Post-exposure prophylaxis protocol for exposure to blood-borne pathogens: an intervention to improve knowledge and practice among medical students in a South African hospital

Background:Globally, approximately three million healthcare workers experience a percutaneous injury each year. Medical students are at a particularly high risk of exposure to blood-borne pathogens. Despite this, the rate of non-reporting is still high. Objectives: The objectives of this study were to describe and improve the knowledge and practice of the post-exposure prophylaxis (PEP) protocol among medical students, through the implementation of quality-improvement interventions, with a view to improving the protocol. Methods: This was an intervention study conducted among third- to fifth-year students, in 2015 and 2016. The quality-improvement interventions took place over 11 months and included the issuing of laminated protocols, posters and lectures. Data from survey questionnaires were used to quantify the impact of these interventions. Student practice was measured by the number of correct steps of the protocol completed. McNemar and Wilcoxon signed-rank tests were used to test differences in the paired categorical data. Results: Of approximately 750 students who participated in the study intervention, 407 returned the initial questionnaire and 148 returned the post-intervention survey questionnaire. Eighty-six students (21.1%) completed both questionnaires. The blood-borne pathogen exposure rate prior to the intervention period was 28.0%. In the paired group, reporting of exposures increased from 12.2% in 2015 to 31.3% in 2016. Knowledge of the PEP protocol increased significantly in the paired group, from 17.4% to 40.2% (p < 0.001). Prior to the intervention, 91.7% completed fewer than half of the steps of the PEP protocol. This decreased significantly to 69.4% in the paired group, post-intervention (p = 0.03). Conclusion: Practice of the PEP protocol significantly improved after the intervention was implemented. In addition, there was a significant improvement in the knowledge of students about postexposure management. However, many exposures were still unreported post-intervention, indicating that more work is needed to improve reporting behaviour

Further seizures following febrile seizure: assessment of risk factors

Retrospective evaluation of records pertaining to 316 children admitted to the Queen Elizabeth Hospital for febrile seizures showed a recurrence rat of 24 per cent. Age at onset of first febrile seizure, a positive family history and atypical initial seizzure were identified as risk factors for subsequent seizures. Other factors, namely abnormal pregnancy, gestational age, birthweight, neonatal problems and neurological abnormality, did not affect the chances of recurrence

Routine investigations in first febrile seizures

Retrospective evaluation of records pertaining to 338 children presenting with a first episode of febrile seizure revealed a high performance rate of routine haemoglobin levels, total white cell and differential count, blood glucose, serum electrolyte and urea levels, lumbar puncture for cerebrospinal fluid examination and blood cultures. Lumbar puncture emerged as the most useful investigation in detecting eight children with meningitis, three of whom were over the age of two years. Transient elevation in blood glucose levels hyponatraemia and low serum bicarbonate levels were noted in some children but their significance is not known. Routine haemoglobin estimation detected sixteen children with unsuspected anaemia, but the remaining investigations were largely unhelpful

Feeding practices of infants, and beliefs of mothers in Western Jamaica

An infant feeding survey was carried out in three parishes in Cornwall County, Jamaica, from March to August, 1984, in an attempt to determine the feeding practices of infants and beliefs of mothers in Western Jamica Forty-one Enumeration Districts (EDs were randomly selected from two strata. urban and rural, in proportion to the population distribution. Six hundred and fourteen households with children under 36 months of age were selected from 41 EDs. The results showed that prevalence of breastfeeding was 98.0%. Despite the high frequency of breastfeeding, infant formula was introduced very early, and only about half of the mothers introduced semi-solids and solids within one month of the recommended time. The most popular foods, identified as good foods, were also popular weaning foods. It is concluded that there is need for adequate rraining of both primary and secondary health-care staff, and reinforcemen of nutrition messages by frontline health workers. The collection of adequate baseline data in evaluating the effectiveness of nutrition education programmes is also important