scholarly journals Comparison of Hand Hygiene Attitudes and Hand Swab Cultures in the Mothers of Children with Heart Disease Before and After Cardiac Surgery

2017 ◽  
Vol 07 (01) ◽  
pp. e27-e31
Author(s):  
Aysu Karaağaç
Keyword(s):  
Heart Disease ◽  
Hand Hygiene ◽  
Postoperative Period ◽  
Cardiovascular Surgery ◽  
Perioperative Period ◽  
Before And After ◽  
Main Factors ◽  
Economic Measure ◽  
Severe Anxiety ◽  
And Training

AbstractNosocomial infections (NI) carry high risk of morbidity and mortality especially for children undergoing surgeries. Hand hygiene (HH) is the most effective and economic measure of NI control. This study was designed to compare the HH practices (HHPs), maternal anxiety scores (MASs), and hand swab cultures (HSCs) in the mothers of children with heart disease before and after cardiovascular surgery (CVS) to determine the factors that raised maternal HH sensitivity for prevention of NI. This prospective study included 120 mothers (age: 20–45 years; mean: 31.6 ± 5.6 years), whose children underwent CVS in the Kartal Koşuyolu Research and Training Hospital, University of Health Sciences between November 2016 and February 2017. HHP of each mother was assessed by a questionnaire, 10 questions in two parts and HH score (HHS) was acquired. Then, HSC was obtained. Beck anxiety inventory was applied to determine MAS. The relations among demographic characteristics, MAS, HSC results, and pre-/postoperative HHS of the mothers were compared statistically. There was a significant increase in the HHS of the mothers in the postoperative period. Cronbach's a coefficient of the questionnaire was 0.84. Maternal HHS was significantly correlated with maternal age (p = 0.001), education (p = 0.002), and MAS (p = 0.001), but not with the income (p = 0.2). Moreover, one mother in the postoperative period (0.8%) versus five mothers in the preoperative (4.2%) had positive HSC. High education level, advanced age, and severe anxiety experienced by the mothers in their children's perioperative period were found to be the main factors that have raised maternal HHS, thereby resulting in better HSC results.

scholarly journals Risk assessment of cardial complications in patients with concomitant ischemic heart disease using different regimens of intraoperative fluid therapy

2020 ◽  
pp. 50-51
Author(s):  
Ya.V. Morozova
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Postoperative Complications ◽  
Fluid Therapy ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hemodynamic Parameters ◽  
Normal Limits ◽  
Significant Correction

Objective. To investigate the incidence of postoperative cardiac complications when performing advanced surgical interventions for cancer in patients with concomitant coronary heart disease (CHD) using two different regimens of intraoperative fluid therapy. Materials and methods. The study included 89 patients who underwent advanced surgery under general anesthesia. The division of patients into two groups was performed depending on the chosen way of intraoperative fluid therapy: the first (n=45) with a restrictive regimen (7.0±0.2 ml/kg/h), the second (n=44) – with a liberal (13.9±0,6 ml/kg/h). Groups of patients had no differences in anthropometric data, the volume of surgery, anesthesia. Intraoperatively, continuous monitoring of routine hemodynamic parameters (blood pressure, heart rate) and electrocardiography (ECG), quantitative assessment of biomarkers of myocardial damage (TnI, NTproBNP) by enzyme-linked immunosorbent assay in three stages (before surgery, immediately after and in the early postoperative period 18-24 h) of operation. Results and discussion. None of the patients had critical incidents during anesthesia, some of them had postoperative complications that did not require significant correction, but only more careful monitoring. In all patients of both groups, stable hemodynamic parameters were observed in the perioperative period, which was ensured by the adequacy of anesthesia, fluid therapy and the use of maintenance doses of sympathomimetics (phenylephrine) if necessary. In the 1st group 8 patients (17.8 %) needed support with sympathomimetics, in the 2nd – 3 patients (6.8 %). The study of the dynamics of cardiac biomarkers revealed a slight increase in cardiac troponin I in both groups, which was within the upper limit of normal. A more significant increase in troponin levels (so-called myocardial injury) was found in 5 patients (11.1 %) of the 1st group and in 6 patients (13.6 %) of the 2nd group in the postoperative stage. In the study of the concentration of natriuretic peptide found a more significant increase in patients of group 2 in the postoperative period, but these values were within normal limits. Manifestations of heart failure decompensation were not found in either patient in either group. According to ECG monitoring, no ischemic changes were found in any of the patients, benign arrhythmias were detected in 5 patients (11.1 %) of the 1st group and in 7 patients (15.9 %) of the 2nd group. Signs of acute renal injury were not found in either patient of either group, all had sufficient diuresis and blood creatinine levels within normal limits in the perioperative period. According to the statistical indicators of stay in the intensive care unit and in the hospital, the patients of both groups did not differ from each other. Thus, the study found no significant differences in the frequency of postoperative complications in patients with concomitant CHD when using relatively restrictive and liberal regimens of perioperative infusion therapy. The key point in the management of these patients is, in our opinion, the desire for “zero” balance by the end of the 1st day of the postoperative period and beyond. The main tools of the anesthesiologist are careful accounting of the injected fluid and its losses. This tactic may allow the use of a more liberal infusion regimen if necessary in patients without signs of heart failure. Conclusions. Relatively restrictive and liberal regimens of perioperative fluid therapy can be safely used in patients with concomitant CHD without signs of heart failure, provided adequate monitoring and management within the “zero” fluid balance.

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

scholarly journals The impact of a ‘milking the COW’ campaign in a regional hospital in Singapore

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Surinder Kaur M. S. Pada ◽  
Poh Lishi ◽  
Kim Sim Ng ◽  
Sarathamani Rethenam ◽  
Lilibeth Silagan Alenton ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Pathogenic Bacteria ◽  
Mixed Model ◽  
Mixed Model Analysis ◽  
Colony Forming Units ◽  
Skin Flora ◽  
Before And After ◽  
The Difference ◽  
And Control ◽  
The Impact

Abstract Background Computerisation of various processes in hospitals and reliance on electronic devices raises the concern of contamination of these devices from the patient environment. We undertook this study to determine if an attached hand hygiene device that unlocks the screen of a computer on wheels (COW) on usage can be effective in decreasing the microbiological burden on computer keyboards. Methods An electronic hand sanitizer was integrated onto the COW. A prospective cohort study with a crossover design involving 2 control and 2 intervention wards was used. The study end point was the number of colony forming units found on the keyboards. Bacteria were classified into 4 main groups; pathogenic, skin flora, from the environment or those thought to be commensals in healthy individuals. We then used a mixed effects model for the statistical analysis to determine if there were any differences before and after the intervention. Results Thirty-nine keyboards were swabbed at baseline, day 7 and 14, with 234 keyboards cultured, colony forming units (CFUs) counted and organisms isolated. By mixed model analysis, the difference of mean bacteria count between intervention and control for week 1 was 32.74 (− 32.74, CI − 94.29 to 28.75, p = 0.29), for week 2 by 155.86 (− 155.86, CI − 227.45 to − 83.53, p < 0.0001), and after the 2-week period by 157.04 (− 157.04, CI − 231.53 to − 82.67, p < 0.0001). In the sub-analysis, there were significant differences of pathogenic bacteria counts for the Intervention as compared to the Control in contrast with commensal counts. Conclusion A hand hygiene device attached to a COW may be effective in decreasing the microbiological burden on computer keyboards.

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

scholarly journals Access to Alcohol-Based Hand Rub Is Associated With Improved Hand Hygiene in an Ebola-Threatened District of Western Uganda

2020 ◽  
Vol 41 (S1) ◽  
pp. s457-s457
Author(s):  
Mohammed Lamorde ◽  
Matthew Lozier ◽  
Maureen Kesande ◽  
Patricia Akers ◽  
Olive Tumuhairwe ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Wide Distribution ◽  
Patient Contact ◽  
Improve Hand Hygiene ◽  
Before And After ◽  
Hygiene Compliance ◽  
Handwashing With Soap

Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan

Mental disorders that occur against the background of water-electrolyte disorders in patients with neoplasms of chiasmal-sellar region

2020 ◽  
pp. 38-56
Author(s):  
K. V. Koval ◽  
G. E. Chmutin ◽  
P. L. Kalinin ◽  
M. A. Kutin ◽  
V. V. Ivanov
Keyword(s):  
Mental Disorders ◽  
Postoperative Period ◽  
World Literature ◽  
Sellar Region ◽  
Electrolyte Disorders ◽  
Appropriate Treatment ◽  
Specific Category ◽  
Neurosurgical Patients ◽  
Before And After ◽  
Shed Light

The work is devoted to assessing the results of the analysis of world literature for a period of more than 50 years: it reflects the data on the nature of the occurrence of mental disorders developing in patients with tumors of the chiasmal-sellar region against the background of water-electrolyte disorders both before and after surgery. The presented data shed light on the occurrence of the variants of mental disorders in such a specific category of neurosurgical patients, which may allow the clinician to timely determine the appropriate treatment tactics and reduce the severity of complications in the postoperative period.

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