Assessment of knowledge, attitude and practices pattern of hand washing in some major public sector hospitals of Pakistan [a multi-center study]

To assess knowledge, attitude and practices of hand washing in major Public sector Hospitals of Pakistan and see the differences in practices in different levels of health care workers. Cross sectional hospital based survey conducted in all provinces of Pakistan in major tertiary care hospitals. A Cross sectional hospital based survey was conducted on knowledge, attitude and practices of hand washing in doctors, nurses and paramedical staff. From each hospital 10 OPD's and 10 wards i.e. 2 medical, 2 Surgical, Gynae, Peads, Dermatology, Eye, ENT, and Causality/ICU were selected and from each unit. Four doctors, four nurses and two paramedical staff were interviewed. A total of 3243 respondents were interviewed. Of these 87.3% had knowledge of hand washing. Hand washing facilities were available at 75% places and 69% respondents practiced hand hygiene, but only 58.8% washed their hands for more than 20 seconds. Majority used antibacterial soap bought by them. Rush of the patients, shortage of time, non availability of soap and water and lack of encouragement by seniors were the major causes for low hand hygiene practice. Almost 25% sites in major public sector tertiary hospitals did not have hand washing facilities but where available most health care providers were using them. Majority despite having knowledge, need motivation and continuous education of hand hygiene. Facilities of hand hygiene should be made available

Role of cardiac markers in evaluation of suspected myocardial infarction

Current cardiac marker for evaluation of suspected myocardial infarction include CK-MB, myoglobin, CK-MB isoforms and troponins, recommended use for each marker vary according to its cardiac specificity, sensitivity, ease of measurements, turn around time for test results and diagnostic and prognostic uses. CK-MB is an effective marker for reinfarction because it return to normal level within 48 hours after the initial episode. Myoglobin is less specific and sensitive and its pattern of response to infarction is widely variable. CK-MB isoform are good indicator of early stage infarction but technical problems can affect the precision of test result. Because troponin levels remain elevated after onset of chest pain they are good marker for late stage infarction. No single panel consisting of CK-MB and troponin assays is recommended