ABSTRACT
To determine the rate of device-associated healthcare-associated infections [DA-HAIs] at a respiratory intensive care unit [RICU] and in the pediatric intensive care units [PICUs] of member hospitals of the International Nosocomial Infection Control Consortium [INICC] in Egypt. A prospective cohort DA-HAI surveillance study was conducted from December 2008 to July 2010 by applying the methodology of the INICC and the definitions of the NHSN-CDC. In the RICU, 473 patients were hospitalized for 2930 d and acquired 155 DA-HAIs, with an overall rate of 32.8%. There were 52.9 DA-HAIs per 1000 ICU-days. In the PICUs, 143 patients were hospitalized for 1535 d and acquired 35 DA-HAIs, with an overall rate of 24.5%. There were 22.8 DA-HAIs per 1000 ICU-days. The central line-associated blood stream infection [CLABSI] rate was 22.5 per 1000 line-days in the RICU and 18.8 in the PICUs; the ventilator-associated pneumonia [VAP] rate was 73.4 per 1000 ventilator-days in the RICU and 31.8 in the PICUs; and the catheter-associated urinary tract infection [CAUTI] rate was 34.2 per 1000 catheter-days in the RICU. DA-HAIs in the ICUs in Egypt pose greater threats to patient safety than in industrialized countries, and infection control programs, including surveillance and guidelines, must become a priority
ABSTRACT
Hospital-acquired infections affect 5% to 10% of all hospitalized patients, and are the most common cause of preventable morbidity and mortality facing health care. It is estimated that 30% of hospitalacquired infections are avoidable with healthcare provider adherence to hand hygiene [HH] guidelines .Thus preventing patient-to-patient and healthcare worker-to-patient transmission of microorganisms can prevent most nosocomial infections. This work was conducted to study the effect of HH practices on hospital-acquired infections in the Respiratory Intensive Care Unit [RICU] at Ain Shams University Hospital. The study was done in three phases; the first was an observational study for HH practices among physicians and nurses and evaluation of HH resources during the period from December, 2008 to March, 2009, so termed pre-intervention phase. The second was the intervention phase, started by education and on job training for HH practices among physicians and nurses together with replenishing of HH resources in a two months period from April to May 2009. The third was the post-intervention phase, which extended from June to December 2009. The infection rates were calculated through the three phases and re-evaluation of the intervention was carried out by calculating the compliance rates before and after intervention. HH compliance increased significantly from 8.2% in the pre-intervention phase to 53.9% in postintervention phase. The HH practices increased in nurses more than doctors, nurses' compliance in preintervention phase was 42.4% and increased to 70.7% in the post-intervention phase. Doctors' compliance increased from 36.8% in pre-intervention to 55.3% in post-intervention. Overall patient infection rates declined from 63.7% to 50.2% during the study. Such simple, non costly methodologies can increase the compliance of HH practices which can decrease infection rates in RICU
Subject(s)
Respiratory Care Units , Hand , Hygiene , Cross Infection , Infection ControlABSTRACT
Anecdotal data from the southern and eastern Mediterranean region suggests that self-medication with antibiotics is commonly practiced in many countries. In order to provide proper information on the situation, we undertook short structured interviews in out-patients clinics or primary health centres in Cyprus, Egypt, Jordan, Lebanon, Libya, Tunisia and Turkey. A total of 2109 interviews were undertaken of which 1705 completed the full questionnaire. Self-medication was reported by 19.1% [<0.1% in Cyprus to 37% in Lebanon] of respondents. Intended self-medication ranged from 1.3% [95% CI 0%, 3%] in Cyprus to 70.7% [95% CI 64%, 77%] in Jordan. Upper respiratory tract symptoms were the most frequent reasons for which respondents indicated they would self-medicate. 48.4% of the whole group replied that they kept antibiotics at home, being highest in Lebanon [60%, 95% CI 51%, 69%]. We found a significant association between antibiotic hoarders and intended users of antibiotics for self-medication. Our data confirms that non-prescribed antibiotic use is high within ambulatory care in southern and eastern Mediterranean countries, being almost twice that reported in a similar European study. Corrective efforts are clearly required in the region to ensure proper use of antimicrobials so as to reduce pressure for antimicrobial resistance
Subject(s)
Humans , Male , Female , Anti-Bacterial Agents/administration & dosage , Ambulatory CareABSTRACT
Diffuse bacterial otitis externa is a common ear disease. Sometimes the condition resists the conventional treatment of antibiotic ear drops or recurs after primary improvement. This prospective study was done on 120 patients with resistant or recurrent otitis externa to investigate the causative organisms, causes of resistance or recurrence and how to manage this problem. The most frequently isolated organisms were staphylococci [40% of cases], pseudomonas aeruginosa [20%] and fungi [40%]. Failure of response to the current treatment was attributed to development of resistant organisms or skin hypersensitivity to the used drugs, and the presence of underlying chronic otitis media or resistant fungal infection and the inadequacy of otic drops as a medical treatment. These cases were successfully managed by filling the external meatus with an ointment containing broad spectrum antibiotic, antifungal and steroid, using special home made applicator. The used antibiotics were chosen according to the culture and sensitivity testing for the different bacterial isolates. Recurrence was avoided by the prolonged use of the proper antibiotic ear drops for 2-3 months