The Dhaka Hospital provides the clinical services at ICDDR,B.
In 1962 ICDDR,B set up a small hospital that quickly became a refuge for the neediest in Bangladesh, offering treatment that would otherwise be beyond their means. Today’s hospital has grown but continues the same high standard of care and dedication to the poor that made it famous in Bangladesh.
The hospital maintains extremely low mortality rates and a very low average treatment cost per patient. In 2007 alone, the hospital treated over 110,000 people, 35,000 of whom would have died if they had not received our care.
In addition to treating those immediately in need of care, the hospital also provides the research opportunities and information scientists need to battle enteric diseases on a larger scale. During the hospital’s first years, ICDDR,B scientists searched for ways to save patients dying from severe dehydration caused by diarrhoeal disease. Finally, in 1968, our scientists made a discovery that has been called the medical advance of the century, finding a new way to treat dehydration using a simple mixture of water, sugar and salt. Today this mixture, now known as Oral Rehydration Solution, is used around the world and has saved more than 45 million lives.
In like manner, many predict the hospital’s current research for new treatments such as zinc therapy will have a major global impact on public health in the near future, possibly saving as many as 400,000 lives annually.
Since the beginning, ICDDR,B scientists have worked both to save lives and discover cures that benefit people everywhere and our Dhaka Hospital plays a central role in our groundbreaking contributions to global health.
Diarrhoeal disease and enteric infection surveillance at Dhaka and Matlab hospitals
Around 110,000 patients attend the Dhaka Hospital and over 10,000 patients attend the Matlab Hospital for their diarrhoea and/or other health problems. The Diarrhoeal Disease Surveillance System was established at the Dhaka Hospital in 1979, which was extended to the Matlab Hospital in 1999 to collect information on demographic, epidemiological and clinical characteristics of patients. A systematic 2% sample of patients attending the Dhaka Hospital and all patients attending the Matlab Hospital from the Health and Demographic Surveillance System (HDSS) area are enrolled into the surveillance programme. Using structured questions, trained research assistants interview patients and/or their attendants to collect relevant information on socioeconomic and demographic characteristics, housing and environmental conditions, feeding practices, particularly of infants and young children, and use of drugs and fluid therapy at home. Information on clinical characteristics, anthropometric measurements, and treatments received at the facilities and outcomes of patients are also recorded. Extensive microbiological assessments of faecal samples (microscopy, culture, and ELISA) are performed to identify diarrhoeal pathogens and to determine antimicrobial susceptibility of common bacterial pathogens.
The activity provides valuable information to hospital clinicians in their clinical decision-making processes and enables the Centre to detect the emergence of new pathogens and in early identification of outbreaks and their locations, thereby alerting the host government to take appropriate preventive and control measures. The system also monitors changes in patients’ characteristics and antimicrobial susceptibility of bacterial pathogens. These population-based surveillance data constitute an important database for conducting epidemiological studies, validation of results of clinical studies, developing new research ideas and study designs, and improving patient-care strategies and introducing preventive programmes.
Short Stay Unit:
The Short Stay Unit houses the Triage, Out-Patient Department, Short Stay Children’s Ward, Brac Bank Short Stay Ward, Emergency Ward, Critical Care Cell, Immunization Cell, Surveillance Cell and the Breast Feeding (BF) Cellfor promotion of exclusive BF. It is called the Short Stay Unit as the average duration of stay is 12-24 hours. Over 100,00 patients are seen every year.
It is the face and entry point of the Hospital where assessment is done by a Senior Staff Nurse and registration done by a clerk. If there is no sign of dehydration and or any complication, the client is referred to the out-patient department (OPD) for oral rehydration therapy (ORT). At the ORT corner hydration status is maintained and monitored over a period of at least two hours and then discharged. The hydration status is monitored by observing signs of hydration and amount of purging.
If there is any sign of dehydration and or any other complication the client is admitted to the Short Stay ward where the patient is expected to be seen by a Physician within 30 minutes of arrival.
If there are any complications like Pneumonia, Severe Pneumonia, Persistent diarrhea, meningitis, Hyperthermia, Febrile convulsions, Severe Protein Energy malnutrition, Electrolyte imbalance, Sepsis etc; the clients are admitted to the Longer Stay Unit or the Special Care Unit as the case may be or referred to any Hospital outside the centre as per admission and referral criteria of Dhaka Hospital.
In the Short Stay Unit, clinical eyes and hands are the mainstay to the treatment of admitted cases. There are no investigative facilities in this Unit except for the Glucometer to check for hypoglycaemia and the stools to be seen in the bucket for clinical diagnosis of the type of diarrhoea.
Exclusive Breast-feeding remains the mainstay of feeding practice among children up to 6 months. On an average, 70% of children admitted to SSU yearly (aged 0-4 months) are successfully motivated for exclusive breast feeding by the time they leave Dhaka Hospital
EPI Services are other areas of missed opportunity which is addressed in this Unit.
The Surveillance System examines the stool of every 50th patient to provide weekly report on the type of pathogens affecting different age groups of clients admitted.
Longer Stay Unit:
Patients who need to stay in the Hospital relatively for a longer period for advanced management are admitted in this unit. The Longer Stay Unit consists of General Ward (GW), HIV/AIDS ward, Nutrition Ward (NW) and facilities for follow up of severely malnourished children at Out Patient Department (Nutrition OPD) after their discharge from the hospital.
About 4-5% of the patients those visit ICDDR, B for seeking treatment are admitted into LSU. During 2007 a total of 3,864 patients admitted into LSU. The bed occupancy in LSU is about 100%. Ninety percent of the admitted patients are under 5 children and most of them are from Dhaka and surroundings. The most common diseases among the admitted patients are Pneumonia, Severe Pneumonia, Typhoid Fever, Persistent Diarrhea, Meningitis, Hyperthermia, Febrile Convulsions, Severe Protein Energy Malnutrition, Electrolyte imbalance, Sepsis, Hypoglycaemia etc. About 5-6% of the admitted patients of GW become critical at any point during their treatment and those are referred to Special Care unit (SCU) for more intensive treatment and observation. The average stay of the patient at GW is about 5 days and at NW is about 14 days.
Special Care Unit:
The critical care service is an integral component within the Dhaka Hospital clinical services. Critical illness may arise due to an acute episode in a previously well person, an exacerbation of a previously chronic condition, or as a consequence of a planned procedure. The Special Care Unit (SCU) provides specialized personnel and resources for the care of the critically ill infants, children and adults. The fundamental purpose of the SCU is to bring together expert staff and sophisticated equipments so that patients with life-threatening or potentially life-threatening conditions can be treated more efficiently and effectively. The two vital components - the physical machineries and the organizational structure needed to coordinate the human interactions in the SCU are both complex and intricate. Special care is a requirement for closer observation and monitoring than is available on the standard general wards, and includes single and multi-organ support as well as monitoring and step-down facilities for critically ill patients.
Respiratory management is the cornerstone of critical care management, particularly in infants and young children. In fact, more than half of the patients admitted in the SCU have the complaints of respiratory distress, mostly due to severe microbial infections. Respiratory arrests can occur quickly due to small, compliant upper airways that easily become occluded. Early detection of airways problems in children is as vital as is prompt and aggressive management. Patients requiring ventilatory support for acute respiratory failure or who require intravenous cardiac inotropic and/or vasoactive drugs for acute circulatory failure and shock states are cared for in the SCU. About 15% patients present with seizures and conditions with altered levels of mentation, requiring sedation protocols as well as protocols for weaning from sedation, in addition to standard cause-specific management. The other common conditions encountered in the SCU are severe electrolyte disorders and hypoglycaemia, thermal instability, and prolonged and intractable infantile diarrhea requiring subtotal intravenous nutritional support.
The SCU combines the Special Care Ward and the recently-established Isolation Room with negative-pressure system. On an average 1,600 patients are provided care in the SCU every year, and 81% of them are children under the age of 5 years. The case fatality rate in the SCU, despite the limitations in facilities, is 13.4%, which is quite at par with the best Intensive Care Units in the developed countries, and signifies the professionalism, dedication and commitment of the SCU staff. The provision of quality care is integrated with evidence-based practice, clinical audit, appropriate care management, patient satisfaction, clinical research, and clinical supervision.
LSU is one of the unique places at ICDDR,B for receiving training on clinical management of diarrhoeal diseases and severe malnutrition. Currently under fellowship programme 9 Bangladeshi Doctors, 2 nurses receive training in LSU regularly in each year. Moreover, huge number of overseas students opts for their elective training at ICDDR, B Dhaka Hospital and by turn they spent a substantial time in LSU for their learning purpose.
LSU is a potential place for conducting clinical research on various infectious diseases like diarrhoea, pneumonia and on malnutrition.
Immunization and Family planning:
Health Workers (HW) under the supervision of Health Assistants (HA) detects the children and women of reproductive age from the admitted children of GW and mother’s of the children who are not immunised before for their age and for Tetanus Toxoid vaccination respectively. HA’s also motivate and counsel the parents on birth spacing and provide knowledge on different Family Planning methods.
The Travellers Clinic at ICDDR,B – providing medical services to the expatriate community for over 20 years, including many embassies – was recently renovated and expanded to provide an even better service to our clients.