National Institute of Diseases of the Chest and Hospital Health Bulletin 2012
Preface
It is a great pleasure for me to bring out the Health Bulletin’2012 of NIDCH. This is the only tertiary level center in the country for management of TB and Chest diseases in Bangladesh. It was established as “TB hospital” in 1955, upgraded in 1962 as “Institute of Chest Diseases and Hospital” and started Post-graduate course “Diploma in Tuberculosis Chest Diseases” and it was the first Post-graduate Institute in Dhaka. It was upgraded in 2002 as “National Institute of Diseases of the Chest and Hospital”. Introduction of “MD course in Chest Diseases” in 1992 and “MS in Thoracic Surgery” in 1999 are the mile stone for the institute in the field of human resource development. Subsequently “FCPS in Pulmonology and Thoracic Surgery” courses introduced & this is also a further addition for development of human resource or the country. Establishment of “National Asthma Centre” in 1997 bring the asthma and COPD management under a uniform “National Guideline”. Establishment of “National Tuberculosis Reference Laboratory” in 2007 strengthen the “Tuberculosis Control Programme” through appropriate diagnosis and management of “MDR-TB” patient which attain quality of WHO defined level and approved by GLC. Introduction of CT Scan in 2007 further improved the diagnosis of the patients and thus made patient management earlier and more perfect. Establishment of Avian-Influenza Ward and Training Center in 2007 is also a major improvement. This institute is also a main center for implementation of GLC approved pilot project DOTS-Plus for management of MDR-TB Patient. We introduced Poly-somnogram, DLCO and NO measurement facilities, EBUS and fluorescent bronchoscopy. In spite of manpower & equipment lacking, our Anaesthesia department is providing one lung & two lung anesthesia, thoracic epidural technique, etc. for post operative analgesia management to facilitate the specialized thoracic surgery concerned. I think the information presented here will be very valuable and helpful in guiding our doctors for planning their future higher studies in the field of chest diseases. I hope it will be very useful for all concerns which will bring modern technologies in the diagnosis and management of chest disease patients and it will also enable our post-graduate students to update themselves with the modern technologies. We are trying with our utmost sincerity and Endeavour to make significant contribution to the commitment of the present government ~ “Digital Bangladesh:. Warmest Regards Prof. Md. Rashidul Hassan Director Cum Professor National Institute of Diseases of The Chest & Hospital & National Asthma Centre Mohakhali,Dhaka
Prof. Dr.Md. Rashidul Hassan
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Organization at a glance
Name of the Institute National Institute of Diseases of the Chest and Hospital
Address of the Institute Mohakhali, Dhaka
Name of Director Prof. Dr.Md. Rashidul Hassan
Telephone No. 028811910
FAX No. 029899424
Mobile No. 0
Email nidch@hospi.dghs.gov.bd
Description about above data
National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka is situated at Mohakhali adjacent of Gulshan. It has 47.28 acres of land. It was started as “TB Hospital” on September 1955 with 200 beds for tuberculosis patients. In 1962, it was upgraded as the “Institute of Chest Diseases and Hospital”. It has residential accommodation for the Director, officers, staffs, a hostel for DTCD students and a hostel for the nurses. 143 class one officers, 206 class two officers, 215 class three employees and 232 class four employees are surving the institute at present. NIDCH is the only institute of Bangladesh which extend modern specialized medical and surgical treatment to complicated chest and TB patients and also offer training of medical manpower in the specialization of tuberculosis and chest diseases. The Institute provides Post-Graduate training for the students of “Diploma in Tuberculosis and Chest diseases” (DTCD), Doctor of Medicine (MD, Chest), FCPS, Master of Surgery-Thoracic Surgery, and also under graduate teaching in Tuberculosis for the students of different Medical Colleges. In 10 separate blocks, the hospital has accommodation for 670 patients. In order to facilitate management of patients, the Hospital beds are divided and put in 09 medical units and 04 surgical units with care of units chiefs. They are experienced and possess high academic qualification. Objectives of the Institute: • To provide diagnosis and treatment facilities for Tuberculosis and Chest Diseases. • To conduct Post-graduate courses and training facilities for DTCD, MD(Chest), MS(Thoracic Surgery), FCPS(Pulmonary), FCPS (Thoracic Surgery). • To provide specialized training facilities for the chest specialists, nurses and field workers. • To conduct research activities in the field of chest diseases. • To provide surgical treatment of chest diseases accordingly. • To provide and co-ordinate management of Avian-Influenza, Pandemic H1N1. Department of the Institute: • Department of Respiratory Medicine • Department of Thoracic Surgery • Department of Radiology & Imaging • Department of Pathology & Microbiology • Department of Biochemistry • Department of Transfusion Medicine • Department of Physical Medicine & Rehabilitation. Working Hours: From 8:00 a.m. to 2:30 p.m. (as per government rule) (Friday and Government holidays closed) Indoor: Round the clock Emergency: Round the clock Mailing Address: National Institute of Diseases of the Chest and Hospital Mohakhali, Dhaka, Bangladesh Phone : 88-02-8811910 Fax : 88-02-8851668 88-02-9899424 Web-site: www.nidch.org.
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Child health and MDG-4 (January-December, 2011)
Description:
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Maternal health and MDG-5 (January-December, 2011)
Description:
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No. of OPD & Emergency visits, & Deaths at Hospital
Health Facility
OPD
Emergency
T M F Child T M F Child Tertiary Hospital 39388 18252 13632 7504 19694 9126 6816 3752
Description:
No. of Admissions & Deaths at Hospital
Health Facility
Admission
Death
T M F Child T M F Child Tertiary Hospital 11064 7899 2209 956 991 780 201 10
Description:
Those patients with different diseases died were admitted in this hospital with late features & complications. Moreover, those patients had other comorbidities, the incidence of death is more. In this institute ICU,HDU facilities & investigation facilities with manpower are insufficient .Referrals of patients from other hospitals or institute should be earlier before severe complications develop which can be reduce the rate of death.
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Top 10 diseases according to the number of patients admitted in the Hospital during the reporting period
Total number of admitted patients during the reporting period 11064
Serial No.
Disease name
No. of cases
%
1 Tuberculosis(Pulmonary+extra pulmonary) 2684 24.26 2 Pleural effusion(tubercular,malignant,empyema) 1738 15.71 3 Bronchial Asthma 1457 13.17 4 COPD 1210 10.94 5 Pneumothorax 815 7.37 6 Bronchiectasis 636 5.75 7 Chest trauma(RTA,Assault,gun shot injury,Fall from hight) 563 5.09 8 Ca-lung 423 3.82 9 Ca-Oesophagus 295 2.67 10 FB in airway or esophagus 212 1.92
Description:
This is the only National institute in the country which deals with varieties of chest diseases – both medical & surgical cases. It receives referred patients from all over the country as well as new or primary cases. Tuberculosis is by far the most common disease prevailing among the patients admitted in NIDCH. These are pulmonary & Extra-pulmonary TB cases along with complications from tuberculosis. There are also patients having sputum AFB positive & MDR TB cases. Patients who suffer from complications of tuberculosis that require surgery is admitted in the thoracic surgery department. Pleural effusion is defined as collection of fluid in the chest cavity -which is the second highest pattern of patients admitted in NIDCH in a year. This includes effusion due to specific or non- specific infections including TB. It also includes malignant pleural effusion & even pus in the pleural space - termed empyema thoracis. The next most common cases listed in the top 10 diseases are largely diseases receiving medical treatment e.g. COPD & Bronchial asthma. Pneumothorax results from these diseases. They may be classified as primary, secondary, traumatic or iatrogenic pneumothoraces. Bronchiectasis is the condition where patients commonly present with haemoptysis which requires both medical & surgical interventions. One of the most common & rising condition in this era is the cases of chest trauma which includes RTA, stab injury, gun- shot injury & other accidental injuries. Malignancies that require surgical treatment includes carcinoma of the lung & esophagus which are among the top 10 diseases admitted in this institute. Last but not the least in the above list is foreign bodies in the airway or esophagus which are often life threatening conditions that are dealt here in the thoracic surgery department in NIDCH.
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Top 10 diseases according to the number of deaths among admitted patients in the Hospital during the reporting period
Total number of admitted patients during the reporting period 991
Serial No.
Disease name
No. of cases
%
1 COPD 212 21.39 2 Bronchiectasis 132 13.32 3 Tuberculosis 96 9.69 4 ILD 84 8.48 5 Destroyed lung 81 8.17 6 Ca-lung 67 6.76 7 Traumatic Chest injury 65 6.56 8 Lung abscess 63 6.36 9 Pneumothorax 62 6.26 10 TB MDR 23 2.32
Description:
Those patients with different diseases died were admitted in this hospital with late features & complications. Moreover, those patients had other comorbidities, the incidence of death is more. In this institute ICU,HDU facilities & investigation facilities with manpower are insufficient .Referrals of patients from other hospitals or institute should be earlier before severe complications develop which can be reduce the rate of death. Last year total death in this institute were 991.
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Utilization of services
Indicators
Tertiary
Average Length of Hospital Stay (No. of days per patient) 20 Bed Occupancy Rate (%) 92.27 Hospital Death Rate (%) 8.96
Description:
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Surgeries & Interventions done in the Tertiary Hospital
Type
No.
Major Surgeries 687 Minor Surgeries 1642 Major Procedures other than surgery 395 Minor Procedures other than surgery 3382
Description:
Department of Thoracic Surgery provides surgical treatment for Pulmonary, Esophageal, Pleural, Mediastinal, Chest wall, Diaphragmatic pathology. Surgery for Pulmonary diseases include tubercular & non-tubercular. Surgery for patients with complications of pulmonary tuberculosis e.g. Destroyed lung, Bronchiectasis, Aspergilloma, are performed here along with other inflammatory and parasitic lung diseases (e.g. Lung Abscess, Hydatid Disease etc). Pulmonary resection for patients with early Lung Cancer, the leading cancer of the world are performed here. Surgical treatment for Esophageal diseases include Carcinoma Esophagus, Achalasia , Corrosive Esophageal stricture. Common pleural surgery includes Tube Thoracostomy for Pleural Effusion, Pneumothorax, Empyema Thoracis etc and Decortication & Pleurectomy for Thickened Pleura and Pleural tumor respectively. Mediastinal tumors and Chest wall tumors are treated here effectively. Surgery for Diaphragmatic pathology includes Traumatic Ruptured Diaphragm, Eventration and Diaphragmaticc hernia. All Traumatic surgical emergencies including blunt and penetrating chest injury(gun-shot & stab) of various types are managed here. Rigid Bronchoscpy and Esophagoscopy are exercised here for both Diagnostic and Therapeutic ( Foreign body removal from airways and esophagus, Dilatation for Stricture).These are the scenario of year’2011.We believe these can be improved if manpower & other facilities would be increased.
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Class wise Manpower
Class Sanctioned Filled-up Vacant Vacancy % M F Class I Doctor 141 99 27 15 10.64 Non Doctor 2 1 1 0 0.00 Class II 206 11 192 3 1.46 Class III 215 101 70 44 20.47 Class IV 232 142 52 38 16.38
Description:
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Catagory wise Manpower
Manpower Tertiary Sanctioned Filled-up Physician 141 126 Nurse 289 263 Medical Assistant 0 0 Medical Technologist 29 28
Description:
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Existing equipments at Hospital
Equipment Total (No.) Functional (No.) Non-functional Repairable (No.) Non-repairable (No.) Ambulance 4 3 1 0 X-ray machine 3 3 0 0 ECG machine 1 1 0 0 Colorimeter 0 0 0 0 Computer 74 62 5 7 Printer 54 41 8 5 FAX 1 1 0 0 Multimedia 6 6 0 0 Laptop 2 2 0 0
Description:
Despite of all existing equipments we need a lot of equipment for our national specialized institute. Most of the equipments are back date and are not sophisticated for modern diagnostic purpose. Fibre optic bronchoscope, Rigid bronscope, Esophagoscope, radiological instrument such as Ct-Scan, MRI, PET Scan are also needed immediately . For emergency patients transportation purpose the ambulances are not sufficient and this scenario are also same for drugs & surgical instrument purpose. Moreover Doctors & supporting staffs those who are involved emergency services for hospital have limited scope due to transport limitation. We have to develop this sector to improve hospital service more efficiently.
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Important information and necessary issues for National Institute of Diseases of the Chest and Hospital
Last year inspite of our many limitations we gained a lot of success with our maximum effort in health status. This can be improve further - • By doubling the existing bed (670) capacity • By fulfilling the vacant post of doctors and other staffs. • By creating a separate MDR building for MDR TB patients( very urgently necessary as because it is the only institute where MDR TB is treated). • By increasing the existing facilities namely- No. of ICU beds. No. of operation theater No.of equipments (Fibre optic bronchoscope, Rigid broncoscope Esophagoscope) • Improvement of Radiology department by increasing no. of equipments like – i) CT- Scan ii) MRI iii) PET Scan • Improvement of pathology department - it should be reorganized for diagnosis of pulmonary & thoracic diseases. • Chest & pulmonary diseases oriented special nursing institute should be immediately establish for improvement of specialized nursing services.
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