Hand hygiene amongst health workers in a teaching hospital: a study of knowledge, attitude and practices

@#Though a relatively simple procedure, Hand Hygiene compliance rates tend to be highly variable and poor. This cross-sectional knowledge, attitude and practices (KAP) study was conducted at Shri Maharaja Hari Singh (SMHS) Hospital, a teaching hospital in Srinagar, India. The subjects that participated in this study included 106 nursing staff working in different departments of the Hospital. The Self-structured one plus WHO,s hand hygiene questionnaire for health care workers was used in this study. Almost 80% of the respondents skipped hand washing when in hurry. Only 12% and 28% used to hand wash before touching a patient and before doing simple procedures respectively. This study depicts the poor compliance of health workers regarding hand hygiene.

Outcome of Adjuvant Concurrent Chemo-Radiation in Operated Locally Advanced Rectal Cancer.

Background: Rectal cancer is one of the most common cancers in Kashmir, India. The clinical course of patients treated with surgery alone has been characterized by a high death rate and also by the pain and disability associated with pelvic recurrence of the tumor. Adjuvant radiation combined with chemotherapy has been studied for prevention of such recurrences. We treat more than 200 rectal cancer patients annually at our center. Most of the patients registered at our center are those who have been already subjected to surgery at the peripheral hospitals. We studied role of 5-fluorouracil (5-FU) and calcium leucovorin concurrently with radiotherapy in Dukes’ stage B2 and C and toxicities thereof in the adjuvant setting. Objective: To assess the outcome of concurrent chemoradiation in operated locally advanced treated cancer patients. Materials and Methods: In operated Dukes’ B2 and C rectal cancer patients, we conducted a prospective non-randomized study comprising of 40 patients between 2012 and 2014. Patients were treated with two hours protracted infusion of calcium leucovorin 500 mg/m2 on day 1 followed by 5-fluorouracil 500 mg/m2 on days 1 to 5 and repeated four weekly for total of six cycles. Radiotherapy of 45 Gray in 20 fractions was delivered concurrently with chemotherapy for first two cycles. Results: Combination of chemotherapy and radiotherapy in a concurrent setting appears to be more efficient in reducing local recurrence rates and improving survival than either modality alone. Toxicities with this schedule were mostly gastrointestinal mucositis, but no treatment interruption was needed. Conclusion: A combination of 5-fluorouracil and radiotherapy can be administered in operated locally advanced rectal cancer patients.

Assessment of pregnancy outcome with and without antenatal care

Women with poor attendance for antenatal care, have an increased risk of poor pregnancy outcomes. Antenatal care is an effective method of preventing adverse outcomes in pregnant women and their babies. To assess and compare the pregnancy outcome in women with and without antenatal care and to see its effects on maternal and infant morbidity and mortality. A descriptive observational study was carried out in Allied hospitals [Holy Family Hospital, Rawalpindi General Hospital and District Head Quarter Hospital of Rawalpindi Medical College] for a period of 2 months in 2008. All women coming to labor rooms, wards and emergency department of these hospitals for delivery were included in the study. Women who had at least 3 antenatal visits were categorized as [with antenatal care], while those with less than 3 antenatal visits as [without antenatal care]. A total of 170 mothers were seen at these hospitals in 2 months. Of the total, 137 [80%] received antenatal care and 33 did not. Of those who received antenatal care, 85% were immunized and 15% mothers who did not receive antenatal care were also immunized. Majority of women with antenatal care have had regular monitoring of blood pressure, weight monitoring, blood and urine tests during pregnancy. Forty seven percent mothers with antenatal care had spontaneous vaginal delivery with episiotomy as compared to 57.6% mothers without antenatal care who were delivered by caesarean section. Ninety seven percent and 85% newborns were delivered alive in the two groups respectively. Among mothers who received antenatal care, 87% had satisfactory pregnancy outcome and 13% had unsatisfactory outcome. Pregnancy outcome in women taking antenatal care is far better and healthy than those without antenatal care. Awareness about the effectiveness of antenatal care in safe mother and child delivery should be enhanced through various methods including media

Adult mortality in medical, sociodemographic and healthcare perspective

Statistics on causes of deaths can help in determining the pattern and burden of disease and devise measures for planning and controlling unwanted deaths. To assess the pattern of mortality in adult patients in a public sector tertiary care hospital at Rawalpindi during the year 2005. This retrospective study was done through search of hospital records of all deaths in adults during the year 2005 in a public sector tertiary care hospital. Information on pertinent variables was obtained on a proforma. Cause of death in each case was ascertained as it was documented. Important Lab. Investigations, where available were also recorded. Diseases were grouped according to World Health Organization classification [International Classification of Diseases-10]. Causes deaths were analyzed under various medical, sociodemographic and healthcare parameters according to available records. A total of 529 adult deaths occurred during study period. The mean age of the deceased was 54 years. There were 58% males with 13% being unmarried. More than 75% cases belonged to lower socioeconomic status while 55% belonged to urban areas. Almost all [97%] were admitted through casualty department. Hospital stay was less than one hour in 34% and 1-7 days in 52% cases. Death due to diseases of circulatory system was ranked first [33%]. A total of sixty deaths occurred due to liver diseases and hepatitis C virus was positive in 39 [64%] cases. Proportion of female who died of hypertensive disorders was significantly high [p < 0.01]. Both infectious and non infectious diseases are bringing a major death toll in our health setting with circulatory system and liver disease as the leading causes of death in adults. Adult mortality can be reduced by controlling infectious and non infectious diseases

Knowledge about leprosy in doctors of teaching hospitals of Rawalpindi

To assess the knowledge of doctors about leprosy. This was a qualitative study. Specially designed questionnaire based interviews were carried out in three teaching hospitals [Holy Family Hospital, Rawalpindi General Hospital and District Head Quarter Hospital of Rawalpindi Medical College] over 2 months [May-June 2008]. Doctors were interviewed irrespective of their qualification and experience using convenience sampling. A total of 136 doctors were included in the study, out of which 96 were simple MBBS, 34 had done FCPS-I and 6 were FCPS-II. Of the total 68 doctors, 38.2% had seen a case of leprosy whereas 61.8% had never examined a case of leprosy. Majority knew the commonly used drugs for leprosy and only 2.9% did not know them. Eighty two percent doctors knew the management of a suspected case of leprosy. Doctors had adequate knowledge about leprosy that was independent of their qualification and experience. Though leprosy has been eradicated from Pakistan but students and doctors still need to educated on this subject to keep them abreast about the subject

Breast feeding patterns in some lactating mothers of Rawalpindi

The purpose of the study was to assess present patterns of breast feeding [BF] to identify such determinants that can be positively modified in the present socioeconomic scene of the nation. It was a descriptive cross sectional study. This study was done in Rawalpindi city from March 2004 to December 2004. Mother's perceptions [n=501] for breast feeding [BF] were examined through a descriptive cross-sectional study using convenient sampling technique m urban area of Rawalpindi city National [BF] policy guidelines were used as a basis of assessment. Lactational practices were not optimum in majority [87.42%] and in all socioeconomic strata In general no significant association was found between Literacy and economic strata and the pattern of [BF] of the study population [P> 0.1 and > 0.05 respectively] However, practice of additional food intake during Lactational period was significantly associated with right breast feeding practices in the population studied [P < 0.05 and odd's ratio 72] In 29.2% cases qualified health care providers including specialist in obstetrical care promoted formula milk feeding Insufficient information, Ineffective motivation about BF of masses and inappropriate healthcare practices, were major factors responsible for inadequate [BF] practices in the community studied. The issue can be addressed by enhancing health education to potential mothers, sensitizing males and effective monitoring of health care practices