Role of fine needle aspiration in isolating the core bacteria in children with recurrent tonsillitis

Fine needle aspiration [FNA] of the tonsil as a diagnostic tool in evaluating the micro flora in recurrent tonsillitis has not been popularized. A prospective study of 52 patients with recurrent tonsillitis undergoing tonsillectomy was undertaken. Their age ranged from 3 to 11 years. Surface swab and FNA were taken followed by tonsillectomy and the core tissue was sent for culture. No complications were recorded from the procedure of FNA. The correlation between culture results [for each of core, FNA and swab] and clinical or laboratory data [age, sex, number of attacks per year, HB%, TLC, ESR and CRP] were all insignificant with p value always >0.05. The reliability of the culture by Swab and FNA of the tonsil core was validated with the reference [gold] standard which is the dissected tonsil core. The sensitivity of FNA and swab cultures as compared to core culture was 83.3% and 62.1% respectively. The positive predictive value of FNA and swab cultures as compared with core cultures were 96.2% and 85.7% respectively. No significant correlation was observed between culture results and clinical and laboratory variables. No significant correlation was observed between age and type of organism. Our study showed that FNA of the tonsil core is reliable, safe and valid in identifying the bacterial organism within the infected tonsil for appropriate antibiotic therapy. The next step in evaluating this technique is to attempt it as an outpatient setting on children with recurrent tonsillitis under sedation/local anesthesia. As investigators become more experienced, sensitivity may increase. Accordingly; FNA of the tonsil core could revolutionize the management of patients with chronic tonsillitis

effect of an educational program in improving venous catheter management practice in pediatric Cairo university hospital ICUs

Intravascular catheter related blood stream infection [BSI] is an important cause of illness and excess medical cost. In our hospital, the rate of peripheral venous catheter insertion [cannula] is 61.7% at the intensive care units, and the blood stream infection rate was 35.1% at the beginning of the study. This study was designed to conduct infection control practice training [mainly for cannula insertion practice] at neonatal and pediatric intensive care units of Cairo university pediatric hospital, with evaluation of results before and after the study. The pretest found major problems concerning the proper use of alcohol based product for hand hygiene or during skin preparation for cannula Insertion. Also shortage of infection control knowledge and medical supply [cannula device, soap, alcohol, and sterile dressing] was obvious. A significant improvement after training program was observed regarding proper cannula insertion practice [mainly hand hygiene, skin preparation, and no touch method for cannula insertion], [p value = 0.001]. The blood stream infection rate dropped from 35.1% at pre-implementation period to 23.1% at the post implementation period, with a significant decrease of blood isolates which cause intravascular catheter associated blood stream infection [Coagulase negative staphylococci, Staphylococcus aureues, Candida, and Enterococci] P value 0.004. The significant improvement of cannula insertion practice, together with the decrease of blood isolates related to catheter associated BSI, and the drop of BSI rate after the training pro gram point to the importance of the infection control education program targeted to specific problems

Evaluation and monitoring of infection control practices

This work was done to evaluate the impact of infection control practices implementation on intravenous fluid [IVF], medication contamination and neonatal sepsis at NICUs. The study was designed to conduct an infection control practice training course at six private neonatal intensive care units at three governorates with evaluation of the results before and after the study. Samples of all available in-use intravenous fluid bottles and previously used bottles, opened medication ampoules and blood samples from the clinically suspected infants were collected and cultured to detectthe organisms and their sensitivity to antimicrobial agents before and one month later after the training course. Also, infection control practice observation tool was designed and used for evaluation of the infection control practice at each NICU before the study and one month later. The results showed that K. pneumonia, K. terrigena and Enterobacter spp. were the commonest types of organisms at the pre-training visit; while, at the post-training visit, K. pneumonia and coagulase negative Staph. were the commonest types of organisms. At the pre-training visit, the IVF contamination rates was 62%, the medication contamination rate was 16.1% and the blood infection rate was 64.8%. At the post-training visit, IVF contamination rate dropped to 32%, medication contamination rate dropped to 0% and the blood infection rate to 50%. There was a significant reduction in both IVF and medication contamination frequency. The mean score of infection control practices concerning the training aspects was significantly increased at the post-training visit at the six NICUs. A significant positive correlation was found between infection control practice score in the six NICUs and the negative IV fluid [free samples]. In conclusion, surveillance of nosocomial infections in NICUs and successful strategies to decrease infections, such as infection control practice and optimal antibiotic use, are warranted. The significant decrease in contamination rate of IV fluids and medications and positive blood culture results after the training practice point to the importance of microbiological culture of in-use IV fluids, which could be a helpful adjunct to epidemiologic studies to directly assess the effectiveness of infection control practices related to IV fluid preparation and use, also, point to the significance of proper health hygiene in nosocomial infection control