Study of nosocomial respiratory infections and nurses' performance related to infection control measures in artificially ventilated patients

This study was conducted on 30 ventilated patients and the 30 nurses who were responsible for their care. An observation checklist was used to assess nurses' practices regarding daily care activities, ventilator decontamination, use of universal infection control measures and the maintenance of the patients' care environment. A second sheet was developed to estimate the incidence of nosocomial respiratory infection and to identify the causative microorganisms. A third sheet was designed to help in the daily assessment of the patient's health condition. The study revealed a high incidence of nosocomial respiratory infections. Also, it was revealed that pseudomonas was the causative agents in more than one- fourth of the cases. Moreover, nurses' infection control practices were inadequate

Control of heparin anticoagulation during cardiopulmonary bypass experience with a small initial dose

Forty adult patients of both sex undergoing cardiac surgical procedures requiring cardiopulmonary bypass were included in the present study. Patients were classified into two equal groups [each of 20 patients], group I were given the usual initial dose of heparin 400 IU/Kg while group II were given an initial dose of heparin 200 IU/Kg. Additional doses of heparin 50 IU/Kg added to attain ACT just above 400 sec in both groups to study this small initial dose for safe anticoagulation during CPB. It is found that the total heaparin dose before cannulation, the mean ACT values, the total heparin during surgery and the protamine dose for reversal were significantly lower in group II than in group I. So, starting with an initial heparin dose of 200 IU/Kg, adding small incremental doses to attain ACT just above 400 sec and proper ACT monitoring is a safe technique for heparin anticoagulation during CPB avoiding heparin overdosager

effect of pregnancy on epidural spread of bupivacaine

This study had been carried out on 40 female patients ASA physical status I, 20 non pregnant and 20 pregnant women in the first trimester [6-12 weeks pregnancy]. They had been studied to compare the spread of epidural Bupivacaine in both groups. Pregnant women were scheduled to undergo evacuation for inevitable abortion and non pregnant ones to lower abdominal operations. Twenty ml Bupivacaine were injected epidurally according to the standard technique in the L 2-3 space, spread of analgesia was determined in 5 min interval for 40 min. The results showed that both groups were matched for age and height, the upper level of analgesia in the pregnant women reached the fourth thoracic dermatome [4.0+ 0.46] which was significantly higher than the non pregnant women which reached the eighth thoracic dermatome [8.5 + 0.67] [p<0.05]. The dose of Bupivacaine required per spinal segment in the pregnant women was 4.5 + 2.8 mg which was significantly less than required for the non pregnant women 7.0 + 3.2 mg. The caudal spread of analgesia showed a similar pattern in both groups while cephalad spread initially was faster in the pregnant women and further spread was parallel to that of the non pregnant women. The time to complete dermatomal spread in pregnant women was 35.5 + 7.6 min versus 25.4 + 4.7 min in the non pregnant. It was concluded that in early pregnancy there's an increased epidural spread of Bupivacaine, so decreasing the dose of epidural Bupivacaine in early pregnancy as in late pregnancy was recommended

Incidence of transient bacteremia following nasotracheal and orotracheal intubation and bronchoscopy

A study of the comparison of bacteremia occurring with nasotracheal, and orotracheal intubation and rigid bronchoscopy was carried out on sixty patients. Their age ranged from 10-60 years, who underwent general anesthesia for different types of operations and diagnostic procedures. All patients were healthy except for the indicated procedure, and they were classified into three groups. Group I: Includes twenty patients intubated nasally under direct vision [aged from 11-60 years with a mean value of 27.2 years]. Group II: Includes twenty patients intubated orally under direct vision [aged from 10-60 years with a mean value of 29.2 years]. Group III: Includes twenty patients undergoing rigid bronchoscopy for diagnostic and therapeutic purposes [aged from 15-60 years with a mean value of 37.5 years]. For all patients oral, throat and nasal swabs were taken for culture, immediately before the procedure, and blood collected under complete aseptic technique for culture immediately before the procedure and 5, 10, 15 and 30 minutes after the procedure. The results showed that there was a significant increase in the incidence of bacteremia in bronchoscopy [65%] versus [30%] in nasal intubation and [10%] in oral intubation. Also, there was significant increase in the incidence of bacteremia in nasal intubation, compared with oral intubation