scholarly journals Diarrhea Recurrence in Patients withClostridium difficile-Associated Diarrhea: Role of Concurrent Antibiotics

1999 ◽  
Vol 10 (4) ◽  
pp. 287-294 ◽  
Author(s):  
MJ Alfa ◽  
GKM Harding ◽  
AR Ronald ◽  
RB Light ◽  
N MacFarlane ◽  
...  
Keyword(s):  
Relative Risk ◽  
Environmental Contamination ◽  
Tertiary Care ◽  
Specific Treatment ◽  
Fecal Excretion ◽  
Control Group ◽  
Contamination Rate ◽  
Care Hospital ◽  
Frequent Site ◽  
Endemic Strain

OBJECTIVE: To monitor prospectively patients withClostridium difficile-associated diarrhea (CAD) in a six hundred bed tertiary care hospital to determine which factors influenced the recurrence of the diarrhea.DESIGN: A prospective, nonrandomized study. After an initial diagnosis of CAD, patients were interviewed, and each week stool samples and environmental samples were monitored for the presence of toxigenicC difficilefor as long as the patients remained in hospital. The relationship of concurrent antibiotics, prolonged fecal excretion of organism or toxin, and environmental contamination was assessed.PATIENTS: Over a two-and-a-half year period, 75 consecutive patients with CAD were selected and those who gave their written informed consent were enrolled. A control group to evaluate environmental contamination consisted of 75 patients with diarrhea not associated withC difficile.RESULTS: Of the 75 CAD patients, 11 (14.7%) had a recurrence of their diarrhea. Diarrhea recurrence was associated with an increased rate of prolonged excretion of toxigenic organism and/orC difficiletoxin(s) (nine of 11 [81.8%] compared with nine of 64 [14.1%]; P≤0.0001; relative risk 14.25; 95% CI 3.383 to 60.023). The risk of diarrhea recurrence was not related to a specific antibiotic but to concurrent therapy. Treatment within 30 days of initial CAD-specific treatment with an antibiotic other than metronidazole or vancomycin occurred significantly more frequently in patients with recurrence of diarrhea compared with those who did not have a recurrence (eight of 11 [72.7%] compared with 22 of 64 [34.4%], P=0.022; relative risk 4; 95% CI 1.153 to 13.881). The environmental contamination rate for toxigenicC difficilein week one in the rooms of patients with diarrhea not caused byC difficilewas low (two of 75 [2.6%]) compared with week one data for patients with CAD (14 of 75 [18.7%], P=0.002; relative risk 1.922; 95% CI 1.479 to 2.498). The most frequent site contaminated was the bedpan sprayer (eight of 14 [57.1%]). Pulsed field gel electrophoresis analysis of stool and environmental toxigenic isolates indicated that there was not a single endemic strain ofC difficile.CONCLUSIONS: This study indicates that the recurrence of diarrhea may be related to concurrent ‘other’ antibiotics. Although data indicated that there was a correlation between diarrhea recurrence and prolonged fecal excretion of toxin, further studies are required to clarify the clinical significance.

scholarly journals The effect of care transition pathway implementation on patients undergoing joint replacement during the COVID-19 pandemic: a quasi-experimental study from a tertiary care hospital orthopedic department in Beijing, China

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ya-ping Xu ◽  
Pei-yu Zhao ◽  
Yi-tong Bai ◽  
Shuang Li
Keyword(s):  
Joint Replacement ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Transition ◽  
Control Group ◽  
Care Hospital ◽  
Quasi Experimental ◽  
And Control ◽  
Beijing China

Abstract Background The coronavirus disease (COVID-19) pandemic has had a massive impact on individuals globally. The Chinese government has formulated effective response measures, and medical personnel have been actively responding to challenges associated with the epidemic prevention and control strategies. This study aimed to evaluate the effect of the implementation of a care transition pathway on patients that underwent joint replacement during the COVID-19 pandemic. Methods A quasi-experimental study was designed to evaluate the effect of implementing a care transition pathway for patients who underwent joint replacement during the COVID-19 pandemic in the orthopedic department of a tertiary care hospital in Beijing, China. Using a convenient sampling method, a total of 96 patients were selected. Of these, 51 patients who had undergone joint replacement in 2019 and received treatment via the routine nursing path were included in the control group. The remaining 45 patients who underwent joint replacement during the COVID-19 epidemic in 2020 and received therapy via the care transition pathway due to the implementation of epidemic prevention and control measures were included in the observation group. The quality of care transition was assessed by the Care Transition Measure (CTM), and patients were followed up 1 week after discharge. Results The observation group was determined to have better general self-care preparation, written planning materials, doctor-patient communication, health monitoring, and quality of care transition than the control group. Conclusions A care transition pathway was developed to provide patients with care while transitioning through periods of treatment. It improved the patient perceptions of nursing quality. The COVID-19 pandemic is a huge challenge for health professionals, but we have the ability to improve features of workflows to provide the best possible patient care.

ALKALINE PHOSPHATASE AS A PROGNOSTIC MARKER IN CANCER BREAST PATIENTS IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 14-16
Author(s):  
Asha Premlata Omega Oraon ◽  
Bela Rose Ekka
Keyword(s):  
Alkaline Phosphatase ◽  
Cancer Patients ◽  
Prognostic Marker ◽  
Prognostic Markers ◽  
Tertiary Care Hospital ◽  
Serum Alkaline Phosphatase ◽  
Tertiary Care ◽  
Control Group ◽  
Care Hospital ◽  
Cancer Breast

OBJECTIVE: To estimate the value of Alkaline Phosphatase in cancer breast patients in a tertiary care hospital. MATERIAL AND METHODS: The study was conducted to estimate the value of Serum Alkaline Phosphatase in 50 cancer breast patients and 50 normal patients of same age as a control group. RESULTS: The level of serum Alkaline Phosphatase was signicantly increased (p<0.05)in cancer patients compared to the control group. CONCLUSION: There is an increase in serum Alkaline Phosphatase in cancer patients compared to the control group and can be a prognostic markers for the progress of the disease.

scholarly journals 1225. How Frequently Should Sink Drains Be Disinfected?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S440-S440
Author(s):  
Jorge A Ramos-Castaneda ◽  
Matthew L Faron ◽  
Joshua Hyke ◽  
Blake W Buchan ◽  
Rahul Nanchal ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Horizontal Transmission ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Group ◽  
Care Hospital ◽  
Bacterial Reduction ◽  
Post Intervention ◽  
Bacterial Colony ◽  
Healthcare Facilities

Abstract Background New evidence shows the relevance of sink drains in the horizontal transmission of multidrug-resistant organisms. We recently demonstrated that a peroxide-based disinfectant (product B) was better than bleach at disinfecting sink drains; however, we did not determine the duration of this effect. In this study, we evaluate the duration of bacterial reduction in sink drains treated with product B and compared it to an enhanced hydrogen peroxide agent (product A). Methods Testing was performed in a 26-bed medical intensive care unit at a 566-bed tertiary care hospital in Milwaukee, WI. Two disinfectants were compared: product A (hydrogen peroxide, octanoic acid, and peroxyacetic acid; Virasept, Ecolab) and product B (hydrogen peroxide-based disinfectant; Peroxide Multi Surface Cleaner and Disinfectant, Ecolab). Sinks were randomly assigned to product A, product B, and control (no disinfection). On day 0, baseline cultures were obtained and disinfectant agents were applied. On post-intervention days 1, 3, 5, and, 7, samples from each drain were collected using E-swabs (Copan, Italy). Quantitation of Gram-negative burden was determined by serial dilution in saline plated to MacConkey agar and dilutions that contained 20–200 colonies were used for bacterial colony-forming units (CFU). Multivariate multiple linear regression and analysis of variance were used to compare mean Ln(1+CFU) between groups using R v3.5.0. Environmental sampling, cultures, and statistical analyses were performed blinded to the disinfected used. Results All three groups had similar CFU counts at baseline (P > 0.05). On day 1, a statistically significant reduction in bacterial CFUs was observed in the group treated with product A compared with sinks treated with product B (P = 0.04) or the control group (P < 0.01). The same differences were observed on day 3 post-intervention. There were no significant reductions on days 5 and 7. Conclusion Product A was the most effective product at disinfecting sink drains but its effect disappeared at 5 days post-disinfection. These results suggest that treating sink drains every 5 days with a hydrogen peroxide mixture would be ideal for healthcare facilities dealing with sink drain contamination. Disclosures All authors: No reported disclosures.

scholarly journals Comparative Study of Physiological and Haematological Parameters among Mild and Severe COVID-19 Patients Admitted in Tertiary Care Hospital of Pune District, India

2021 ◽  
pp. 132-139
Author(s):  
Suchita Sachin Palve ◽  
Pallavi Sachin Chaudhari
Keyword(s):  
Inflammatory Responses ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Specific Treatment ◽  
Haematological Parameters ◽  
Care Hospital ◽  
Physiological Variables ◽  
The World ◽  
High Level ◽  
The Impact

Background: The COVID-19 pandemic has put global health at stake by creating havoc all over the world, due to which the world, as well as health agencies, are experiencing the greatest challenges. This disease is a health emergency due to its high level of infectiousness and the non-availability of any specific treatment [1]. Objectives: To determine and compare the significance of physiological and haematological parameters in the diagnosis of COVID 19 infection and compare the association of physiological and haematological parameters among mild and severe COVID-19 patients. Methodology: The present comparative, observational study was carried out in a designated tertiary care hospital, where admission of COVID19 patients in Pune district, India. Various parameters like age, height, weight, BMI, various physiological variables, haematological parameters, and CRP levels were assessed among 202 Mild and 50 severe COVID 19 diagnosed patients on day one of the hospital's stays. Results: Pearson’s correlation coefficient showed a significant correlation among physiological and haematological variables compared to both groups, especially physiological parameters like SBP and DBP. The results showed that TLC, CRP, NLR, PLR, among COVID 19 patients cans work as important biomarkers to understand the disease prognosis. Conclusion: Study of physiological and haematological parameters and their interrelation will help in understanding the impact of COVID 19 infection on the reactive inflammatory responses and help in understanding the prognosis of the disease among mild and severe patients.

“A TRUE EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF XYLOCAINE 2% GEL ON PAIN INTENSITY DURING INTRAVENOUS CANNULATION AMONG PATIENTS AT SELECTED TERTIARY CARE HOSPITAL BELAGAVI”

2021 ◽  
pp. 22-23
Author(s):  
Mounesh Badiger ◽  
Honnagouda Patil
Keyword(s):  
Pain Intensity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Adult Patients ◽  
Control Group ◽  
Care Hospital ◽  
Intravenous Cannula ◽  
Cannulation Site ◽  
Post Test ◽  
Experimental Group

A true experimental, post test only control group design was used to nd out the effectiveness of Xylocaine 2% gel on pain intensity reduction during intravenous cannulation among the adult patients tertiary care hospital of Belagavi, Karnataka. Quantitative approach was used for the study. The study was done on 80 adult patients using standardized pain numerical scale. (Based on pilot study the prevalence rates in both group calculated p1=82% p2=100%, q1=18 q2=0, d=18% , Z= 1.96 (at 5% α error), Z= 0.842 (at 80% power) n=38 40). Simple random (lottery method) technique was used .in this study the patients, who have a patent intravenous cannula in place and who are unable perceive and responds for pain (unconscious patient). Demographical variables analyzed for the study Age, Gender, Education, Occupation, Previous experience, duration of pain during intravenous cannulation, site of cannulation and size of intravenous Cannula (Variables Independent variable: Xylocaine 2% gel. Dependent variable: Pain intensity experience during intravenous cannulation). Total 21 reviews were taken under the title of the above study (Indian- 03, International- 18). The conceptual framework used for this study is based on General Systems Theory introduced by Ludwig Von Bertalanffy in 1968. The obtained data was analyzed by using descriptive and inferential statistics. The mean of post test pain intensity during IV cannulation in experimental group was 1.93 and 4.30 in control group and SD of 0.60 in experimental group, 0.61 in control group. In this study 62.50% of participants have mild pain and 15% have moderate pain in experimental group as compared to 55% have severe pain followed by 37.50% have worst pain in control group. The difference is found to be statistically signicant

scholarly journals Derivation of a Model to Guide Empiric Therapy for Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection in an Endemic Area

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Gregory Weston ◽  
Fathima Jahufar ◽  
Nikhil Sharma ◽  
Christopher Su ◽  
Eran Bellin ◽  
...  
Keyword(s):  
Blood Culture ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
Tertiary Care ◽  
Classification Rule ◽  
Control Group ◽  
Care Hospital ◽  
Clinical Classification ◽  
Carbapenem Resistant ◽  
Good Ability

Abstract Background Appropriate therapy for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is often given late in the course of infection, and strategies for identifying CRKP BSI earlier are needed. Methods A retrospective case–control study was performed at a tertiary care hospital, university hospital, and community hospital in Bronx, New York. All participants had a blood culture sent and received an antibiotic within 48 hours of the culture. The case group (n = 163) had a blood culture with CRKP. The control group (n = 178) had a blood culture with carbapenem-susceptible Klebsiella. Data were obtained by electronic or conventional medical record abstraction. A multiple logistic regression model was built to identify associated factors and develop a clinical model for CRKP BSI. Model performance characteristics were estimated using a 10-fold cross-validation analysis. Results A prior nonblood culture with carbapenem-resistant Enterobacteriaceae, skilled nursing facility (SNF) residence, mechanical ventilation, and admission &gt;3 days were strongly associated risk factors. A significant interaction led to development of separate clinical models for subjects admitted &lt;3 days at the time of positive blood culture from those admitted at least 3 days. The derived models had a good ability to discriminate between subjects with and without CRKP BSI. A clinical classification rule to guide therapy can prioritize sensitivity or specificity. Conclusions Prior nonblood cultures showing resistance and exposure to SNF and health care settings are factors associated with carbapenem resistance. The clinical classification rules derived in this work should be validated for ability to guide therapy.

Laryngopharyngeal Reflux Has Negative Effects on Taste and Smell Functions

2016 ◽  
Vol 155 (1) ◽  
pp. 117-121 ◽  
Author(s):  
Aytug Altundag ◽  
Melih Cayonu ◽  
Murat Salihoglu ◽  
Hasmet Yazıcı ◽  
Onuralp Kurt ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Tertiary Care ◽  
Control Group ◽  
Prospective Clinical Study ◽  
Care Hospital ◽  
Reflux Symptom Index ◽  
Negative Effects ◽  
Symptom Index ◽  
Umami Taste ◽  
First Time

Objective We evaluated the halimetric, olfactory, and taste functions of patients with laryngopharyngeal reflux (LPR). Study Design Prospective clinical study. Setting Multicenter tertiary care hospital. Methods Patients who were diagnosed with LPR for the first time on the basis of a Reflux Finding Score (RFS) >11 and a Reflux Symptom Index (RSI) >13 were enrolled in this study. A control group was selected from patients without a complaint of LPR. OralChroma was used for the halimetric measurement; Sniffin’ Sticks were used for the smelling test; Taste Strips were used for the taste test; and monosodium L-glutamate was used for the umami test. Results A total of 110 subjects were included, with a mean age of 36.8 ± 10 years (range, 19-57 years). The differences in odor threshold scores were significant between the groups ( P < .001), but no change was detected for the odor identification or discrimination scores between the groups. Bitter taste scores were significantly diminished in the reflux group compared with those in the control group ( P = .001), whereas no impairments were found in the other taste scores (sweet, salty, and sour). The reflux group had significantly higher umami taste scores than those of the control group for the posterior tongue and soft palate anatomic sites ( P < .001 and P < .001, respectively). Dimethyl sulfite levels were significantly higher in the reflux group than in the control ( P = .001). Conclusion Questioning patients who present with halitosis, taste, or smelling disorders is important to diagnose LPR.

scholarly journals Effectiveness of Hand Hygiene Video cum Demonstration on Knowledge and Practice, among Mothers of Neonates Admitted in NICU

2021 ◽  
Vol 10 (33) ◽  
pp. 2799-2802
Author(s):  
Sangithaa Varsha G. ◽  
Geetha D ◽  
Anita David
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Hospital Environment ◽  
Control Group ◽  
Study Group ◽  
Care Hospital ◽  
Post Test ◽  
Knowledge And Practice

BACKGROUND Proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of health care association infection (HAIs) and nosocomial infection. Several studies have demonstrated that hand washing virtually eradicates the carriage of infections in intensive care units (ICUs). For more than 150 years, hand hygiene has been researched in the hospital environment as a way of preventing transmission of bacteria, infection and death. The purpose of this study was to import the significance of the hand hygiene and to improve the skills in performing hand hygiene among mothers of neonates admitted in neonatal intensive care unit (NICU) at tertiary care hospital. METHODS A self structured knowledge questionnaire (KQ), practice questionnaire (PQ) and practice checklist (PC) was administered. The one to one method video on hand hygiene was played by using a laptop for about 15 minutes as an intervention with demonstration done by investigator and return demonstration was done by mothers, post test was conducted on 3rd day and 5th day followed by the intervention. RESULTS The mean scores of knowledge showed improvement in post test than the pre test in both the groups, but there was an increase in practice mean score between the groups which showed an improvement in the study group, it was higher than the control group which was statistically significant at P < 0.001. Overall, there were minimal positive correlations between the level of knowledge and practice for the study group in post-test and post-test II. Minimum positive correlation was evident but there was no significance. CONCLUSIONS This study concludes that it enhanced the knowledge on hand hygiene among mothers of neonates and it helped mothers to understand the importance of hand hygiene, when to do, how to do, why to do. Thus, it expected directly or indirectly to reduce the infection rate among neonates admitted in NICU. Further, the nurses have a great responsibility in ensuring parents adherence to hand hygiene. KEY WORDS Mothers of Neonate in NICU, Hand Hygiene, Video cum Demonstration, Mothers KPC.

scholarly journals Effect of in-house training of health care personnel on biomedical waste management in a tertiary care hospital, Warangal, Telangana, India

2020 ◽  
Vol 7 (3) ◽  
pp. 1110
Author(s):  
Priyanka Sriramula ◽  
Rajashekar Neelakanti ◽  
P. S. Supriya
Keyword(s):  
Health Care ◽  
Waste Management ◽  
Tertiary Care ◽  
Specific Treatment ◽  
Health Care Facilities ◽  
Health Care Personnel ◽  
Healthcare Personnel ◽  
Care Hospital ◽  
Biomedical Waste ◽  
Post Test

Background: Every day, relatively large amount of potentially infectious and hazardous wastes is generated in the health-care hospitals and facilities around the world. Indiscriminate disposal and improper management of waste generated in health care facilities causes serious threat to environment and to human health that requires specific treatment and management prior to its final disposal.Methods: Cross-sectional study was conducted among 241 health care personnel working at Mahatma Gandhi Memorial hospital, Warangal. Data was collected and pre and post analysis was done using a pre-validated self-administered questionnaire. Data was entered in MS Excel and analysed using SPSS 17 software.Results: Among 241 respondents, 33.2% were sanitary staff, 35.3% are nursing staff and 31.5% are nursing students. Only 35.7% of participants has knowledge regarding the colour of the bag into which expired antibiotics are discarded and 45.2% of participants were aware of the colour of the bag in which IV bottles, gloves were discarded. Scoring for 10 was done in both pre and post-test and post test scores were found to be higher and there is significant increase in level of knowledge of biomedical waste management rules in study population in post-test analysis (p<0.001).Conclusions: Training program on the waste management in the health sector has significant effect in increasing knowledge of the healthcare personnel. 

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