Evaluation of the risk factors associated with emergency department boarding: A retrospective cross-sectional study / 中华创伤杂志(英文版)

PURPOSE@#Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.@*METHODS@#All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.@*RESULTS@#Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.@*CONCLUSION@#The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

Genotyping and antibiotic susceptibility patterns of pseudomonas aeruginosa isolated from burn ward of sina hospital in Tabriz

Background and Objectives: Pseudomonas aeruginosa is one of the important nosocomial Gram-negative bacilli which are resistant to most of antimicrobial agents and antibiotics. This opportunistic bacterium is capable of causing life threatening infections in patients, especially in those with immunodeficiency such as those in ICUs and burn wards. This study was conducted to detect antibiotic susceptibility and also molecular typing of P. aeruginosa isolates from burn infections by using RAPD [Random amplified polymorphic DNA]

Materials and Methods: Totally 124 P. aeruginosa isolates collected from bum patients consisting of burn infection discharge and blood specimens by application of conventional microscopic, culture and biochemical identification tests. The collected isolates were studied for their antibiotic susceptibility patterns using routine antibiotics ceftazidim [30 microg], aztreonam [30 microg], carbenicillin [100 microg], polymixin B [300 u], colistin [100 microg], gentamicin [10 microg] and ciprofloxacin [5 microg] by disc agar diffusion method and detection of genotypes by two short primers namely 272[5-AGCGGCCAA-3] and 208[5-ACGGCCGACG3] according to RAPD-PCRmethod

Results: Results of antibiotic susceptibility tests showed high resistance to aztreonam [70.1%], ceftazidime [66.1%], colistin [61.2%] and gentamicin [47.5%] but less resistance to ciprofloxacin[18.5%] and polymixin B[13.7%]. Based on antibiotic susceptibility 41 patterns were detected. RAPD-PCR created 32 genotypic profiles with base pair length ranging from 250 to 10000. Each genotype showed between 1 and 8 different weight DNA bands. Genotype 3 was the most prevalent, identified in 42 isolates [33.8%] and accommodated isolates with similar antibiotic susceptibility patterns, while in other genotypes no similar susceptibility patterns were encountered

Conclusion: Our P. aeniginosa isolates collected from burn infections were most resistant to aztreonam [70.1%], but least resistant to polymixin B [13.7%]. The test isolates showed 41 antibiotic susceptibility patterns and 32 RAPD genotypes. Genotype 3 was the most prevalent and accommodated isolates with similar antibiotic susceptibility patterns, but in other genotypes, isolates with similar antibiotic susceptibility patterns was not detected. Some isolates with similar antibiotic patterns underline possibility of their transfer among burn patients and suggest need for restricted conditions and microbiplogic surveillance in the bum wards