Influence of Handprint Culture Training on Compliance of Healthcare Workers with Hand Hygiene.

OBJECTIVE: We aimed to study the effect of visual observation of bacterial growth from handprints on healthcare workers' (HCWs) compliance with hand hygiene (HH). SETTINGS: Medical and postoperative cardiac surgery units. DESIGN: Prospective cohort study. SUBJECT: The study included 40 HCWs. INTERVENTION: Each HCW was interviewed on 3 separate occasions. The 1st interview was held to obtain a handprint culture before and after a session demonstrating the 7 steps of HH using alcohol-based hand rub, allowing comparison of results before and after HH. A 2nd interview was held 6 weeks later to obtain handprint culture after HH. A 3rd interview was held to obtain a handprint culture before HH. One month before implementation of handprint cultures and during the 12-week study period, monitoring of HCWs for compliance with HH was observed by 2 independent observers. MAIN RESULTS: There was a significant improvement in HH compliance following handprint culture interview (p < 0.001). The frequency of positive cultures, obtained from patients with suspected healthcare-associated infections, significantly declined (blood cultures: p = 0.001; wound cultures: p = 0,003; sputum cultures: p = 0.005). CONCLUSION: The visual message of handprint bacterial growth before and after HH seems an effective method to improve HH compliance.

Disseminated coccidioidomycosis in a 5-year-old Sudanese boy.

A 5-year-old Sudanese boy not known to be immunodeficient and with no history of travelling developed septic shock from a disseminating coccidial infection. The diagnosis was delayed, as the eosinophilic hepatic abscess was initially thought to be secondary to schistosomiasis, which is endemic in Egypt and Sudan. A further survey about the existence of coccidial infection around the climatic area of the river Nile is warranted.

Pattern of neurological dysfunctions in pediatric intensive care unit.

The aim of this retrospective study is to evaluate the burden, characterize the demographics and visualize the final outcome of the critical neurological cases admitted to a tertiary pediatric intensive care unit in Cairo University Children Hospital. Data of 139 pediatric critical care patients admitted with neurological dysfunction were reviewed, retrospectively. Patients with critical neurological illness represented 30% of the total admissions (n = 139). Coma patients (n = 115, 83%) were divided into structural/intrinsic coma (n = 54, 47%) and metabolic/toxic (n = 61, 53%). Patients with neuromuscular disorders comprised 17% (24/139) of the cohort. Patients with toxic/metabolic coma had higher Pediatric Risk of Mortality scores, higher inotrope scores, more organ system failures, a higher percentage of pre admission cardiac arrests and higher frequency of septic shock diagnosis. Predictors of death in the whole group included (a) Number of organ failure: patients with three or more organ systems failure were 3.1 times more liable to die (b) Glasgow Coma Scale (GCS): cases with GCS score less than eight were 4.2 times more prone to die, (c) Those who developed acute lung injury in less than 14 days of mechanical ventilation were 10.7 times more prone to die than those who had not. Patients with toxic/metabolic coma required more intensive support giving into consideration that advanced sepsis and presence of a family member with drug addiction played a big role as an underlying cause. National programs for implementation of sepsis goal directed therapy and health awareness about the hazards of accidental drug intake are of supreme importance. Predictive factors for death in coma patients on admission were low GCS score, presence of multiple organ system failure and acute lung injury.