employs fewer workers than was foreseen in the contract, the cleaning tools are not hygienic for hospital use.

"If they have wiped me with a knife, they have harmed us, themselves, the patients... With a knife... now we don't use it at all. What did they tell me? The WC is not in question. Here, 13 rooms are hidden", said this professional.

KOHA has sent questions to the company, but has not received an answer.

In search of paper soap

The challenge of finding shampoo and conditioner in October 2023 is tough.

"No, what kind of paper do you use?" There is not even a health staff, sister," says one of the maintenance workers.

The lack of hygienic material spoils the image of the health institution in many cases when patients express satisfaction with the services of the staff, but for other problems they leave the fault to the management.

"There is no water in one bathroom. The bathrooms are a disaster than the doctors, the nurses very well. They are kind, they are careful. The operation went well. Except for the bathroom, there was nothing here. The mess smells like a disaster," says Hafie Zeqiri, a patient at the Orthopedic Clinic.

He gets a little nervous when asked if there was paper in the bathroom.

"No paper! What letter? It is not even expressed. There is nothing. Come in and see for yourself. You only looked at the door. You didn't even have a lock when the door closed. We need men and women to join us. Without a key, where are you without it? Besides, I have to take care of a patient, I was told if a doctor is coming. It's not like I've been there for five days, but the first two days I'm fine. For the bathroom and not for anything else," she says.

The companion of a patient lying in the Urology Clinic shares the same revolt.

"There is no paper. Beds disaster. We didn't have a wheelchair to lift the patient up. Too many states of disaster. No, we thought it was better, but there was no kurga here", says Fitim Gashi.

The biggest challenge of the workers is the management of the urinary bags.

One of them said that she can't carry much weight, so she often pours them in the bathroom, without being aware of the consequences.

"I have been operated on since the fight and I can't carry heavy weights. I take the urine bags and empty them in the hole here, which is easier than the garbage bag and send it out," she says.

When asked if she knows the risk of getting an infection from their unhygienic emptying - she shrugs.

No one at KKUK has training on how medical waste should be managed.

A health worker confessed how a companion of the patient had contracted an infection during his stay at the KKUK.

"A family member who was with his father is in Germany. God bless you, when you went there you got infected in the quiet room you have with your father. Calculate you, in Germany, something with a microbe something. He said, "I don't know how you can manage there, when the patient dies, for example, no one comes to disinfect him, neither the bed, nor the bed." We need alcohol and whatever we can do", said this worker.

The issue of intra-hospital infections is regulated by an administrative instruction issued in 2011.

Public hospitals have infection control teams who report to the Hospital Infections Commission.

The team was dismissed a few days ago, as the sources said "due to communication problems within the team". The commission for Hospital Infections in the KKUK started its work for the first time only a few months ago.

The chairman of this commission, Gazmend Spahija, said that they are at the beginning of the task they have received, but initially they are only dealing with what he called "hot spots". As a first point, he emphasized the importance of hand hygiene.

"They contribute a lot to the incidence of hospital infections. The first is the culture of our population but also the culture of the health staff, where both in research and in works, we read a lot that one of the main factors that can be a carrier is hygiene, and especially hand hygiene, for which even more first, the manual for hand hygiene was worked on and distributed, which is monitored, but not so satisfactorily", stated Spahija.

He explained how the measurement is done.

"The team for intrahospital infections has a liaison person in the ward where we have the highest incidence of infection, and through that person they collect data on individual cases, on the way it came or if the patient was transferred to other units. All these roads are followed and then all this information is collected and a certain percentage is extracted", he said.

Far from Africa

But some clinics do not report these types of infections at all, making the data completely unreliable. As KOHA has learned, last year, the Infectious Disease Clinic did not report whether or not there are such infections.

In the latest report on this matter, it is said that the Central Intensive Care Unit has the highest rate of infections, with about 42 percent, which is much higher than in developed countries, but according to him, somewhere close to countries in the region.

Spahija has said that they are on the right track for this low figure.

At the end of each report, recommendations are given on how to reduce the rate of infections. Hygiene according to standards, filters in front of operating rooms, automatic doors, removal of climates from operating rooms and intensive care are some of them.

KOHA has visited some of the operating rooms to see the situation.

He first visited the Orthopedics Clinic to see the new complaint that was issued at work only a few months ago and in which 2 million euros were invested.

"This facility is built in two phases. They built the halls in one phase and the upper rooms in another phase. They didn't leave an elevator. They destroyed the old halls that they told them, but they were new, but unchanged without criteria. Even in those, they are building another annex, they want the elevator to be quiet and tidy. However, I am pessimistic about the work they have done and the success this facility has had," said Gani Jashanica, director of the Orthopedic Clinic.

The head of anesthesiologists at this clinic is frustrated with the situation.

"Disaster hall. Besides, they have given us peace. That, look. There is nothing good. Forget them. There is no heating. There is no ventilation. Jena entered the hall. No relation but... Far from international norms. Far from Africa than international norms. By going to Africa, you have the best conditions now that we know what conditions we live in", said Agron Bala, anesthesiologist at KKUK.

On the other hand, as KOHA has learned, the infection control team has neither analyzed nor treated many clinics and wards, even operating rooms, drawing incomplete conclusions in the report.

But the condition of the operating rooms visited by KOHA are far from international standards.

Halls have no neutral zone or filter zone which should be completely clean. In their entrance, the floor is damaged and has already taken on the color of soil. A few steps away are the places where patients are operated on. These halls are not centrally ventilated either. As health professionals have explained to KOŠA, operating rooms should not have this climate but the hepafilter where the air from the ground does not rise up to mix with the other air because it is supposed to increase the likelihood of infections in the room.

Spahija of the commission for infections, says that the project exists and that they expect that the areas in front of each operating room will soon be filtered.

While officials within the KKUK wait for the hand of the state, there are some examples of the opposite for the better.

The Oncology Clinic has renovated the toilets and bathrooms, through a donation from a relative of a patient who was treated there, and the new Pediatric Clinic was built by an Arab donation, which is responsible for the good conditions.

In SHSKUK, they constantly complain about the large presence of patients' companions, but their presence near the operating rooms is also inevitable. They go inside to bring the missing material for their relative's operation.

"So far we have bought quite a lot of drugs. I don't know exactly, but plenty. Every day", said Fitim Gashi, companion of a patient hospitalized at KKUK.