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.

Frequency of abnormal hepatic venous waveforms in cirrhotic patients

Objective: To determine the frequency of abnormal hepatic venous waveforms in patients suffering from hepatic cirrhosis

Study Design: Cross sectional

Place and of Study Duration: Shafique Medical Centre Quetta and Radiology Department Combined Military Hospital, Quetta from December 15[th] 2009 to July 15[th] 2010

Material and Methods: The instrument used in this study was Toshiba Eccocee SSA-340A and ALOKA SSD- 5000 doppler ultrasound machines with linear and convex probes. Hepatic venous Doppler was performed with convex 3-5 MHz probe. Hepatic venous Doppler examination was performed by two radiologists [operators] on all the 135 patients with positive HCV, HBV, chronically raised amino transferase level and clinical and radiological features of cirrhosis, who independently and blindly recorded their findings. Nonprobability, purposive sampling was done. After Doppler ultrasonographic examination liver biopsy and histopathology of all the patients was performed. Data from each patient was collected on designed form for age, gender, types of hepatic vein waveforms and grades/severity of liver cirrhosis on histopathology

Results: 135 patients with maximum 50 years and minimum 41 years of age have mean age of 46.79 +/- 2.37. Out of 135 patients in 103 [76.3%] Type 1 [Triphasic] flow was observed in 3%, Type II [Biphasic without reduced oscillation] flow was observed in 29.6%, type III [Biphasic with reduced oscillation] flow was observed in 34.1% and type IV [Monophasic] flow noted in 33.33%. There was significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology [r=0.887, p< 0.001]

Conclusion: Hepatic venous Doppler is noninvasive tool which can be employed to assess the types of abnormal hepatic venous waveforms in patients with hepatic cirrhosis. There is significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology

Diagnostic accuracy of magnetic resonance imaging in meniscal injuries of knee joint and its role in selection of patients for arthroscopy

Magnetic Resonance Imaging [MRI] is frequently advised to evaluate clinically suspected cases of meniscal injuries in our setup. The objective was to determine the diagnostic accuracy of MRI in meniscal injuries of knee joint and its effectiveness in selection of patients for arthroscopy. A Cross-sectional comparative study was conducted at Radiology Department Military Hospital [MH] Rawalpindi in collaboration with Orthopaedic Department Combined Military Hospital [CMH] Rawalpindi from 31 Jan 2007 to 1 Aug 2007. Fifty-seven patients with clinical suspicion of meniscal injuries were subjected to MRI. Arthroscopy was done only in 34 patients while 23 were excluded on the basis of MRI findings. MRI findings were compared with arthroscopic findings. Medial and lateral menisci were considered separately in each case. Among 57 patients only 30 showed significant tear on MRI. Arthroscopy was done in these cases. Arthroscopy was considered on clinical grounds only in 4 patients who did not show significant tear on MRI. MRI showed Medial Meniscus [MM] injury in 23 patients and Lateral Meniscus [LM] injury in 10 patients. Arthroscopy confirmed MM injury in 17 patients and LM injury in 7 patients. MRI missed two MM and one LM injuries. This showed that MRI has sensitivity of 89.4% and specificity of 62% in diagnosing injuries of MM, while sensitivity of 87% and specificity of 88% in diagnosing injuries of LM. Diagnostic accuracy of MRI in MM and LM injuries was 76.4% and 88.2% respectively. MRI is accurate in diagnosing meniscal injuries of knee joint and is effective in selection of patients for arthroscopy

Vacuum assisted closure of laparostomy wounds a novel technique

Management of a laparostomy wound is contentious. Specific pathologies like severe intraabdominal sepsis, trauma requiring damage control, abdominal compartment syndrome, staged abdominal repair and other complex abdominal pathologies can be managed with a novel technique of Vacuum Assisted Closure dressing. This device applies sub-atmospheric pressure that leads to reduced bowel wall edema, bacterial count and inflammatory burden found in open abdominal wounds. This leads to a reduced need for frequent dressing changes, maintaining intact skin and improvement in fluid management. Controlled clinical studies are needed to establish the safety and effectiveness of this treatment strategy. We present our experience with this technique suggesting it to be safe and effective. A brief outline of the working of Vacuum Assisted Closure dressing is also presented