The study revealed good knowledge of infection control procedures but there were problems in practices of
sterilization. Most of them did not separate the needle from the syringe prior to disposal therefore needle
prick injuries were common. So more intensive and regular training programs to surgeons must be included
in the plans of quality control in all hospital and regular inspection from the ministry of health guarantees
good infection control practices
The international survey on the management of allergic rhinitis by physicians...Georgi Daskalov
ORIGINAL RESEARCH Open Access
The international survey on the management of
allergic rhinitis by physicians and patients
(ISMAR)
Carlos E Baena-Cagnani
1
†
ˆ
, Giorgio W Canonica
2*
, Mohamed Zaky Helal
3
†
, René Maximiliano Gómez
4
†
,
Enrico Compalati
2
†
, Mario E Zernotti
5
†
, Mario Sanchez-Borges
6
†
, Fabio F Morato Castro
7
†
,
Margarita Murrieta Aguttes
8
†
, Aida López-Garcia
9
†
, Faheem A Tadros
10
†
and ISMAR Study Group
ASSESSMENT OF KNOWLEDGE REGARDING HOSPITAL ACQUIRED INFECTIONS (NOSOCOMIAL INFECTION) AMONG HEALTH CARE WORKERS IN A TERTIARY CARE HOSPITAL OF WAH CANTT
The international survey on the management of allergic rhinitis by physicians...Georgi Daskalov
ORIGINAL RESEARCH Open Access
The international survey on the management of
allergic rhinitis by physicians and patients
(ISMAR)
Carlos E Baena-Cagnani
1
†
ˆ
, Giorgio W Canonica
2*
, Mohamed Zaky Helal
3
†
, René Maximiliano Gómez
4
†
,
Enrico Compalati
2
†
, Mario E Zernotti
5
†
, Mario Sanchez-Borges
6
†
, Fabio F Morato Castro
7
†
,
Margarita Murrieta Aguttes
8
†
, Aida López-Garcia
9
†
, Faheem A Tadros
10
†
and ISMAR Study Group
ASSESSMENT OF KNOWLEDGE REGARDING HOSPITAL ACQUIRED INFECTIONS (NOSOCOMIAL INFECTION) AMONG HEALTH CARE WORKERS IN A TERTIARY CARE HOSPITAL OF WAH CANTT
DOI:10.21276/ijlssr.2016.2.4.1
ABSTRACT- Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation
and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in
terms of prolonged hospital stay and lost work days.
Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the
common organism isolated and its antibiotic sensitivity and resistance.
Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the
study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases
had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity.
Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and
clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07%
of all the SSI’s and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most
commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then
E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were
isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that
could promote a more rational use of antibiotics. Key-words- Surgical site infections, National Nosocomial Infections Surveillance (NNIS) risk index, Antibiotic
Surgeons’ Perception to Needle Stick Injuries and Transmission of Blood Borne...CrimsonpublishersCJMI
Needle stick injuries (NSI) are commonly seen in health care workers and those into surgical practice are at a higher risk of sustaining such injuries. As per WHO Report of 2002, of the 35 million health-care workers, 2 million experience percutaneous exposure to infectious diseases every year
Ochsner Sherren regimen Vs Appendectomy in Adults with Acute Appendicitis.QUESTJOURNAL
ABSTRACT: The main Objective of this study is to examine whether Ochsner Sherren regimen in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. A retrospective review of 480 patients who underwent an appendectomy for acute appendicitis between November2012 and October 2015 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was <12>71 hours group compared with total interval<12 hours. Although both prolonged patient and hospital intervals were associated with advanced pathology, prehospital delays were more profoundly related to worsening pathology compared with in-hospital delays . Advanced pathology was associated with tenderness to palpation beyond the right lower quadrant , guarding , rebound , and CT scan findings of peritoneal fluid , fecalith , dilation of the appendix , and perforation . Increased length of hospital stay and antibiotic treatment as well as postoperative complications also correlated with progressive pathology. In adult patients with acute appendicitis, the risk of developing advanced pathology and postoperative complications increases with time; therefore, delayed appendectomy is unsafe. As delays in seeking medical help are difficult to control, prompt appendectomy is mandatory. Because these conclusions are derived from retrospective data, a prospective study is required to confirm their validity
Etiologia de la celulitis y Predicción clínica de la enfermedad Estreptocócic...Alex Castañeda-Sabogal
Etiologia de la celulitis. Estudio prospectivo y predicción clínica de la infeccion por Estreptococcus basado en la frecuencia encontrada de las especies de estreptococo
DOI:10.21276/ijlssr.2016.2.4.1
ABSTRACT- Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation
and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in
terms of prolonged hospital stay and lost work days.
Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the
common organism isolated and its antibiotic sensitivity and resistance.
Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the
study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases
had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity.
Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and
clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07%
of all the SSI’s and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most
commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then
E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were
isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that
could promote a more rational use of antibiotics. Key-words- Surgical site infections, National Nosocomial Infections Surveillance (NNIS) risk index, Antibiotic
Surgeons’ Perception to Needle Stick Injuries and Transmission of Blood Borne...CrimsonpublishersCJMI
Needle stick injuries (NSI) are commonly seen in health care workers and those into surgical practice are at a higher risk of sustaining such injuries. As per WHO Report of 2002, of the 35 million health-care workers, 2 million experience percutaneous exposure to infectious diseases every year
Ochsner Sherren regimen Vs Appendectomy in Adults with Acute Appendicitis.QUESTJOURNAL
ABSTRACT: The main Objective of this study is to examine whether Ochsner Sherren regimen in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. A retrospective review of 480 patients who underwent an appendectomy for acute appendicitis between November2012 and October 2015 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was <12>71 hours group compared with total interval<12 hours. Although both prolonged patient and hospital intervals were associated with advanced pathology, prehospital delays were more profoundly related to worsening pathology compared with in-hospital delays . Advanced pathology was associated with tenderness to palpation beyond the right lower quadrant , guarding , rebound , and CT scan findings of peritoneal fluid , fecalith , dilation of the appendix , and perforation . Increased length of hospital stay and antibiotic treatment as well as postoperative complications also correlated with progressive pathology. In adult patients with acute appendicitis, the risk of developing advanced pathology and postoperative complications increases with time; therefore, delayed appendectomy is unsafe. As delays in seeking medical help are difficult to control, prompt appendectomy is mandatory. Because these conclusions are derived from retrospective data, a prospective study is required to confirm their validity
Etiologia de la celulitis y Predicción clínica de la enfermedad Estreptocócic...Alex Castañeda-Sabogal
Etiologia de la celulitis. Estudio prospectivo y predicción clínica de la infeccion por Estreptococcus basado en la frecuencia encontrada de las especies de estreptococo
A Study to Assess the Knowledge and Practices of Hand Hygiene among Nursing S...ijtsrd
Topic A study to assess the Knowledge, And Practice of Hand Hygiene among Nursing Staff in different department of the Hospitals in Uttar Pradesh. Background of the study Health care associated infections persist as amajor problem in health care settings especially Intensive Care Units. Hand hygiene is the most simple and effective method for the prevention of these healthcare associated infections. So, assess the reported hand hygiene practices and observing is very much important to find out gaps, plan remedial measure to reduce HAIs. Hand hygiene practice is still burdened by inadequate compliance, whether in the professional sphere by health professionals or in the non professional sphere by lay population Aims of the study A. To assess the hand hygiene practices among nurses B. To assess the reason for non compliance. Material and method This study was conducted in different department of Fatima hospital. It was an observational, study50 different professional categories nurses were taken for observational study, 50 for assess the reported hand hygiene practices. Questionnaire and observation tool were used for data collection. Result The study revealed that there is a corelation between the knowledge and the practices of hand hygiene among the nurses. The overall observed compliance was 58 50 nurses included in observation study, 308 number of opportunities are given only 180opportunities of hand hygiene being performed . The BSc nurses shows higher compliance rate 93.4 . The GNM nurses show 64 and the ANM show low rate 60 . The reported hand hygiene compliance among Questionnaire given to50 Nurses they were may or may not be included in observation study . Conclusion There were two studies conducted by the investigator. The observational study and reported study. The observational study shows that the overall hand hygiene compliance was58 and the reported study give more than 93.4 of compliance among different categories of nurses. The investigator found that the overall observed hand hygiene compliance among nurses was 58.4 , from that BSC Nurses have performed better. They reported the reason for noncompliance was that they were too busy 64 . Sister Ancy Varghese | Dr. Priyanka Chaudhary | Mrs. Ramanpreet Kaur "A Study to Assess the Knowledge and Practices of Hand Hygiene among Nursing Staff in Different Department of the Hospitals in Uttar Pradesh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47804.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/47804/a-study-to-assess-the-knowledge-and-practices-of-hand-hygiene-among-nursing-staff-in-different-department-of-the-hospitals-in-uttar-pradesh/sister-ancy-varghese
A Study on Awareness of Needle sticks injury in students undergoing paramedic...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Exploring Knowledge, Attitudes and Practices of ICU Health Workers Regarding ...QUESTJOURNAL
Background: Nosocomial Infection is a localized or systemic infection acquired at any health care facility including hospitals by a patient admitted for any reason other than the pathology present during admission. Including an infection acquired in a healthcare facility that manifest 48 hours after the patient's admission or discharge. Objective: Themain aim of this study is toassess the level of knowledge, attitudes and practice of ICU health personnel with regards to the spread of nosocomial infections. Methodology: A cross-sectional and facility based study was conducted from March to November 2016 at King Khalid hospital in Najran, Saudi Arabia. By adopting convenience technique, 50 subjects had been recruited to participate in this study. Results: 62% of respondentswere female. The mean age was 29 years. Concerning educational status, 54% of the participants have Bsc. professionally most of them (48%) were nurses. 60% of the participants have less than three year working experience in ICU.86% of them highlighted that hands must be washed with soap and water or even rubbed with alcohol before contacting with patients. Additionally, the result reveals that employees who had master degree or above displayed higher mean knowledge scores as compared to the other two groups (diploma or less & bachelor) (0.7147 & 4.6656) respectively. High significant statistical differences were found between the three academic groups in relation to sharp devices, personal protective equipment (gloves, gowns &masks), care of intravenous infusion therapy, central line care and urinary catheter care (F=4.594, F=7.982, F=5.539, F=4.471, F=15.310, F=4.345) respectively at p < 0.05. Recommendation & conclusion: Health workers in ICU (King Khalid hospital) showed adequate knowledge and faire attitude regarding universal precautions
Evaluation of infection control at Butiru Chrisco Hospital in Manafwa Distric...PUBLISHERJOURNAL
Infection prevention and control is important for the improvement of quality care in hospital. This study aimed to identify risk associated with infection control, and to determine which infection control measures are available at Butiru Chrisco hospital and how these measures are put to use by the staff working in the hospital. This descriptive cross-sectional study was conducted at Butiru Chrisco hospital in Manafwa District. The study involved 100 respondents who were staff employed by Butiru Chrisco hospital. With different educational standards, awareness of infection control was assessed through a structured questionnaire that was administered to those who consented to participate. Random sampling was done on 10 staff, this helped correct the questionnaire making it suitable for the study but the results were not included in this study. The study revealed that out of 100 respondents, 72(72%) were nurses, 60(60%) were females and 78(78%) had been employed by the hospital for less than four years. Half 50(50%) revealed that airborne infections are the commonest infections in the hospital. The study also reveals that more than 80% reported positive response to infection control tasks with 80(80%) agreeing that practice of infection control reduces likelihood of infection spread to patients. From the study, it was concluded that, there is moderate awareness of infection control with more than half of the respondents having positive ideas about infection control and use of available measures like glove, apron, and hand washing. However, practice and compliance with standard precautions was less than optimal. The researcher recommends continuous health visits by ministry of health (MOH) of Uganda to the hospital and evaluation of the practices to ensure that the health workers practice infection control following the standard guidelines. Also, hand washing or use of hand sanitizers with alcohol or other antiseptics as a measure of disinfecting the hands before or after handling a patient is encouraged.
Keywords: Infection, health workers, hand washing, Manafwa District
Evaluation of infection control at Butiru Chrisco Hospital in Manafwa Distric...PUBLISHERJOURNAL
Infection prevention and control is important for the improvement of quality care in hospital. This study aimed to identify risk associated with infection control, and to determine which infection control measures are available at Butiru Chrisco hospital and how these measures are put to use by the staff working in the hospital. This descriptive cross-sectional study was conducted at Butiru Chrisco hospital in Manafwa District. The study involved 100 respondents who were staff employed by Butiru Chrisco hospital. With different educational standards, awareness of infection control was assessed through a structured questionnaire that was administered to those who consented to participate. Random sampling was done on 10 staff, this helped correct the questionnaire making it suitable for the study but the results were not included in this study. The study revealed that out of 100 respondents, 72(72%) were nurses, 60(60%) were females and 78(78%) had been employed by the hospital for less than four years. Half 50(50%) revealed that airborne infections are the commonest infections in the hospital. The study also reveals that more than 80% reported positive response to infection control tasks with 80(80%) agreeing that practice of infection control reduces likelihood of infection spread to patients. From the study, it was concluded that, there is moderate awareness of infection control with more than half of the respondents having positive ideas about infection control and use of available measures like glove, apron, and hand washing. However, practice and compliance with standard precautions was less than optimal. The researcher recommends continuous health visits by ministry of health (MOH) of Uganda to the hospital and evaluation of the practices to ensure that the health workers practice infection control following the standard guidelines. Also, hand washing or use of hand sanitizers with alcohol or other antiseptics as a measure of disinfecting the hands before or after handling a patient is encouraged.
Keywords: Infection, health workers, hand washing, Manafwa District
Running head hand hygiene compliance1hand hygiene compliance8.docxwlynn1
Running head: hand hygiene compliance1
hand hygiene compliance8Hand Hygiene Education Implementation and Nurses Compliance in Reducing Nosocomial Infections
Grand Canyon University NRS-490
March 31, 2019
Background
Hygiene is a very crucial factor in prevention of infection in any health care facility. Also, compliance of handwashing ensures patients safety, aids in the treatment and recovery of hospitalized patients. Hand hygiene is important action performed by healthcare works to prevent transmission of healthcare associated infection (Smiddy, O’Connell & Creedon, 2015). Health care professionals such as doctors, nurses, physical therapist and laboratory technicians, take the responsibility of providing efficient, effective and quality care that will improve the health of their patients.
The purpose of this paper is to discuss the change proposal project components the author has been working on throughout the course. The goal of health care works rendering a quality, effective and efficient care to their patient in the health care setting will be difficult to achieve if the rate handwashing adherence is below expectation. Unclean healthcare environments harbor germs that can cause disease, thereby placing the patient at risk of developing infection instead of recovering from their present health condition. Healthcare providers inability to comply with hand hygiene is one the main reason patient develop hospital acquired infections (HAIs). Healthcare employees have the lives of patient in their hands therefore, hand hygiene should not by any means be neglected or dominated out in any healthcare facility.
Approximately 250 health care specialists in a Metro Detroit facility happened to be watched and assessed directly; prior to the start of the exercise, participants were selected based on their hand washing comprehension and compliance. Partakers expresses that they observed improvement on handwashing practices and that most nurses complied to hand washing guidelines evidenced by some significant reductions in the rate of transmission of HAIs within the healthcare facility. HAIs are the infections a patient acquire during the period of hospitalization. The result of the research showed a huge decrease in the spread of nosocomial infections due to progress of hand hygiene training and nurses’ compliance to handwashing protocols. These infections mostly manifest during or after 48 hours of admission or thirty days after discharge from the hospital or health-care facility. The author of this research study sees HAIs as a dangerous disease with many complications. Because inadequate handwashing practices by healthcare workers are the main cause of spread of hospital acquire infections, it is important to educate staff members on proper hand hygiene, implement plan to encourage hand hygiene compliance in the healthcare settings. Blood-stream, ulcers / surgical wounds, CAUTI and respiratory infections are the most common types of HA.
PRACTICE OF FIVE MOMENTS OF HAND HYGIENE AMONGTHE NURSES IN SELECTED HOSPITAL...AJHSSR Journal
ABSTRACT :A Quantitative Research approach with a Cross sectional descriptive survey design was used in
the study. 100 Nurses from Thumbay University Hospital, Ajman, UAE who met the sampling criteria were
selected. Written consent was taken. A structured questionnaire to elicit the demographic profile, as well as a
modified Self-reported hand hygiene practice scale, was used online to assess the practice of five moments of
hand hygiene.The majority of the nurses 94-99 % of them had moderate to adequate hand hygiene practice
during the five moments of hand hygiene of which 99% before touching the patients, 95 % before carrying out
clean and aseptic procedures, and after body fluid exposure, 96 % after touching patient unit and 94 % after
touching patient surroundings. Overall, 90 % of the nurses had good hand hygiene practice. No significant
association was found between hand hygiene practices among the nurses with their demographic variables.
KEYWORDS: Five moments, Hand Hygiene, Infection, Nurses.
Infection Prevention and Control in Hospitals by Dr DeleKemi Dele-Ijagbulu
Infection prevention and control is everybody's business! It is an essential, though often under-recognised and under supported part of the infrastructure of health care. However it saves lives and prevents avoidable morbidity and mortality. This presentation highlights the importance and the practical components of infection prevention and control in the hospital setting.
SYSTEMS-LEVEL QUALITY IMPROVEMENTFrom Cues to Nudge A Knolisandrai1k
SYSTEMS-LEVEL QUALITY IMPROVEMENT
From Cues to Nudge: A Knowledge-Based Framework
for Surveillance of Healthcare-Associated Infections
Arash Shaban-Nejad1,2 & Hiroshi Mamiya2 & Alexandre Riazanov3 & Alan J. Forster4 &
Christopher J. O. Baker2,5 & Robyn Tamblyn2 & David L. Buckeridge2
Received: 3 June 2015 /Accepted: 30 September 2015 /Published online: 4 November 2015
# Springer Science+Business Media New York 2015
Abstract We propose an integrated semantic web framework
consisting of formal ontologies, web services, a reasoner and a
rule engine that together recommend appropriate level of
patient-care based on the defined semantic rules and guide-
lines. The classification of healthcare-associated infections
within the HAIKU (Hospital Acquired Infections – Knowl-
edge in Use) framework enables hospitals to consistently fol-
low the standards along with their routine clinical practice and
diagnosis coding to improve quality of care and patient safety.
The HAI ontology (HAIO) groups over thousands of codes
into a consistent hierarchy of concepts, along with relation-
ships and axioms to capture knowledge on hospital-associated
infections and complications with focus on the big four types,
surgical site infections (SSIs), catheter-associated urinary tract
infection (CAUTI); hospital-acquired pneumonia, and blood
stream infection. By employing statistical inferencing in our
study we use a set of heuristics to define the rule axioms to
improve the SSI case detection. We also demonstrate how the
occurrence of an SSI is identified using semantic e-triggers.
The e-triggers will be used to improve our risk assessment of
post-operative surgical site infections (SSIs) for patients un-
dergoing certain type of surgeries (e.g., coronary artery bypass
graft surgery (CABG)).
Keywords Ontologies . Knowledge modeling .
Healthcare-associated infections . Surveillance . Semantic
framework . Surgical site infections
Introduction
Healthcare-associated Infections (HAIs) affect millions of
patients around the world, killing hundreds of thousands
and imposing, directly or indirectly, a significant socio-
economic burden on healthcare systems [1]. According
to the Centers for Disease Control (CDC) [2], hospital-
acquired infections in the U.S., where the point preva-
lence of HAIs among hospitalized patients is 4 %, result
in an estimated 1.7 million infections, which lead to as
many as 99,000 deaths and cost up to $45 billion annually
[3, 4]. Similar or higher rates of HAI occur in other coun-
tries as well with an estimated 10.5 % of patients in Ca-
nadian hospitals having an HAI [5]. Clinical assessment
and laboratory testing are generally used to detect and
confirm an infection, identify its origin, and determine
appropriate infection control methods to stop the infection
from spreading within a healthcare institution. Failure to
monitor, and detect HAI in timely manner can delay di-
agnosis, leading to complications (e.g., sepsis), and
allowing an epid ...
Occupational exposure to blood & body fluids among the nursing staff in a ter...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
SYSTEMS-LEVEL QUALITY IMPROVEMENTFrom Cues to Nudge A Kno.docxdeanmtaylor1545
SYSTEMS-LEVEL QUALITY IMPROVEMENT
From Cues to Nudge: A Knowledge-Based Framework
for Surveillance of Healthcare-Associated Infections
Arash Shaban-Nejad1,2 & Hiroshi Mamiya2 & Alexandre Riazanov3 & Alan J. Forster4 &
Christopher J. O. Baker2,5 & Robyn Tamblyn2 & David L. Buckeridge2
Received: 3 June 2015 /Accepted: 30 September 2015 /Published online: 4 November 2015
# Springer Science+Business Media New York 2015
Abstract We propose an integrated semantic web framework
consisting of formal ontologies, web services, a reasoner and a
rule engine that together recommend appropriate level of
patient-care based on the defined semantic rules and guide-
lines. The classification of healthcare-associated infections
within the HAIKU (Hospital Acquired Infections – Knowl-
edge in Use) framework enables hospitals to consistently fol-
low the standards along with their routine clinical practice and
diagnosis coding to improve quality of care and patient safety.
The HAI ontology (HAIO) groups over thousands of codes
into a consistent hierarchy of concepts, along with relation-
ships and axioms to capture knowledge on hospital-associated
infections and complications with focus on the big four types,
surgical site infections (SSIs), catheter-associated urinary tract
infection (CAUTI); hospital-acquired pneumonia, and blood
stream infection. By employing statistical inferencing in our
study we use a set of heuristics to define the rule axioms to
improve the SSI case detection. We also demonstrate how the
occurrence of an SSI is identified using semantic e-triggers.
The e-triggers will be used to improve our risk assessment of
post-operative surgical site infections (SSIs) for patients un-
dergoing certain type of surgeries (e.g., coronary artery bypass
graft surgery (CABG)).
Keywords Ontologies . Knowledge modeling .
Healthcare-associated infections . Surveillance . Semantic
framework . Surgical site infections
Introduction
Healthcare-associated Infections (HAIs) affect millions of
patients around the world, killing hundreds of thousands
and imposing, directly or indirectly, a significant socio-
economic burden on healthcare systems [1]. According
to the Centers for Disease Control (CDC) [2], hospital-
acquired infections in the U.S., where the point preva-
lence of HAIs among hospitalized patients is 4 %, result
in an estimated 1.7 million infections, which lead to as
many as 99,000 deaths and cost up to $45 billion annually
[3, 4]. Similar or higher rates of HAI occur in other coun-
tries as well with an estimated 10.5 % of patients in Ca-
nadian hospitals having an HAI [5]. Clinical assessment
and laboratory testing are generally used to detect and
confirm an infection, identify its origin, and determine
appropriate infection control methods to stop the infection
from spreading within a healthcare institution. Failure to
monitor, and detect HAI in timely manner can delay di-
agnosis, leading to complications (e.g., sepsis), and
allowing an epid.
knowledge of health care professionals regarding medico-legal aspects and its...Anil Haripriya
knowledgeable about medical legal aspects and informed consent but when it came to actual objectives of consumer protection act and methods of filing cases their knowledge was satisfactory. So, medical health professionals need to update their understanding on consumer protection act and its amendments to be on a legally safer side.
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
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KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROCEDURES IN GENERAL HOSPITALS
1. International Journal of World Research, Vol: I Issue VIII, August 2014, Print ISSN: 2347-937X
32
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION
CONTROL PROCEDURES IN GENERAL HOSPITALS
Dr. Vibha Haripriya, Assistant Professor, Obs & Gynaecology, CIMS, Bilaspur
Dr. Anil Haripriya, Assistant Professor, General surgery, CIMS, Bilaspur
ABSTRACT
Background: Cross infection control is an essential aspect of medical profession, so the purpose of the
study was to assess knowledge and practice towards infection control.
Method: A structured self–administered pretested questionnaire was administered to 142 surgeons in
order to assess their knowledge and practice regarding cross infection control methods. Data were
analyzed using SPSS vers. 15., at p < 0.05.
Result: Half of the participants (53%) knew about immunization schedule for hepatitis B vaccination. 77%
were properly aware about universal precaution guidelines. 72% of the surgeons wash their hands after
gloves removal and 68% participants have the habit of separating needle from the syringe prior to disposal
but still they are having needle prick injuries. Females had higher level of knowledge and practices than
males.
Conclusion: Our finding showed adequate knowledge regarding infection control but their practices were
limited.
Key words: Cross infection, sterilization, surgeons, hospitals
INTRODUCTION
Hospitals are places where sick people go with the expectations that they will get better. Ironically,
hospitalized patients may at times become infected in the environment of the hospital, and such infections
are referred to as nosocomial infections.(1) It is the imbalance between classical triad of epidemiology i.e.
agent, host and environment which leads to the initiation of disease process and to which even hospital
acquired infections are not an exception. By controlling and adequately sanitising the environment of the
2. International Journal of World Research, Vol: I Issue VIII, August 2014, Print ISSN: 2347-937X
33
host, the hospital authorities can markedly reduce the incidence of these infections.(2) Also, the physical
design of hospital is an essential component of a hospital’s infection control strategy, incorporating
infection control issues to minimise the risk of infection transmission.(3)
Effective infection control in a surgery clinic is a priority as number of diseases can also be transmitted in
the surgical environs, including streptococcal and staphylococcal infections, tuberculosis, the common
cold, influenza, mumps, herpes simplex, hepatitis B virus (HBV), syphilis, and human immunodeficiency
virus (HIV).(4)
Since the discovery of HIV, cross infection control has occupied the attention of health care workers
(HCW). Consequently, certain health care authorities, including the British Dental Association, the British
Medical Association and the World Health Organization, have recommended stringent guidelines for the
management of HIV infected and AIDS patients.(5)
In 1987, the Centers for Disease Control and Prevention (CDC) developed universal precautions to help
protect both health care workers (HCWs) and patients from infection with blood-borne pathogens in health
care settings. Their recommendations stress that blood is the most important source of HIV, HBV and other
blood-borne pathogens, and that infection control efforts should be focused on the prevention of exposures
to blood as well as the receipt of HBV immunizations.(6)
Previous seroepidemiological studies have confirmed these occupational hazards, showing higher
concentrations of serum antigen and antibodies for hepatitis B, hepatitis C and Legionella spp. (7) in
surgeons than in the lay population and an increased prevalence of respiratory infections and symptoms
possibly related to aerosols. The use of procedures to control infection and universal precautions in
surgeries is effective in preventing microbial pollution and cross-contamination, and is strongly supported
by organizations such as the Centers for Disease Control and Prevention, the American Dental Association,
schools of dentistry, and many other health agencies and professional associations.(8)
Even before the sudden awareness of the potential infectivity of HIV and hepatitis B virus (HBV),
practitioners followed a practice of washing their hands before and after examining patients, as an aspect of
infection control. However, a U.K. study (9) showed that this practice was no longer strictly observed.
Furthermore, an observation of compliance with hand washing by physicians and nurses in a medical
intensive care unit was disappointing as only 28% of physicians and 43% of nurses washed their hands
following contact with patients.(10) Hence, the objective of the present study was to assess the knowledge
and practices of infection control procedures among surgeons in Chhattisgarh.
MATERIALS AND METHODS
The present cross-sectional study was conducted in January – February 2014 among surgeons to access the
knowledge and practices regarding cross infection procedures in Chhattisgarh.
Study population
Before starting the study, information about total number of surgeons in the state was obtained. All
surgeons available during the study period were included in the study. So a total of 160 surgeons were
available at the time of the survey, of whom only 142 agreed to participate consisting o (92 males and 50
females).
3. International Journal of World Research, Vol: I Issue VIII, August 2014, Print ISSN: 2347-937X
34
Official permission was received from the Institute and a written informed consent was obtained from all
those who were willing to participate in the survey. Before data collection, a pilot survey was conducted
among surgeons to assess the appropriateness of the questionnaire, and it was found that the questions were
unambiguous and easy to respond. A self-administered, structured questionnaire written in English and
validated through a pilot survey including questions on demographic information and other were on
knowledge and practices regarding infection control.
These questions were like asking about medical history, knowledge about the universal precaution, have
you ever had a needle stick, vaccination for hepatitis, wearing gloves & face mask, changing instruments,
sterilization of instruments, needle recapping, use of disinfectant, hand washing.
Methodology
Surgeons were visited by a single investigator, and all available and willing participants were given the
questionnaire on the day of the visit. Participants were asked to respond to each item according to the
response format provided with the questionnaire.
Data analysis
For data analysis, each correct answer was given a score of ‘1’ and each wrong answer was given a score of
‘0’. Individual scores were summed up to yield a total score. Data were analyzed using SPSS vers. 15
(SPSS, Chicago, IL, USA). Frequency and percentage distributions were calculated. Student’t test and
ANOVA test were used to access knowledge and practices. Statistical significance for all tests was
accepted at P < 0.05.
RESULTS
The distribution of the study subjects according to their gender and experience is demonstrated in Tables.
Regarding knowledge of the participants, mostly (84%) know about cross infection control measures and
67% were aware of the precautions taken during accidental needle exposure from a HIV positive patient.
Half of the participants (53%) knew about immunization schedule for hepatitis B vaccination. 77% were
properly aware about universal precaution guidelines and 69% knew about biomedical waste procedures
(Table 1).
Table 2 shows different practices by the study subjects regarding infection control as 85% of surgeons took
past medical history of their patients. More than half of the participants change face mask and gloves
before the start of new patient and almost all of them (98%) change instruments on each patient. 72% of the
surgeons wash their hands after gloves removal and 68% participants have the habit of separating needle
from the syringe prior to disposal as mentioned in Table 2.
In the present study, Females had higher level of knowledge and practices regarding cross infection
procedures and sterilization techniques as mentioned in Table 3. However, regarding experience a
statistically significant difference was observed among all the three groups (P<0.001), as shown in Table 4.
Graph 1 showed different procedures of sterilization by the study subjects and the most common was
autoclave and boiling water (34.7%) followed by just autoclave (30%). Very few participants follows
different methods of cold sterilization as 18.4% cold sterilization and autoclave, 8.1% cold sterilization and
boiling water and 3.6% only cold sterilization. A positive correlation between knowledge and practices
regarding infection control procedures was seen which was found to be (r=0.67, p<0.001).
4. International Journal of World Research, Vol: I Issue VIII, August 2014, Print ISSN: 2347-937X
35
DISCUSSION
Infection is most often used in relation to healthcare, in particular with reference to preventing patients
acquiring those infections most often associated with healthcare (such as wound infection) and preventing
the transmission of micro-organisms from one patient to another (sometimes referred to as cross-infection).
Hand washing commonly seen in our study but according to the results of the compliance study in
Germany and Austria (2002), 44% of doctors did not know any regulations concerning hand
disinfection.(11)
As regard the variation in compliance to hand washing hygiene among different health care workers.
Doctors showed the highest compliance (37.5%) in comparison to nurses (36.4%) and housekeepers
(22.6%) and this disagree with Lipsett and Swoboda (2001) who had found that nurses showed higher
compliance (50%) than doctors (15%) and nursing supporting personnel (37%).(12) However in other
study, it was found that only 26% of physicians and 43% of nurses washed their hands after patients’
examination.(13)
Most of the participants use gloves while treating the patients in this data. It has been traditional teaching
that gloves should be changed promptly if punctured.(14) Some surgeons use double gloves for more
protection, mentioned by Patterson et al who demonstrated that double gloving may be uncomfortable,
reduce manual dexterity and tactile sensitivity but it provides increased protection from penetration of
needle stick injuries.(15) Also randomized studies within various surgical specialties have shown that
wearing two pairs of gloves decreases leaks by 3-9 fold in water permeability tests, when compared with
wearing one pair of gloves.(16)
It was found in this study that 38% of surgeons had needle prick injuries where as it was 60% in nurses and
50% in resident doctors in a study done by Haudhari et al. Nurses had high prevalence as they are more
involved in giving injections.(17)
Around half of the participants had knowledge regarding HBV transmission which is essential health care
and the results were similar in Daud et al study among MBBS students. They must take proper protection
as HBV is 50 times easier to transmit than HIV.(18)
Despite the fact that surgeons undertook procedures which generated aerosol and some of which caused
blood splashes on the face, it was disturbing to find that, about 45% of them did not regularly wear face
masks when carrying out invasive procedures on patients. Studies have demonstrated that cutaneous,
percutaneous and mucous membrane exposures to patients blood are common even during general surgical
practice. However, the efficacy of facemasks in reducing cross infection in practice is questionable.(19)
The present data showed positive correlation between knowledge and practices regarding infection control
and sterilization which was similar to results found in the literature.(11,20)
There is good level of knowledge regarding awareness of biomedical waste management. A separate study
reported a varied compliance rate regarding universal precautions among hospital physicians in United
States: glove use as 94%; disposal of sharpsas 92%; not recapping needles as 56%.(21)
5. International Journal of World Research, Vol: I Issue VIII, August 2014, Print ISSN: 2347-937X
36
CONCLUSION
The study revealed good knowledge of infection control procedures but there were problems in practices of
sterilization. Most of them did not separate the needle from the syringe prior to disposal therefore needle
prick injuries were common. So more intensive and regular training programs to surgeons must be included
in the plans of quality control in all hospital and regular inspection from the ministry of health guarantees
good infection control practices.
TABLES
Table 1: Showing knowledge regarding standard cross infection precautions
Sr no Question Yes (%)
1 Do you know cross infection control measures? 84%
2 First step to be done after accidental needle exposure from a HIV positive
patient?
67%
3 Disinfectant effective in removing dried blood on a surface? 58%
4 Does hand washing minimize infection risk secondary to leakage? 88%
5 Immunization schedule for hepatitis B vaccination? 53%
6 How often is biological monitoring of autoclave sterilization done? 61%
7 Do you know about the universal precaution guidelines? 77%
8 Can hepatitis B be transmitted by needle stick? 65%
9 Aware of biomedical waste procedures 69%
Table 2: Showing practices regarding standard cross infection precautions
Sr no Question Yes (%)
1 Asking about medical history of patients? 85%
2 Do you have vaccination for hepatitis B? 56%
3 Do you wear gloves? 62%
4 Do you wear face masks? 55%
5 Changing instruments on each patient? 96%
6 Storage of sterilized instruments packed in plastic bag? 47%
7 Sterilization of instruments in an autoclave? 79%
8 Do you wash hands after gloves removal? 72%
9 Do you separate the needle from the syringe prior to disposal? 68%
10 Do you had needle prick injuries 38%
Table 3: Mean scores of Knowledge & practices regarding standard cross infection precautions
according to gender
Gender No Mean SD p-value
Male 92 11.6 3.566
0.001Female 50 13.4 4.654
6. International Journal of World Research, Vol: I Issue VIII, August 2014, Print ISSN: 2347-937X
37
Table 4: Mean scores of Knowledge & practices regarding standard cross infection precautions
according to experience
Experience No Mean SD p-value
0-5 years 70 12.5 3.876
0.0015-10 years 49 11.2 3.265
10-15 years 25 13.6 3.156
Graph 1: Showing different methods of sterilization among surgeons
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