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

Serum adenosine deaminase [ADA] level in the cases of tuberculous pleural effusion

Pleural biopsy is conventionally considered as a sole important procedure for the diagnosis of tuberculous pleural effusion even though pleural fluid contain sensitive biochemical markers like adenosine deaminase [ADA] gamma interferon and tumour necrosis factor. This prospective study was conducted at Nishtar Hospital, Multan. The objective of the study was to assess the value of adenosine deaminase activity for the diagnosis of tuberculous pleural effusion without performing needle pleural biopsy. Sixty patients with history and clinical examination suggestive of tuberculous pleural effusion admitted in four medical units and chest unit of Nishtar Hospital, Multan were included in this study and these were labeled as group-I. In addition as a control of study, the pleural fluid was also aspirated in 20 selected patients having transudative pleural effusion secondary to congestive cardiac failure and cirrhosis of liver, denoted as group-II. The selection criteria for the patients was the history, clinical examination and lymphocytic exudative pleural effusion. Pleural biopsy was performed in all the patients of group-I and ADA activity in the pleural aspirate of all the subjects of group-I and group-II was estimated by Giusti G method1. The ADA activity was compared in both the groups by setting a cut off value 40 U/L. The results were statistically analyzed by applying chi square test. The ADA activity of the group-I was 40.2 + 10.82 U/L while that of group-II was 24 + 11 U/L. Thirty three in group-I and one of group-II had ADA activity above cut off value. The p value was <0.001. The results of this study favor the application of ADA activity in pleural fluid as the diagnostic tool for tuberculous pleural effusion without performing an invasive procedure like the pleural biopsy

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