Barriers to hand hygiene compliance in the medicine wards and intensive care unit of a tertiary teaching hospital in the Philippines

INTRODUCTION: Healthcare associated infections (HCAI) continue to be major problems in our institution. Studies have shown that hand hygiene remain to be the primary measure that prevents HCAI. This study aimed to measure hand hygiene compliance rate and determine factors affecting compliance. METHODS: Healthcare workers in the medicine wards and intesive care units (ICU) were directly observed for compliance to the World Health Organization hand hygiene guidelines. In a month period, subjects were selected by convenience sampling. Factors affecting hand hygiene compliance was investigated. Survey of infrastructure and hand hygiene products was concurrently done. Thereafter, self-administered survey was distributed to assess knowledge, attitudes and perceptions toward hand hygiene. RESULTS: Overall hand hygiene compliance was 11%. Compliance was less likely for doctors, in the ward, and before patient contact. On the other hand, compliance was likely among nurses, in the ICU, before aseptic procedure, after exposure to body fluid, and after patient contact. Demand for hand hygiene was high with mean of 35 (SD=nine) opportunities per hour of patient care. Hand hygiene products are less available in the wards than in the ICU. Sinks are not in convenient locations. Hand hygiene posters were either not visible or lacking. Majority of the survey respondents know at most only two of the five hand hygiene indications. DISCUSSION: Access to hand hygiene products, training and education, and reminders in the workplace are among the basic requirements in the implementation of hand hygiene programs. With problems related to these three components, hand hygiene compliance is expected to be low. CONCLUSION: Low compliance to hand hygiene was associated with professional status, location and indication. Barriers to hand hygiene include inadequate and inaccessible sinks and hand hygiene products in the ward, high demand for hand hygiene, poor knowledge of hand hygiene, and lack of reminders in the workplace.

Prevalence, clinical profile, and treatment outcomes of adult patients diagnosed with disseminated tuberculosis seen at University of the Philippines Manila-Philippine General Hospital Tuberculosis Directly Observed Treatment Short Course (TB-DOTS) Clinic

OBJECTIVE: To determine the prevalence, demographic, clinical profile, diagnostic and treatment outcomes of adult patients diagnosed with disseminated tuberculosisMETHODS: This is a cross sectional study of patients referred to the UP-PGH TB DOTS clinic with a diagnosis of disseminated TB from January 2011 to December 2015.RESULTS: The prevalence of disseminated tuberculosis was 1.7 %.Mean age at diagnosis was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. The most common comorbidity was HIV (5.8%). The mean duration of symptoms before initial consult was 281 days (SD 510.7). The most common presenting symptoms were abdominal pain (19%), back pain (13%), and abdominal enlargement (11%). The lungs (86%) are still the most commonly involved site, followed by the gastrointestinal tract (22%) and the vertebra (27%). Majority were started with Category I treatment regimen (54%, 37 patients). Of the 68 patients, only 16% (11 patients) continued follow-up at PGH; all had documented treatment completion.CONCLUSION: Patients with disseminated tuberculosis are young and majority had no comorbid illness. They have long latency of symptoms prior to diagnosis, and usually present with nonpulmonary symptoms despite high evidence of pulmonary involvement. To date, this is the largest local study on disseminated TB known to the authors.

Splenic actinomycosis mimicking malignant lymphoma - A rare case of abdominal actinomycosis

BACKGROUND: Splenic Actinomycosis is a rare entity which usually presents as a difficult diagnostic case. It is a chronic granulomatous infectious disease, caused by Actinomyces which is commonly associated with history of abdominal surgery and manipulation. Majority of cases would present as an enlarging abdominal mass often mimicking malignant tumors.CASE PRESENTATION: This paper presents a rare case of splenic actinomycosis in a 24-year-old Filipino female presenting as multiple splenic abscesses leading to gradual progressive ascites initially thought to be due to a malignant lymphoma. On physical examination, massive ascites and splenomegaly were the only abnormality appreciated. Initial radiologic imaging (x-ray, ultrasound, CT scan) revealed presence of multiple splenic nodules associated with extensive mediastinal and retroperitoneal lymphadenopathy as well as peritoneal extension/carcinomatosis (Figure 1 and 2). Splenic biopsy revealed presence of actinomyces (Figure 3).TREATMENT AND OUTCOME: Patient was started on amoxicillin 2.0 g per day for 24 months which led to a significant resolution of her massive ascites. Subsequent abdominal ultrasound showed gradual reduction in the hepatic and splenic size with resolution of splenic foci. Patient is currently on frequent follow-up.CONCLUSION: Splenic actinomycosis although extremely rare should be included as a differential diagnosis when presented with an unusual splenic mass or abscess on CT scan. Majority would mimic different forms of malignancy hence early histologic biopsy is usually needed to prevent unnecessary extensive and invasive surgical procedures. Radiologic and biochemical test are usually non-specific and not helpful with the establishment of the diagnosis. Although surgery remains to be the cornerstone for its management, prolonged antibiotic therapy might show promising results due to intensive closer follow up and accessibility to monitoring modalities for treatment response.