Prevalence of Staphylococcus aureus in Intensive care Units and Post Operative Ward as a possible source of Nosocomial infection: An experience of tertiary care hospital

Background and Objectives: Hospital Acquired Infection (HAI) also called nosocomial infection is a global problem. It also acts as a leading cause of death and increased morbidity among hospitalized patients. Staphylococcus aureus is one of the commonest pathogens causing HAI and is also closely associated with human body. WHO study has shown highest prevalence of HAI in Intensive care unit (ICU), Neonatal care unit (NICU), Post operative ward (POW). Hence it becomes very imperative to check the prevalence of HAI. Therefore this study was carried out to determine the prevalence of S. aureus in hospital environment as a possible source for HAI. Material and Methods: Environmental samples and blood samples of the patients were collected from ICU, NICU, POW using sterile cotton swabs during study period. Standard protocol was followed to isolate and identify S. aurues which was followed by antibiotic sensitivity tests. Results: A total of 216 environmental samples were collected out of which 18.98% (41) samples showed the presence of S. aureus. It was also isolated from the blood samples of patients admitted to ICU (7.5%) and NICU (6.8%). None of the isolates from environmental samples were MRSA(methycillin resistant Staphylococcus aures). Conclusion: S. aureus was found as a prominent environmental flora of hospital setting. Presence of these organisms in sensitive units like ICU, NICU, POW and the isolation of S. aureus from clinical samples indicates a possibility of HAI. It indicates the necessity of continuous surveillance of hospital environmental for quality control.

Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy.

INTRODUCTION: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. PATIENTS AND METHOD: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. RESULTS: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. CONCLUSION: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop.

Informed consent: is it really understood?

Pre-operative counselling is an important part of the care that we give to our patients undergoing surgery. It ensures that the patients understand about their disease and the procedure that they are undergoing. This study was done with the objective of finding whether or not the patients do actually understand what has been explained to them. This is a prospective study done in the form of a survey with a set questionnaire in two hospitals in Kathmandu namely Patan hospital and Tribhuvan University Teaching Hospital. The patients surveyed were those who were admitted for elective surgery after counselling has been done and consent forms signed. The result showed that the level of understanding was poor in 11%, unsatisfactory in 33%, satisfactory in 37% and excellent in 19%. The level of understanding was affected by the education level of the patients. To conclude, the level of understanding was unsatisfactory in nearly half the patients. Only 19% had optimal understanding. This may reflect the education level of the many of our patients but it clearly points out that the medical profession needs to make more effort to make the patients understand more about their disease process. This can be said to be a reflection of our quality of care.